How to Become Hospice and Palliative Medicine Specialist : A Comprehensive Guide

Updated on January 18, 2024

Providing comfort and support to patients with serious or terminal illnesses is an incredibly meaningful yet challenging career path. Hospice and palliative medicine (HPM) specialists play a vital role in improving quality of life for these patients. If you feel drawn to provide compassionate end-of-life care, becoming an HPM specialist may be right for you. This guide will walk you through the step-by-step process of training in this specialty, beginning with obtaining a medical degree and completing a primary residency. Additionally, you’ll learn the skills and knowledge required to take the HPM subspecialty board exam in order to become certified. By the end, you’ll understand exactly what’s expected and how to prepare yourself to take on this emotionally-rewarding vocation focused on relief of suffering and support for patients as well as their families.

What is an Hospice and Palliative Medicine Specialist?

A hospice and palliative medicine (HPM) specialist is a physician who provides medical care, pain management, and emotional and spiritual support to patients with serious or life-threatening illnesses. HPM specialists aim to improve quality of life for patients and their families when a cure is not possible by controlling pain, managing symptoms, and addressing psychological, social, and spiritual needs National Hospice and Palliative Care Organization.

HPM specialists have completed a one-year fellowship after a primary residency and are board certified in this sub-specialty of medicine. They work with an interdisciplinary team that may include nurses, social workers, spiritual counselors, and others to provide whole-person care. HPM specialists often act as consultants to advise primary physicians on pain and symptom management, transitions to end-of-life care, and conversations about goals, values, and priorities Center to Advance Palliative Care.

Key Responsibilities

Some of the key responsibilities of an HPM specialist include:

HPM specialists aim to improve quality of life and relieve suffering for those with serious illnesses. They play a critical role in ensuring patient values guide decision-making about medical treatments toward the end of life. Their specialized skills in pain/symptom management and communication make them invaluable members of healthcare teams caring for complex patients.

What do Hospice and Palliative Medicine Specialist Do?

Hospice and palliative medicine specialists focus on providing relief from the symptoms, pain, and stress of serious illnesses. Their goal is to improve quality of life for patients and their families. Specifically, hospice and palliative medicine specialists:

In essence, hospice and palliative medicine specialists aim to optimize comfort and calm when patients face the challenges of serious disease. Their compassionate care eases suffering and improves quality of life.

Educational Requirements for Becoming a Palliative Medicine Specialist

To become a hospice and palliative medicine specialist, you need extensive education and training beyond medical school. The typical path includes:

Medical School

You must complete 4 years of medical school after finishing your bachelor’s degree. Medical school provides foundational education in areas like anatomy, physiology, pharmacology, pathology, medical ethics, and laws governing medicine. Students also get clinical experience during their 3rd and 4th years by rotating through various specialties.


After medical school, aspiring hospice doctors must complete an accredited 3-5 year residency program in a specialty like family medicine, internal medicine, or anesthesiology. Residencies provide intensive, hands-on clinical training in evaluating, diagnosing, and treating patients.


Following residency, physicians pursue an accredited 1-2 year hospice and palliative medicine fellowship. These highly competitive programs offer specialized skills for managing terminal illnesses and end-of-life care. Fellows get advanced training in pain management, communicating with patients and families, ethical issues, grief counseling, and more.

Board Certification

After completing their fellowship, doctors can become board certified in hospice and palliative medicine by passing exams from the American Board of Medical Specialties. Maintaining certification requires ongoing education and re-examination every 10 years.

Becoming a certified hospice specialist takes many years of rigorous, specialized medical training. But it allows doctors to provide compassionate, dedicated care to patients and families facing life-limiting illnesses.

Postgraduate Training for Hospice and Palliative Medicine Specialist

Becoming a hospice and palliative medicine (HPM) specialist requires extensive postgraduate training after completing medical school. Here are the main steps:

While certification is not required to practice, it demonstrates an advanced level of training and assessment in the specialty. Many employers prefer or require it.

In summary, hospice and palliative medicine physicians must complete 4-7 years of postgraduate training including a primary residency, an HPM-focused fellowship, and optional specialty certification. This provides them with exceptional expertise in caring for patients with serious or terminal illnesses.

Skills and Qualities of a Successful Hospice and Palliative Medicine Specialist

Becoming a hospice and palliative medicine specialist requires certain skills and personal qualities to provide compassionate, patient-centered care. Excellent communication and interpersonal abilities are essential. Hospice specialists need to have difficult conversations with patients and families regarding prognosis, goals of care, and end-of-life preparation. They must be able to clearly explain options and listen sensitively to concerns. Strong emotional intelligence and empathy are vital to establish trust and rapport.

In addition to communication expertise, hospice specialists must have sharp critical thinking and problem-solving skills to manage complex symptoms and improve quality of life. They collaborate with interdisciplinary teams, so the ability to work well within a team is crucial. Attention to detail is also important when adjusting care plans and medications.

Hospice specialists need to be extremely organized to coordinate care services, equipment needs, and transitions across care settings. Administrative skills related to documentation, record-keeping, and follow-up are key. Knowledge of palliative medication uses, side effects, and interactions is required to provide optimal prescriptions. Staying updated on the latest evidence and best practices through continuing education demonstrates a commitment to professional development.

On a personal level, hospice specialists should have abundant patience, resilience and self-care strategies to withstand the emotional weight of the role. A caring, supportive nature and desire to provide comfort empowers patients. Strong ethics and integrity build trust with individuals facing the end of life. Acceptance of mortality and belief in death with dignity enable specialists to develop care goals aligned with patient values and priorities. With compassion and dedication, hospice specialists make a remarkable difference guiding patients and families through profound life transitions.

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Hospice and Palliative Medicine Specialist Salary

The salary for a Hospice and Palliative Medicine Specialist can vary depending on experience, location, and employment setting. However, according to the Medscape Physician Compensation Report, in 2020 the average salary for a Hospice and Palliative Medicine Specialist in the United States was $251,000.

Salaries tend to progress as a Hospice Specialist gains more experience over their career. The table below shows average salaries by years of experience for Hospice and Palliative Medicine Specialists:

Experience LevelAverage Salary
Entry-level (0-5 years)$200,000
Mid-career (5-10 years)$225,000
Experienced (10-20 years)$275,000
Late-career (20+ years)$300,000

As shown, those just entering the field can expect average starting salaries around $200,000. With 5-10 years experience, salaries jump to $225,000 on average, progressing steadily through mid-career and experienced levels. After 20+ years in the field, average pay reaches $300,000 for late-career specialists.

Geographic location is another major factor, with specialists earning the highest salaries in regions like the North East and West Coast. Those practicing in more rural areas or lower-cost regions may earn less. Employment setting also impacts pay, with specialists working in hospitals and medical centers earning more on average than private practice or hospice facility roles.

Overall the career outlook for Hospice and Palliative Medicine remains strong, with an aging population driving demand and competitive salaries. The compassionate and meaningful work of helping terminally ill patients and families cope draws many physicians to specialize in this field. Professional organizations like the American Academy of Hospice and Palliative Medicine also work to advance the specialty and support specialists throughout their careers.

Career Opportunities and Advancement

Becoming a hospice and palliative medicine (HPM) specialist opens up various career opportunities in both inpatient and outpatient settings. As a relatively new medical subspecialty, the field of HPM is seeing strong growth to meet the needs of an aging population.

Inpatient HPM specialists often work in hospital palliative care teams to provide integrated and collaborative care for patients with serious illnesses. They work alongside other specialists to manage pain, symptoms, family stress, and end-of-life care planning [1]. According to research, over 90% of large hospitals with over 300 beds now have a palliative care program [2]. As demand increases, hospital-based palliative care teams are expanding and hiring more palliative medicine physicians.

Outpatient opportunities are also abundant in home hospice agencies and stand-alone hospice centers. Hospice organizations employ HPM specialists to oversee patient care plans and work with the interdisciplinary team. According to the National Hospice and Palliative Care Organization, hospice utilization has grown nearly 80% over the last decade [3]. This rapid growth suggests a strong job market for hospice physicians. Additionally, some HPM specialists choose to open their own hospice practices to provide customized in-home end-of-life care.

In terms of career advancement, HPM specialists can take on leadership roles such as Medical Director of a hospital palliative care program or Chief Medical Officer at a hospice organization. They can also pursue academic medicine as a professor focused on research or medical education in palliative care. Some physicians also choose dual HPM board certification in another specialty like Family Medicine, Internal Medicine, Anesthesiology or Psychiatry. This allows them to integrate palliative medicine into their primary specialty.

Overall, the field of HPM promises a wide scope of practice settings and opportunities to improve quality of life for patients and families facing serious illness. Both inpatient and outpatient demand for specialized palliative care continues to grow nationwide.


In conclusion, becoming a hospice and palliative medicine specialist is a meaningful career path for compassionate physicians who want to provide comfort care to seriously ill patients. It requires completing medical school and residency, then pursuing a 1-2 year fellowship in this specialty. Once board-certified, these specialists can work in various settings to manage pain, provide emotional support, handle complex symptoms, and improve quality of life during difficult illnesses. Though the work can be emotionally heavy at times, it also brings great reward in making a positive difference for patients and families facing life-limiting diagnoses. For those with an interest, review the eligibility requirements and fellowship opportunities at the American Academy of Hospice and Palliative Medicine website to further explore this specialty.


Additional Resources

American Academy of Hospice and Palliative Medicine– Professional association for hospice and palliative care physicians – Information on fellowship programs and board certification
Hospice and Palliative Credentialing Center– Provides CHPN certification for nurses – Study materials and exam prep available
National Hospice and Palliative Care Organization– Resources for healthcare professionals and the public on hospice care – Overview of services, care settings, and processes
Journal of Pain and Symptom Management– Peer-reviewed medical journal – Latest research and guidelines in palliative care
Center to Advance Palliative Care– Training programs for clinicians – Tools and guidelines for delivering palliative care


What is a hospice and palliative medicine specialist?

A hospice and palliative medicine (HPM) specialist is a physician who provides medical care, pain management, and emotional and spiritual support to patients with serious or life-threatening illnesses. HPM specialists aim to improve quality of life for patients and their families when curing the patient’s condition is not possible.

What education is required to become an HPM specialist?

Becoming an HPM specialist requires extensive education and training. First, you must complete a 4-year bachelor’s degree, then finish 4 years of medical school to earn your MD or DO. After this, you must complete a primary residency program such as internal medicine, family medicine, pediatrics, or anesthesiology which lasts 3-7 years. Finally, you must complete a 1-2 year fellowship program specifically focused on hospice and palliative medicine. [1]

How much work experience is needed?

In total, you need at least 8 years of post-graduate medical training before you can work independently as a board-certified HPM specialist. This includes your primary residency and your hospice/palliative fellowship. Some doctors choose to gain additional years of experience practicing internal or family medicine before specializing. Hands-on experience caring for terminally ill patients is very valuable preparation for this career.

What is the job outlook and salary range for HPM specialists?

The job outlook for HPM specialists is excellent due to our aging population and rising rates of chronic illnesses. According to the Bureau of Labor Statistics, employment of these specialists is projected to grow 8% from 2016 to 2026, faster than average for all occupations. The average annual salary for hospice and palliative medicine physicians was $208,000 as of 2018. Those working in academic medicine tend to earn less, while specialists in private practice settings have the highest earning potential. [2]