WEBVTT

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Alrighty then, I'll go ahead and start myself.

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Welcome, everyone! My name is Chelsea Perez, I'm an education associate here with the Center to Advance Palliative Care. Very excited to welcome you to today's.

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Capsi fireside chat, leading through change and uncertainty in palliative care.

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Before we get started, I just want to briefly provide you with instructions on how to participate in today's webinar. If you need technical assistance from myself as the CAPSI host.

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You can use the chat function and select host from that drop-down menu. Let me know if you're running into any technical issues there. You can also use the chat.

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To submit comments and questions as we go through the session, we encourage you to do so.

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Just make sure that, uh, the option everyone is selected in that drop-down in the chat before you submit any of those comments, so we can all, um, see them and engage with them as well, so… I will be keeping an eye on that chat box throughout the session. When we do open for audience questions at the end, you can also use the Q&A panel to submit questions if you'd like to submit questions anonymously, that Q&A panel would allow you to do so.

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The webinar recording and slides will be available on CAPSE's website under the On-Demand Webinars page, where you can find all of our recorded webinars. Lastly, we ask you to provide your feedback on this session, and the very brief survey you'll see pop up in your browser once we end the session. So on to today. We're very lucky to be joined by our group.

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of presenters. Cap sees very own CEO, Brynn Bowman.

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Ricky Hooper, Chief Clinical Operations Officer of Care at Four Seasons, and President of the Hospice and Palliative Nurses Association.

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Dr. Christy Newport is the Chief Medical Officer for the American Academy of Hospice and Palliative Medicine and Chief of Palliative Care.

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and associate professor at Penn State Health, as well as Dr. Sean Morrison, Ellen and Howard C. Katz Professor and Chair of the Brookdale Department of Geriatrics and Palliative Medicine.

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Whether the Icahn School of Medicine at Mount Sinai. He is also co-director of the Patti and J.

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Baker National Palliative care center and director of the National Palliative Care Research Center. So with that, I'll go ahead and hand it over to.

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Thanks a lot, Chelsea. Thank you, everyone, for being here. Um, I think all of us panelists today thought.

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It would feel good to get together at the beginning of the year, um, and compare notes about what we see for the year ahead.

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So, a huge thank you to our panelists today. Um, we organized this conversation because it takes all of our orgs, CAPSE, the Academy, the Hospice and Palliative Nursing Association.

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Um, our major health systems and our research community.

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It takes all of us to pursue long-term field objectives together, um, and we consider that we are collectively serving the field.

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And we are strongest when we're working together. So rather than have this conversation amongst the four of us, we thought it made great sense to have it with you.

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As we start the new year. So we are going to dive right in.

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Um, and I love for each of you to reflect as we start on the state of the field right now, heading into 2026. Where do you think we're at in palliative care?

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Um, and Christy, let me start with you.

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Yeah, thanks so much, Bryn, and I just have to echo, um, your comments about the reason that we're here today.

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I always appreciate the opportunity for all of us to work together across our organizations, but I really love the opportunity to share this with a greater audience, too.

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Um, so I, um, I've been practicing in the field for about 18 years, and.

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I would say I… never been more optimistic or more proud of the work that we all are doing.

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Um, in all of the time that I've been practicing and in leadership roles.

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And it's not that this is not a difficult time to be in palliative medicine or in healthcare in general.

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Um, but it's… I think it's pretty remarkable where we are right now.

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you know, when I started in practice, we were still begging for consults.

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Um, we were trying to make the case just to say, hey, we'll save you some money. We won't cost you anything.

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Um, and we're in a place now that we just demonstrate our value.

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And we demonstrate that we help people live better.

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Um, and we don't have to say for ourselves anymore, because our evidence shows that.

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Our patients and families ask for it and demand it, and our colleagues ask for it.

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Um, so we really are in a place where we've.

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made the case that we improved care. Um, we have to make the case in different ways now, and with different stakeholders, and it's not always easy. You know, my team this morning was having to.

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back up our support for our interdisciplinary team. Um, but we have the evidence to demonstrate it now. So I think we're in a different place, and I'm really proud and excited about where we're going to hit with that.

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Yeah, it's… you're talking, Christy, reflecting when I came to CAPSI in 2013, consult etiquette was the… top thing that people wanted to hear about, not so today.

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Ricky, what about you? What's your take on the state of the field?

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Yeah, I mean, I think it's, um, you know, as Christy said, it's definitely, um.

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there's optimism out there, um, and I speak, you know, both as a clinician.

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Um, in a palliative care and hospice organization, but also from the nursing perspective for HPNA.

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Um, I think we've always talked about palliative care being a team sport, and it's important that we look at things from an interdisciplinary.

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perspective across the board. Um, I think that we have come a long way. I do think that we still have some ways to go.

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Um, and there are spots in the country where things are really great, and then there are other spots where we're still, you know, where we were 10 years ago in a lot of, in a lot of ways.

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Um, we're also kind of straddling this, um, transition from fee-for-service to value-based care.

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And how do we get organizations the tools that they need.

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to be able to demonstrate the value in the value-based care, um, kind of.

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minefield that's out there, and so that kind of, for me, feels like I'm in the middle of the trenches and trying to deal with that on one side, while also still trying to make the case for keeping the program alive and looking towards the future.

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Uh, for… from a nursing perspective and an organizational perspective.

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Yeah, and it feels like we've been straddling those two worlds for a long time now, and everybody wants to know, where is this going, and when is it going there?

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Yeah. It does, it does, yeah, for sure. Yes, exactly. I'd really like to know the when.

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Yeah, I mean, I would also agree. I think that.

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Sean, how about you?

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we have seen extraordinary. growth and development in the field over the past.

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25, 30 years, and I think that. If anybody had said to me back in 1995, when.

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We started the program at Mount Sinai that we would be where we are as a field now.

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I would have thought that they were crazy. And we have a lot to be… Both proud of, a lot to be thankful for.

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And many people to acknowledge. in terms of building that field.

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And at the same time, I think all of us are feeling a tremendous amount.

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of uncertainty and worry as we work. to the future. Um, Ricky mentioned.

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The challenge between the continual balance between moving to value-based care.

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And staying with fee-for-service. And where does that sit?

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And I think we have never figured that out, and that's something we're still working.

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On trying to balance and adjust to. I think the other piece that we need to… recognize is that when.

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the Medicaid restrictions go into place. And I've been 11 months in this country, we are going to be facing financial pressures in the healthcare system.

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that we have never faced before. Um, in the 30 years I've been in medicine, through good and bad times, we will never.

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We have never faced the financial pressures that we are going to face in 11 months, and that is both, in many respects, scary.

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But also for us as a field. a real opportunity, because we have been.

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the field that focuses on caring for the most vulnerable.

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And the most symptomatic patient populations, and those are the ones.

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That had the most at risk. With the loss of the insurance. We have been incredibly creative.

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in terms of developing. new models of care delivered.

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That align with financial pressures, and… It is the opportunity for us to lead in that respect.

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I wish that I didn't have to say that, I wish that there wasn't another leadership opportunity, but there's going to be.

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And I think as a field, we need to reckon with that.

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And so, there's a reason a lot of people are feeling anxious out there.

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Uh, in healthcare, and I think that's a big one.

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Yeah, Sean, it sounds like your head is very similar to where mine's at when I think about this year.

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thing that came to mind for me was kind of holding pattern. I think, as all of our organizations sort of.

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Wait and watch and worry. about cuts and reimbursement that Chana's talking about, about rising rates of uninsured Americans.

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Um, it does suppress some decision-making. It may make it harder for palliative care teams to pursue growth strategies that, you know, we may have had in mind a couple of years ago.

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But like you said, I think there are real opportunities out there right now if we are savvy about it.

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Um, the other thing I think about for this moment in time is… you know, like Christy started, we have achieved so much growth in the last 20, 30 years.

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Where we're serving patients, how we're serving patients, and if we want to continue that growth in the future, and we want to be reliably delivering high-quality care, we've got to unlock new resources. That's the reality, and that either has to come from changes in the environment that.

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You know, our advocates in the field could be pushing towards, um, and trying to influence that.

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Or we have to be thinking about the next kind of long-term strategic push inside of our field.

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Um, and so, you know, I know we'll talk about this for the rest of the hour, but I think of this as sort of a moment of regroup and what is… what is that next phase for palliative care?

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But before we go into money and quality, um, and program operations, I'd love to just start with.

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How are we doing? Um, and we talked about wanting to kind of take the temperature on our palliative care professional workforce to start this conversation. So, you know, for all of you, as you're listening to your colleagues, as you're listening to your members.

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Um, what I'd love to hear is, what's your sense of how people are feeling out there? How are people doing? Um, and Ricky, let's start with you this time.

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Yeah, I think, um, you know, from a nursing perspective especially, there's.

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still, um, a sense of moral distress. Um, across the workforce, no matter which.

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end of the field we're in. Um, there's also… Um, some… Questions, concern, and I guess uncertainty, really, about, um, how to integrate technology and the use of AI.

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from… and from a safe perspective, and how much of that can we use.

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to, um… not necessarily increase efficiency or effectiveness.

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But how do we augment our work? Um, with those tools. Um, and we're seeing a lot of employers kind of shifting from this focus on recruiting nurses, or recruiting APRNs.

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to, uh, how do we retain the ones that we've got.

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And how do we maximize well-being? You know, a decade or so ago, I've been in nursing a long time.

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Probably longer than most of you have been practicing, for sure. And years ago, I actually remember somebody saying, you're expendable, right? There are nurses on every street corner.

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And there are not anymore. There are certainly not quality nurses on every street corner. There are definitely not quality APPs on every street corner.

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Um, and training professionals. to do this really important work.

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is expensive, and takes time. Um, and so we want to make sure that we're, A, choosing the right people.

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But we're also investing on. keeping them in this field for a long period of time, and to do that, we've got to be able to focus on.

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How do you deal with fatigue? How do you deal with.

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the challenging, um, stressors on a daily basis. Uh, and I think that from an HPNA perspective, we've been looking at how do we do that? How do we provide those resources?

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Um, from an organizational perspective, I do that on a, you know, weekly basis as well, and trying to think, how can I keep my team intact?

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Um, and so I think that's… kind of the… the question for all of us to think about is how do we do that?

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from a global perspective as well.

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Yeah, I'll piggyback on that, Ricky, because. Um, this past year was the second year that we ran our annual palliative pulse survey, and that was.

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Palliative care professionals in any role from any discipline.

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Telling us how they're doing, and it was the second year in a row when emotional well-being.

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Apologies for the siren in the background. Emotional well-being, um, and moral distress were a top… were the top.

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Mm-hmm. Yeah.

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The Iran's actually very fitting for the topic.

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No kidding. We're the top, um, top-sighted concern by all respondents, whether they were leading a program or members of a program.

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And on the one hand, we saw, okay, programs were reporting console volumes are up and team size is the same, so obviously that's a stressor, moral distress around just feeling like you.

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Yeah.

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Do not have the resources for your patients that they need. As you said, Ricky. And then I think the third.

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kind of theme that came out of all of those responses, um… Had to do with, um… the health… healthy functioning of teams.

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Yeah.

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Um, and, you know, to me, again, in this moment of uncertainty, this is a really good opportunity to focus on what we can control, and that is healthy, high-functioning teams. Um, and, you know.

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It gets me really fired up when we hear people tell us about their team dynamics and where they have a lot of.

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opportunity to improve, and that would mean better role clarity, better team communication, um… thinking about, you know, how every team member can best leverage their expertise and work top of license.

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fostering a sense of trust and safety on teams. Um… So, like I said, I think that's something we can do about, um, and if U.S. Healthcare is in a wait-and-watch mode.

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this year, you know, this is a really good year to invest in those strategies to make sure that our.

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the folks on their teams… Are feeling fulfilled and valued at work, and that we keep them in this profession, like you said, Ricky.

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Yeah, I think we're in an interesting. time in healthcare in general, in that.

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There's an unprecedented… threat to the health and well-being of individual clinicians.

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Right? Of people feeling not safe when they go to work.

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Um, you know, their physical safety, but also their… the burden that they feel from the threats of their administration or healthcare system that they're working under.

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Um, there's also… We are just being undermined right and left in terms of the trust that.

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People come to us with. Um, you know, entering into our clinical spaces.

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Um, assuming that you're not there to help them.

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in a way that, you know… wasn't always the case before, and so, in addition to all of those things that are, you know, palliative care teams have been.

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facing for a long time of resources. Um, healthcare in general has this.

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Right? So even, you know, the nurse in your clinic that ruined your patient.

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you know, somebody was rude to them or threatened them.

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I mean, these are really… Um, some pretty crazy things that we're all facing and dealing with.

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And… I think our teams are uniquely positioned to acknowledge those.

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To acknowledge the stress that it puts on our own teams and those that we're dealing with.

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Um, to create space for that, to debrief the difficult interactions. That's been a part of our DNA all along.

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Um, and so we are already set up. to navigate those things, and I think there's recognition in health systems and organizations that.

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Palliative folks already do incorporate those principles. you know, you're seeing that in palliative care physicians becoming chairs of departments.

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Um, and palliative nurses being the chief clinical officers in non-palliative organizations.

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Um, so there's a demonstration that our bedrock principles.

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Um, are really demonstrating their value, and we can double down on.

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treating people as humans. taking care of their well-being, always acknowledging that first, both in our teams and in our patients.

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Don, what are your thoughts sitting as a health system leader perspective?

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Uh, a couple of thoughts, and I actually, Brynn, I think for the first time in my life, I'm going to disagree with you.

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Um, I don't think… We should be.

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in a holding pattern, or a watching pattern. And I think that… I think that as a field, we can't afford to be.

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We all… everybody went through. The exhaustion and the moral distress.

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Hmm…

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of the pandemic. You know, stretching into… 22, 23.

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And… with people… Emerging from that at different rates.

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And at different places. And I think there was a lot of feeling.

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In healthcare, and particularly within palliative care. that it was just about recovery.

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And that people weren't ready to move forward. And that is absolutely true.

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And yet, when… We look nationally where we are as a field.

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I do believe that it is time for us to step up.

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in a leadership role to a… address a number of challenges.

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that we're facing, that if we don't face. We won't have a field.

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Um, both Ricky and Christy talked about the workforce issue.

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And the fact that teams are overwhelmed. Um, that's not going to get better.

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Despite the number of people we're training across. all of our disciplines.

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we're still barely keeping up with retirement. So we need… to create systems of care.

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that are not heavily dependent. upon workforce.

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So that we have routine… care and management of pain and other symptoms, so that doesn't fall on palliative care teams, for example.

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We need to really think about whether the full IDT.

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is necessary for every single patient. Um, and you know, that is counter to what we've all been taught.

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That's counter, for example, in the Medicare hospice benefit, and yet I think we need to entertain the fact that if we're going to survive.

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We need to think about some different models of care.

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We have to prepare. for the changes that are going to be coming in healthcare insurance this year.

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Um, the… the reality is that the people who are going to lose their.

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Medicaid benefits. and are going to be seeking healthcare.

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our patient population. Um, and we're going to need to think about.

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How do we care for that population if our health system is going to survive?

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And then I think, from my perspective. One of the biggest threats to us.

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Um, in many respects, is the financialization of healthcare.

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Which we have not experienced to the extent. That other fields have.

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But right now, the most rapidly growing sector of private equity and healthcare is hospice and home health.

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Um, and you can argue, and we've been back and forth as a field.

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You know, does tax status matter. The data are crystal, crystal clear.

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Every single study demonstrates that it does. Now, there may be high-performing.

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Mm-hmm.

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for-profit organizations and low-performing not-for-profits. But the reality and the data are consistent on this, and we need, as a field.

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to start actually talking about that in the community.

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Um, whether that means development of better quality standards, I think that would help.

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But the reality is when. You're responsible to… a shareholder rather than a patient.

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There are conflicting motivations, and I think we really need to begin to address that as a field.

00:21:34.000 --> 00:21:37.000
And I think we are the ones that need to take leadership in that.

00:21:37.000 --> 00:21:40.000
And so I think now is the time to start.

00:21:40.000 --> 00:21:47.000
Talking and taking that leadership role. Rather than watching and waiting.

00:21:47.000 --> 00:21:51.000
Because if it's not us. It isn't going to be anybody else.

00:21:51.000 --> 00:21:55.000
Um, and we have both the track record and the experience.

00:21:55.000 --> 00:21:59.000
Of doing… We grew a field from milking.

00:21:59.000 --> 00:22:03.000
We grew a field from nothing when there was no reimbursement model for it.

00:22:03.000 --> 00:22:09.000
Um, we took hospice from a, you know, community-based volunteer organization.

00:22:09.000 --> 00:22:13.000
into a major industry. And that industry needs tweaking.

00:22:13.000 --> 00:22:18.000
Um, and we need to think very carefully about how palliative care is being delivered.

00:22:18.000 --> 00:22:24.000
by entities. who see it solely as a means to reduce costs.

00:22:24.000 --> 00:22:30.000
Rather than proof care. Um… And that also is something that keeps me awake.

00:22:30.000 --> 00:22:36.000
So, I think we've got 11 months to figure out how do we address the workforce issue?

00:22:36.000 --> 00:22:42.000
And think about what are… What does system-based care mean for palliative care?

00:22:42.000 --> 00:22:48.000
Um, how do we prepare for. the healthcare reimbursement crisis that we're going to be facing.

00:22:48.000 --> 00:22:51.000
And number 3, how do we deal with financialization of healthcare?

00:22:51.000 --> 00:22:56.000
Um, and I think we… That's where we should be energized around.

00:22:56.000 --> 00:23:00.000
And I think those are opportunities for us to solve.

00:23:00.000 --> 00:23:07.000
Let me defend my good name here, Sean, because I completely agree with you that we should be.

00:23:07.000 --> 00:23:11.000
Sprinting towards opportunities and thinking about where we can be right now.

00:23:11.000 --> 00:23:18.000
Um, I think many of our organizations, as larger organizations, are in a holding pattern right now, but let's, let's.

00:23:18.000 --> 00:23:21.000
talk about this issue of quality, like you're saying.

00:23:21.000 --> 00:23:33.000
Um… So, one thing that we are starting to do at CAPSI on this front is really to get serious about launching a process to develop program standards.

00:23:33.000 --> 00:23:52.000
Or palliative care in all care settings. Um, take into account the unique circumstances of those settings. With the primary goal of helping our palliative care programs have conversations with payers, with ACOs, with their own health systems, if that's, um.

00:23:52.000 --> 00:23:56.000
You know, where you sit, um, to say, you know.

00:23:56.000 --> 00:24:04.000
This is the standard recognizable set of services and structures that we have in place for specialty palliative care.

00:24:04.000 --> 00:24:13.000
These are the resources it's going to take to pull off the outcomes that I promise you we could deliver with those resources and with this structure in place.

00:24:13.000 --> 00:24:16.000
that we have our NCP guidelines now, and they articulate.

00:24:16.000 --> 00:24:23.000
the North Star, the highest quality palliative care delivery, what we all wish that our.

00:24:23.000 --> 00:24:27.000
You know, mothers and grandmothers would receive, and at the same time, we need to define.

00:24:27.000 --> 00:24:35.000
what is good enough in the context of that payment contract, in the context of that organizational support.

00:24:35.000 --> 00:24:49.000
Um… to set a floor. Um… We haven't defined a floor, and we need that protection to ensure that we have high-quality programs. Um, so that's a process that we're going to be starting this year.

00:24:49.000 --> 00:24:58.000
And I don't think that it immediately solves. All or maybe any of the problems that you're talking about, Sean, but I think it's a really necessary first step.

00:24:58.000 --> 00:25:03.000
As we work towards converging on what do those standards look like, um.

00:25:03.000 --> 00:25:20.000
You know, if there is opportunity for better reimbursement out there for our services, um, if it is in Medicare Advantage and ACO contracts, that, you know, we as a field are coming with a consistent offer and ask, so that we can help facilitate some of those negotiations.

00:25:20.000 --> 00:25:26.000
Um, and long-term, that we can be accountable in the context of, you know, a profit-driven healthcare system.

00:25:26.000 --> 00:25:32.000
That we can be accountable to those standards. Um, so like I said, it's a long road.

00:25:32.000 --> 00:25:38.000
But this is a process that we at CAPSE will be doing in collaboration.

00:25:38.000 --> 00:25:49.000
Um, we really hope, with all of the palliative care organizations, we will be asking for feedback from everybody in the field who has a point of view on this. This has to be a collaborative process.

00:25:49.000 --> 00:26:04.000
Um, and of course not, you know, us at our desks, but we've got to start that process, because it's a long one, and making those standards matter out in the world, and getting them adopted takes even longer, and this is the year that we're going to be starting this.

00:26:04.000 --> 00:26:10.000
Um, Ricky, Christy, I know your organizations are very much concerned with… with care quality.

00:26:10.000 --> 00:26:18.000
in this… in this environment as well, you know, what are you thinking? What are you doing here?

00:26:18.000 --> 00:26:28.000
Um, sure. So, you know, and having… wearing two hats here as the, you know, as a chief clinical operations officer and.

00:26:28.000 --> 00:26:35.000
facing the challenges of the hospice reimbursement and a community-based palliative care program, etc.

00:26:35.000 --> 00:26:49.000
And also, um… talking from a nursing perspective, representing HPNA's board, um… I think, you know, we're all feeling the need to try to work.

00:26:49.000 --> 00:27:00.000
collectively on standards, and to be able to collaborate with our, um, our… our colleagues at AHPM, and also with the social work groups.

00:27:00.000 --> 00:27:07.000
Uh, and, you know, from my perspective in an organization, you know, involving our social workers and our chaplains, um, and I noticed there was a couple of comments about.

00:27:07.000 --> 00:27:13.000
You know, having those disciplines or, you know, patient-family support services to addressing moral distress.

00:27:13.000 --> 00:27:20.000
I think part of our limitations come from the reimbursement system, um, because those disciplines are not reimbursed.

00:27:20.000 --> 00:27:31.000
Um, in the current models, and that creates some challenge. And it also makes us feel like we're not… it's hard to create those standards to involve all of those disciplines.

00:27:31.000 --> 00:27:36.000
When it's not part of a bundled reimbursement, if you will.

00:27:36.000 --> 00:27:42.000
Um, to be able to do that. Um, HbNA is definitely working towards.

00:27:42.000 --> 00:27:48.000
Um, standardizing educational materials, ensuring that our certification is.

00:27:48.000 --> 00:27:53.000
maintaining currency, um, to, you know, offering orientation guides.

00:27:53.000 --> 00:28:04.000
ensuring that organizations have access to. good quality materials to be able to train their workforce, um, and to be able to then continue to support them.

00:28:04.000 --> 00:28:10.000
Um, but it's… I think it's… we won't be able to do it.

00:28:10.000 --> 00:28:14.000
in a silo, right? We'll all have to work together in order to be able to do this.

00:28:14.000 --> 00:28:19.000
Um, in a successful manner. For sure.

00:28:19.000 --> 00:28:26.000
Yeah, I agree, Ricky, and we always appreciate the collaboration with these groups, and, um, with those that are mentioned in the.

00:28:26.000 --> 00:28:35.000
the chat as well. Um, HPM is often in a position to be able to comment on, you know, proposed payment models, or to, you know, propose.

00:28:35.000 --> 00:28:42.000
Um, new ones, and we're always advocating for support for the interdisciplinary team, too. To Sean's point.

00:28:42.000 --> 00:28:50.000
Not every patient needs everybody on the team. But a lot of patients need skilled spiritual care support, they need skilled social work.

00:28:50.000 --> 00:28:52.000
Um, and so, always trying to work to promote.

00:28:52.000 --> 00:28:58.000
Um, ways to support them so that they can be a part of the care that's delivered.

00:28:58.000 --> 00:29:03.000
Um, I think the other aspect that I can comment on from HPM in terms of workforce.

00:29:03.000 --> 00:29:09.000
development is, um, many of you will know that, you know, we've been really strong partners in supporting.

00:29:09.000 --> 00:29:15.000
fellowship programs, our fellowship match was, again, very strong this year in comparison to some other.

00:29:15.000 --> 00:29:24.000
Um, of the kind of cognitive fields, we have higher percentage of matching that on the 80% match, and while we want that to be 100%.

00:29:24.000 --> 00:29:30.000
It's a lot higher than some other areas of geriatrics is falling down into the 30s and 40s, and.

00:29:30.000 --> 00:29:37.000
Um, so we continue to support fellowship programs and the program directors, um, development of really high-quality.

00:29:37.000 --> 00:29:43.000
hospice and palliative medicine physicians. Um, I saw that, you know, something else that was asked in the chat, and.

00:29:43.000 --> 00:29:48.000
And that maintains a priority for us to make sure that the people that are entering the specialty.

00:29:48.000 --> 00:29:53.000
you know, are well-trained, and they do have, um, really the quality principles that they need.

00:29:53.000 --> 00:29:58.000
But we also recognize that, um, you know, back in, um.

00:29:58.000 --> 00:30:05.000
Uh, 2013, I believe, when… when the pathway became closed to people that were in the middle of their career, that cut off.

00:30:05.000 --> 00:30:07.000
the supply of folks that are entering the field.

00:30:07.000 --> 00:30:12.000
So, again, one of our bedrock principles is that we get creative, right? And so.

00:30:12.000 --> 00:30:23.000
We are collaborating, you know, with HMDC. I'm really excited to be talking some more, um, with ACGME and ABIM about, um, expanding mid-career fellowships.

00:30:23.000 --> 00:30:28.000
Um, and an alternate pathway for people to get boarded, um, by HMDC.

00:30:28.000 --> 00:30:37.000
It remains a priority, it's something that, in every different space that we're in, whether it's education or advocacy policy development, we're always looking at how do we promote.

00:30:37.000 --> 00:30:42.000
Um, high-quality education to make sure the people that call themselves.

00:30:42.000 --> 00:30:47.000
a hospice or palliative clinician really are trained to do that, um, to do that well.

00:30:47.000 --> 00:30:55.000
And that it's a sustainable, um, you know, model to be able to do that.

00:30:55.000 --> 00:31:02.000
Yeah, um… While we're talking about workforce, I think, and to piggyback where you were, Christy.

00:31:02.000 --> 00:31:16.000
Um, you know, Caps East Lane. vis-a-vis palliative care professionals. Historically, we've focused on primary palliative care education rather than on palliative care specialists, but over the years, as we've.

00:31:16.000 --> 00:31:38.000
disseminated those palliative care skills. A quarter of the people taking CAPSI courses on our website, so… almost 44,000 people, um, are actually working on palliative care teams, and that tells us what we already know, um, that a lot of programs struggle to find specialty-certified palliative care professionals to hire.

00:31:38.000 --> 00:31:46.000
And are looking for good education and training options to make sure that everybody on that program is prepared. Um, we put out, um.

00:31:46.000 --> 00:32:10.000
in the fall of last year, two new resources that I want to make sure everybody's aware of, because they can help in this context. They are as comprehensive as we could make it, an audit of all of the education and training programs out there intended for people working on specialty palliative care teams. Some are virtual, some are in-person, some are immersion courses, some are certificate programs over the course of a year.

00:32:10.000 --> 00:32:22.000
Um, but we give as much detail as we can about what they cover, how much they cost, for which professions, is it an interprofessional education program? Um, so a resource to be aware of.

00:32:22.000 --> 00:32:27.000
Um… I do want to acknowledge also, while we're on this topic.

00:32:27.000 --> 00:32:33.000
We should have social work and spiritual care colleagues in this conversation, and we don't.

00:32:33.000 --> 00:32:38.000
And that's a big mess. Um, so I will be reaching out to Swipin and to the Chaplaincy orgs.

00:32:38.000 --> 00:32:45.000
Think about, you know, what conversation… Specifically, as we're talking about a population with.

00:32:45.000 --> 00:32:58.000
hugely complicated and growing social needs. As we're talking about moral distress in patients' interactions with healthcare and with serious illness, that's a conversation that we should be having together for the field as well.

00:32:58.000 --> 00:33:04.000
Um, so I want to acknowledge that.

00:33:04.000 --> 00:33:10.000
I wonder, and I… building on something, because. I know that the Academy has done this.

00:33:10.000 --> 00:33:14.000
started to invest in this. But I also believe that.

00:33:14.000 --> 00:33:20.000
Our investment right now. In so many ways, needs to be in leadership.

00:33:20.000 --> 00:33:28.000
that… with the one-year clinical training for physicians.

00:33:28.000 --> 00:33:37.000
Um, and even less… For nurses. We are not giving our young clinicians.

00:33:37.000 --> 00:33:44.000
the leadership skills they need. to run programs. And I don't think we can afford to do that anymore.

00:33:44.000 --> 00:33:50.000
Because with the workforce challenges that we face. We're going to make a difference when.

00:33:50.000 --> 00:33:56.000
Our clinicians become. the chief nursing officers.

00:33:56.000 --> 00:34:03.000
When they become the CMOs. when they become health system leaders, because then.

00:34:03.000 --> 00:34:10.000
Then, they can put in place. systems of care.

00:34:10.000 --> 00:34:14.000
that are better aligned with what the population needs.

00:34:14.000 --> 00:34:21.000
And until we invest in giving those people that knowledge, set of knowledge and skills.

00:34:21.000 --> 00:34:26.000
We are going to be facing this huge workforce deficit without an ability.

00:34:26.000 --> 00:34:33.000
to change it. And… I think it's as important as teaching the clinical skills.

00:34:33.000 --> 00:34:41.000
is giving people the administrative. and leadership skills to move forward, which nobody teaches you in clinical training.

00:34:41.000 --> 00:34:47.000
At all. Um, and we can't afford to be the apprentice model of that anymore.

00:34:47.000 --> 00:34:50.000
Which is where it's from.

00:34:50.000 --> 00:34:51.000
Yep.

00:34:51.000 --> 00:34:56.000
I will just toot the horn of Catsy that I have learned significant leadership.

00:34:56.000 --> 00:35:05.000
um, skills and elements from, you know, being involved, um, and attending webinars and office hours of.

00:35:05.000 --> 00:35:10.000
of CAPC over the years. Um, I personally also, when I was just a baby doctor, attended.

00:35:10.000 --> 00:35:15.000
Um, and participated in the leadership training that was offered, um, from HPM.

00:35:15.000 --> 00:35:24.000
We continue to, um, support. the movement of leaders and offer funds, actually, for people to be able to get leadership training, since so many people's.

00:35:24.000 --> 00:35:42.000
you know, educational funds are being cut. Um, and do that for various disciplines, so… Um, we obviously always have the opportunity to do more, um, but I do… So just give credit that, um, I personally have learned from that in developing leadership skills, and I think those of us that have had that experience.

00:35:42.000 --> 00:35:46.000
Um, also, you know, do our best to participate in future.

00:35:46.000 --> 00:35:51.000
Um, trainings and to pass that information down to our future leaders. I also see, um.

00:35:51.000 --> 00:35:55.000
you know, a much better, um, kind of acknowledgement of.

00:35:55.000 --> 00:36:01.000
uh, you know, when somebody's coming out of their training, or they're just entering into the field of, you know, not asking.

00:36:01.000 --> 00:36:05.000
a nurse to take on the leadership of an entire program without having.

00:36:05.000 --> 00:36:10.000
Um, some mentorship and having some, um, guidance in that, and there… there is, I think, um.

00:36:10.000 --> 00:36:20.000
more support and interest in saying, like, hey, we need some leadership training before you do something like that. Don't bite that off without having mentorship and guidance on it.

00:36:20.000 --> 00:36:32.000
Yeah, and I think the other thing we hear a lot of… Um, from folks who we're talking to at CAPSE is, I mean, a leadership position, I've been there a year, and now I've just hit the point of maximum overwhelm.

00:36:32.000 --> 00:36:38.000
Because I've… because I've been plumbing the depths of what I didn't know I didn't know.

00:36:38.000 --> 00:36:58.000
We… that's just so everybody on the line understands, is a question that we talk about a lot between our organizations, and how can we best serve people who are really busy, have less and less continuing education money, and that applies… Particularly for chaplains, for social workers, for RNs, you know, how can we.

00:36:58.000 --> 00:37:04.000
meet those needs, um… While accommodating the challenges.

00:37:04.000 --> 00:37:26.000
Um, we did put out a series of 18 leadership development self-study courses continuing ed courses over the last year, and um… you know, I'm gonna toot the horns of the lead authors of that curriculum, including Helen Fernandez, who's the author of the LEAP Leadership Development Program at Mount Sinai. They're really high quality.

00:37:26.000 --> 00:37:31.000
And there's still self-study content, um, so what we want to do for the next step.

00:37:31.000 --> 00:37:41.000
is to figure out how we can. use these courses, but then springboard into more longitudinal leadership teaching and coaching opportunities.

00:37:41.000 --> 00:37:44.000
And we're going to be reaching out to people in the field, including the.

00:37:44.000 --> 00:37:49.000
Um, you know, if you came to this webinar and are interested in this, uh, put it in the chat.

00:37:49.000 --> 00:37:58.000
Because we want to get feedback on how can we make this work for people? How can we make it feasible to layer in, um, that… those leadership development, um.

00:37:58.000 --> 00:38:07.000
activities next to everything else that you're doing. Um, so we want to make sure we build something that people can actually use and benefit from.

00:38:07.000 --> 00:38:11.000
Kathleen, I see you in the chat, thank you.

00:38:11.000 --> 00:38:16.000
Any other thoughts, Ricky, Sean, as we're focused on.

00:38:16.000 --> 00:38:21.000
leadership now, before we… we take a pivot in the conversation.

00:38:21.000 --> 00:38:33.000
Yeah, I mean, I think it's, um… The points are all very well made, and uh, you know, those of us that have been in the field for a while, you know, we've been leaders, but now we have to grow some new leaders, because.

00:38:33.000 --> 00:38:39.000
You know, I've been the leader for our palliative care program for more than a decade, and thinking.

00:38:39.000 --> 00:38:42.000
All right, I am getting closer and closer to.

00:38:42.000 --> 00:39:00.000
potentially retiring, and. somebody has to be… how do I take all of the knowledge that I've accrued over that time, um, and that experience, and how do we hand that off? So, mentoring is a big thing. It's something that HPNA has been focused on for a while, and we're continuing to expand that.

00:39:00.000 --> 00:39:10.000
HPNAs, you know, launched, taken the basics training modules from a, you know, a fee-based thing to including that in membership benefits, and so that's.

00:39:10.000 --> 00:39:15.000
helping, but we're also continuing to focus on, um.

00:39:15.000 --> 00:39:25.000
leadership. kind of… qualities as well, and really, uh, enhancing that, because as we've all said.

00:39:25.000 --> 00:39:28.000
You don't get taught to be a leader in clinical training.

00:39:28.000 --> 00:39:39.000
Um, and you can't… not everybody can go do an MBA in healthcare administration, and that may not necessarily be what you need, but how do you get taught how to.

00:39:39.000 --> 00:39:44.000
care for people, and how do you manage the people-ing part.

00:39:44.000 --> 00:39:49.000
of your leadership role. Um, and leadership is different than management, right?

00:39:49.000 --> 00:39:55.000
It's, um… I think a lot of us as leaders might say that it's not the.

00:39:55.000 --> 00:40:03.000
the spreadsheet pieces, it's not the clinical work that's most challenging, it is the peopling and how to manage.

00:40:03.000 --> 00:40:11.000
conflict resolution amongst our people, uh, and how to deal with some of those other things, like how do you manage moral distress, and how do you manage.

00:40:11.000 --> 00:40:17.000
other people's compassion fatigue and balancing the staffing models and all of those elements.

00:40:17.000 --> 00:40:22.000
So I think that's where we all have to continue to focus as well.

00:40:22.000 --> 00:40:31.000
Absolutely. speaking people, working with people, um, let's take a moment and talk about cross.

00:40:31.000 --> 00:40:36.000
specialty collaboration. I'm wondering for all of you. What are your observations about?

00:40:36.000 --> 00:40:43.000
clinical culture change, about structural change in the way that palliative care teams are collaborating with other specialties these days.

00:40:43.000 --> 00:40:52.000
Um, I am finding some… some real reasons for optimism on this front. Uh, Sean, let's, um, start with you, thinking about Mount Sinai Hill system.

00:40:52.000 --> 00:41:00.000
Oh, yeah, I mean, it's a very different environment than we've been in before, in that in many.

00:41:00.000 --> 00:41:05.000
places in the country. Uh, palliative care is now just part of the landscape.

00:41:05.000 --> 00:41:14.000
It's not the new kid on the block. It's not… novel, it's not innovative.

00:41:14.000 --> 00:41:19.000
It's just like every other specialty, and that's both good and bad.

00:41:19.000 --> 00:41:28.000
Um, but it does give us a platform. in a way that we've never had before, and a responsibility to use that.

00:41:28.000 --> 00:41:37.000
platform. Uh, you know, I have… trainees now who say, well, I'm not going to do an oncology fellowship in an institution that doesn't have palliative care.

00:41:37.000 --> 00:41:50.000
I can't believe those still don't exist. Never heard that before. Um… It… yeah, um… And… It also means that.

00:41:50.000 --> 00:41:54.000
As the programs grow, you have program directors who are at the leadership tables.

00:41:54.000 --> 00:42:02.000
for other parts of the health system. And again, that's a real opportunity, and it comes again back to.

00:42:02.000 --> 00:42:11.000
creating leaders. And also, in some respects, brand… For those who are in leadership positions.

00:42:11.000 --> 00:42:16.000
to really think strategically and actively about succession planning.

00:42:16.000 --> 00:42:23.000
Because in a system that's sort of a pyramid-based system, if you don't get out of the way for the next generation.

00:42:23.000 --> 00:42:31.000
Um, things are going to stagnate. And so, I think we also don't think enough about, as you're saying, when we're working with.

00:42:31.000 --> 00:42:36.000
within a healthcare system. the idea of succession planning.

00:42:36.000 --> 00:42:41.000
Where is it that are… the next generation is going to go.

00:42:41.000 --> 00:42:46.000
within that healthcare system, so that we keep them, we build the programs, and we don't lose them.

00:42:46.000 --> 00:42:56.000
And so, actively. Both thinking about mentorship, leadership development, but succession planning and transitions are things we've never had to think about in the field.

00:42:56.000 --> 00:42:59.000
And we need to think about it now.

00:42:59.000 --> 00:43:03.000
Yeah, first major generational chain.

00:43:03.000 --> 00:43:06.000
Well, Sean, I can give you some hope. I am not coming to take your job, where I currently.

00:43:06.000 --> 00:43:12.000
Well, you're taking my job, Christy.

00:43:12.000 --> 00:43:25.000
You're having a little bit of challenges? Um, but, um… No, you know, HPM, we have, um, special interest groups and communities, and our, um, early career professionals.

00:43:25.000 --> 00:43:30.000
Special interest group is… really one of our most vibrant and dynamic, um.

00:43:30.000 --> 00:43:41.000
groups, um, really great people that are passionate about the work, um, coming up and are going to be, you know, really some great leaders, you know, and… We are trying to engage them.

00:43:41.000 --> 00:43:51.000
Um, to do just, like, what you're talking about. So, rest assured that when you are ready to move on, there will be some great people, probably people that you've yourself trained.

00:43:51.000 --> 00:43:58.000
Um, to step in there. Um, but I think to reflect, Bran, on your original question about kind of cross-specialty.

00:43:58.000 --> 00:44:06.000
Um, I think it's true, we are in an ecosystem now where it's expected that palliative care is at the table for anyone with serious illness.

00:44:06.000 --> 00:44:12.000
To the point where, you know, in my role at HPM now, I had no idea.

00:44:12.000 --> 00:44:19.000
of all of the organizations that have communities of practice or subspecialty groups within their organizations.

00:44:19.000 --> 00:44:29.000
that are palliative care focused. Um, you know, 20 years ago, we had to knock on people's doors and ask to get a seat at the table, you know, at an ASCO meeting, to ask to even walk through the door.

00:44:29.000 --> 00:44:35.000
Um, and now, those organizations are coming to us and saying, hey, hey, we wrote this possession statement, what do we think?

00:44:35.000 --> 00:44:39.000
Um, you know, within our nephrology societies and surgical.

00:44:39.000 --> 00:44:44.000
Um, in American Heart Association, you know, all of those places.

00:44:44.000 --> 00:44:51.000
Um, we don't have to force it anymore. Um, it's… it's growing within itself, and so that idea of primary palliative care.

00:44:51.000 --> 00:45:01.000
really is being developed, um, within the specialties, but also an acknowledgement, um, that there's a need for specialty palliative care and interdisciplinary support.

00:45:01.000 --> 00:45:06.000
in all of those settings. So I think we're at a great place, and I think it's critical.

00:45:06.000 --> 00:45:14.000
That we understand how to collaborate. Um, and really understand how to be in the spaces with those folks.

00:45:14.000 --> 00:45:18.000
Um, a lot of my career has been in the cancer setting.

00:45:18.000 --> 00:45:21.000
I think we have a better understanding how to do that.

00:45:21.000 --> 00:45:25.000
Um, we still have a lot to learn in the surgical settings.

00:45:25.000 --> 00:45:31.000
Right? And we have a lot to, to, um, you know, we always have to have that humility when we come to the table.

00:45:31.000 --> 00:45:43.000
of a place that maybe we haven't, um, had a big presence before. And so, I think it's… it's really critical for us to continue to have a seat at the table and continue to be a part of that value-based equation.

00:45:43.000 --> 00:45:53.000
Um, is to demonstrate how we can, um, help in the places that we haven't been before, the places that we'd like to have a bigger presence.

00:45:53.000 --> 00:46:07.000
Yeah, this is one place where we've seen just a sea change in the last year in terms of… we're talking about CAFC doing primary palliative care education, receptivity, or just demand for that from other specialties.

00:46:07.000 --> 00:46:15.000
Um, we just finished a year-long. primary palliative care clinical education certificate program, um.

00:46:15.000 --> 00:46:20.000
with a partner, the Michigan Oncology Quality Consortium, they do.

00:46:20.000 --> 00:46:34.000
Um, uh, cancer care QY across the state of Michigan, and they realized, hey, there are parts of the state of Michigan, especially rural areas, where there is little to no access to specialty palliative care, this is important for cancer patients.

00:46:34.000 --> 00:46:47.000
Recruited nurse practitioner, oncology nurse practitioners, um, to put a whole lot of time over a year into learning palliative care skills and got nearly 3x the number of applications than the program could accommodate.

00:46:47.000 --> 00:46:53.000
Um, and that, I mean, I… again, that's another thing I wouldn't have imagined when we started doing this, just.

00:46:53.000 --> 00:47:01.000
10 years ago, um… We… Sean made a point earlier about where our field leaders go, and.

00:47:01.000 --> 00:47:08.000
represent the needs of people with serious illness, of represent palliative care in other venues and in other tables.

00:47:08.000 --> 00:47:30.000
We've been working this past year with the National Kidney Foundation, American Cancer Society, American Thoracic Society, American College of Surgeons, and in all of those cases, it is because palliative care champions for the last 10 years who are, you know, impressive, recognized leaders in their own rights, have been socializing this message about palliative care.

00:47:30.000 --> 00:47:36.000
in those groups, to the point where now those associations are telling their audiences, their members.

00:47:36.000 --> 00:47:51.000
these palliative care services are in scope for us, and collaborating with palliative care is really important for us. So I see a huge difference there and a ton of opportunity. And if we're not the only ones making the case for palliative care in our organizations, but our colleagues who depend on us are.

00:47:51.000 --> 00:47:57.000
That is a big difference. Ricky, tell me from a nursing perspective how you see this.

00:47:57.000 --> 00:48:06.000
Yeah, um, I think that, you know, a lot of the kind of normal connections have been mentioned. Oncology.

00:48:06.000 --> 00:48:17.000
Organizations, etc. So, you know, the oncology Nursing Association, but HPNA has also had interactions with the American Heart Association, and the emergency Nurses Association, you know, we talk about the, um.

00:48:17.000 --> 00:48:24.000
changing landscape of healthcare and the fact that we're going to be seeing more uninsured or underinsured Americans, and so.

00:48:24.000 --> 00:48:29.000
Those individuals land in the emergency room when they have not been able to.

00:48:29.000 --> 00:48:40.000
obtain healthcare in another location. And so, we really have to be thinking about how do we access palliative care clinicians in those spaces in the emergency rooms.

00:48:40.000 --> 00:48:43.000
And how do we ensure that our patients are.

00:48:43.000 --> 00:48:52.000
cared for in the most appropriate way, and so that's where we've been, um, kind of focusing on, um, on kind of making some connections from an HPNA perspective.

00:48:52.000 --> 00:48:58.000
Um, and so we'll be working on, um, a plan to be able to provide access to our basics.

00:48:58.000 --> 00:49:07.000
training modules for RNs and APRNs to members of the ENA, the Emergency Nurses Association. So that's going to be a focus for this year.

00:49:07.000 --> 00:49:09.000
That's exciting. There's a lot of opportunity there, it feels like.

00:49:09.000 --> 00:49:13.000
Yeah, for sure. Mm-hmm.

00:49:13.000 --> 00:49:22.000
I think we will work towards trying to answer some of the questions that have come into the chat along the way before we wrap up, because I realize we only have 10 minutes left. This hour flew by.

00:49:22.000 --> 00:49:24.000
Golly.

00:49:24.000 --> 00:49:30.000
Please do, if we, um… I'm gonna answer, address a question in the beginning about, um, data collection in the field.

00:49:30.000 --> 00:49:38.000
PCQC. If you have a question that hasn't been responded to in the chat, please bring it back so that we can see it.

00:49:38.000 --> 00:49:49.000
The question was, you know. what is happening with the future of palliative care program data collection, now that the palliative Care Quality Collaborative has closed its doors.

00:49:49.000 --> 00:49:58.000
I have part of the answer to this, and I know my colleagues will have other parts of the answer from their organizational purviews.

00:49:58.000 --> 00:50:05.000
We will be, before the end of this year at CAPSE, standing up a new data collection platform online.

00:50:05.000 --> 00:50:08.000
Um, that will start with a very simple question.

00:50:08.000 --> 00:50:14.000
Excuse me, so excited I'm losing my headphones. With the very simple question of, you know.

00:50:14.000 --> 00:50:20.000
where are you delivering services in what care settings and in what geographies, and ask.

00:50:20.000 --> 00:50:36.000
a small, we promise to keep it small, set of structure and process questions about your programs. Um, this will not… be an identical replica of the program registry that PCQC had held.

00:50:36.000 --> 00:50:45.000
And part of that is because we got a lot of feedback when talking to them and talking to folks in the field, um, that it was difficult to participate in that program registry.

00:50:45.000 --> 00:51:00.000
Um, we needed to streamline and focus on the information that, as we report back to the field, is going to be of maximum usefulness to all of you as you're advocating for your programs. So look for that in the fall of this year. We really, really, really.

00:51:00.000 --> 00:51:07.000
Aim to reach as many palliative care programs as we can once we launch this new data collection platform.

00:51:07.000 --> 00:51:13.000
Partially because we do not have a national data source of where community-based palliative care is being delivered in our field right now.

00:51:13.000 --> 00:51:19.000
Um, and that means we're flying by, in a sense. We don't know where care is and isn't available.

00:51:19.000 --> 00:51:30.000
We often don't know where to send our own family members, um… Um, or friends when they reach out, um, and we don't have a good way to track.

00:51:30.000 --> 00:51:37.000
Are we… are we growing? Are we expanding access? What do those programs look like? What are the patterns in care delivery?

00:51:37.000 --> 00:51:46.000
That I think would help us all move forward. Um, so, we are going to do everything we can to get the word out, and we're getting everybody's help, um, to do that.

00:51:46.000 --> 00:51:51.000
Any other thoughts on data collection? Um, for many of the three of you.

00:51:51.000 --> 00:51:57.000
Yeah, Brynn, um, it's… it's, I think, really a great thing that CAPS is going to be able to do that.

00:51:57.000 --> 00:51:58.000
It just is the bedrock of our field that we always need to be reflecting on what we can do better.

00:51:58.000 --> 00:52:03.000
Mm-hmm.

00:52:03.000 --> 00:52:07.000
You know, comparing ourselves, because there's so much heterogeneity in the field, and.

00:52:07.000 --> 00:52:14.000
So, um, having access to that data is valuable for us all to continue to improve the care that we provide.

00:52:14.000 --> 00:52:22.000
You know, an element that we didn't get to address today is, um, that we have some really great news in the field in terms of research, and.

00:52:22.000 --> 00:52:27.000
data that will be flooding into palliative care as well, with the Ascent Consortium.

00:52:27.000 --> 00:52:32.000
I don't know if a lot of folks are familiar, and, you know, if you listen to just the leg press, you might think that.

00:52:32.000 --> 00:52:46.000
no good research is going to be supported by the federal government anytime soon. Um, but, you know, whatever way it happened, um, there is great support, um, for a consortium of researchers who will be contributing some really meaningful work.

00:52:46.000 --> 00:52:52.000
Not only in just doing palliative care research, but developing palliative care researchers.

00:52:52.000 --> 00:52:57.000
Um, to be sure that we always have that feedback loop of what can we be doing better.

00:52:57.000 --> 00:53:11.000
How do we make the case for continued, um, value care? So in addition, I know they're two different things. The data collection is super important, but also continuing robust research is really important, and we have a great mechanism for that that's growing.

00:53:11.000 --> 00:53:15.000
Yeah, I'm so glad you mentioned that, Christy, thank you.

00:53:15.000 --> 00:53:29.000
building the evidence base. Um, another great question that came in through the chat, um… Has there been any thought on combining geriatrics and palliative care fellowships as the norm in the future? And Sean, as, um…

00:53:29.000 --> 00:53:36.000
As, uh, One Health System running a large combined geriatrics and palliative medicine fellowship. I wonder if you have any.

00:53:36.000 --> 00:53:42.000
Thoughts about the future of fellowship programs in palliative medicine and in geriatrics.

00:53:42.000 --> 00:53:55.000
You know, I mean, we… At Mount Sinai, we have… Six fellowship programs, um… One is a traditional one-year geriatrics program, the second is.

00:53:55.000 --> 00:54:05.000
a traditional 2-year geriatric program. The third is a traditional one-year palliative care program. We have a two-year integrated geriatrics and palliative care program.

00:54:05.000 --> 00:54:08.000
Um, now it's one that we have a mid-career palliative care.

00:54:08.000 --> 00:54:15.000
Fellowship, we have now a mid-career geriatrics fellowship. And we have two-year leadership.

00:54:15.000 --> 00:54:22.000
clinical fellowship in palliative medicine, and the same thing in geriatrics. That's 7, 8, and then we have a medicine geriatrics program.

00:54:22.000 --> 00:54:27.000
Fellowship. So the answer is yes, and I think the future needs to be.

00:54:27.000 --> 00:54:33.000
for us to be creating training pathways. That meet the needs of our trainees.

00:54:33.000 --> 00:54:41.000
and meet the needs of the field. So… There's always going to be a need for a straight palliative.

00:54:41.000 --> 00:54:49.000
Palliative medicine fellowship program. But since the majority of people with serious illness are older adults, the idea of having a combined.

00:54:49.000 --> 00:54:54.000
fellowship program where you double-boarded has been one of our most successful programs.

00:54:54.000 --> 00:55:01.000
Um, our successful programs. Where we get the best applicants have been our non-traditional programs.

00:55:01.000 --> 00:55:06.000
They have been our… combined geriatrics palliative care fellowship program are.

00:55:06.000 --> 00:55:13.000
combined clinical leadership programs and recently. Um, our mid-career program.

00:55:13.000 --> 00:55:20.000
And our oncology palliative medicine fellowship. We had 150 applicants for one slot.

00:55:20.000 --> 00:55:22.000
And that fellowship program. So, 150 applicants for one.

00:55:22.000 --> 00:55:25.000
Wow.

00:55:25.000 --> 00:55:28.000
So I think as a field, we need to be thinking about.

00:55:28.000 --> 00:55:35.000
Where's the need, and what do people want? And a lot of times, people need that debunk trail.

00:55:35.000 --> 00:55:44.000
Um, I see a question in the chat, hoping to learn more about that mid-career fellowship program. I am going to post a link here.

00:55:44.000 --> 00:55:50.000
Um… So we are getting close to the top of the hour.

00:55:50.000 --> 00:56:01.000
Um, covered a lot of ground. If there are any last chance questions in the… for the chat, please… Um, please make them known.

00:56:01.000 --> 00:56:13.000
Um, we have a question, um, from a patient advocate about palliative care programs, seeing patients diagnosed with ALS, and thinking about, sort of.

00:56:13.000 --> 00:56:22.000
You know, palliative care patients. So, do any of you care to comment on that?

00:56:22.000 --> 00:56:34.000
I think, um, just from my perspective, Brynn, we certainly are seeing more patients with ALS. We thankfully are seeing them.

00:56:34.000 --> 00:56:39.000
Earlier in their disease trajectory, which gives us an opportunity to discuss.

00:56:39.000 --> 00:56:44.000
you know, true goals of care at a more meaningful stage in the disease.

00:56:44.000 --> 00:56:55.000
Uh, we're also having more conversations about. At what point does hospice overlay be able to, you know, provide adequate care for those folks?

00:56:55.000 --> 00:57:00.000
Um, I think it's an area that, uh, that probably.

00:57:00.000 --> 00:57:07.000
deserves more focus, you know, than the progressive neurological conditions as well. We're seeing a lot more across the board.

00:57:07.000 --> 00:57:14.000
Um, but, uh, not anything specific, and I think that that may be an area that we need to look at.

00:57:14.000 --> 00:57:16.000
As a field.

00:57:16.000 --> 00:57:22.000
So… Um, seeing, um, a number of.

00:57:22.000 --> 00:57:50.000
chats around… Opportunities for advocacy, um, particularly around really exciting activity happening at the state level, which we have not had time to cover today, but is real. It is… Happening. Um, CAPSI has a state, um, state advocacy forum that is public and open if you want to join. All three of our organizations have advocacy resources, so please check out those toolkits. They've been linked in the chat.

00:57:50.000 --> 00:57:51.000
Um…

00:57:51.000 --> 00:57:56.000
Yeah, and I would just make them… make them plea… to join your organizations that represent your interests, whether, you know, it's your local organization, the state or community.

00:57:56.000 --> 00:58:01.000
Yeah.

00:58:01.000 --> 00:58:08.000
Um, your national organizations. Um, our aim is to help you to do the work you want to do.

00:58:08.000 --> 00:58:21.000
and provide better care to patients, and. Um, when we become a member, that allows us to do that better, and so then you can access all of those resources, and we can advocate on your behalf.

00:58:21.000 --> 00:58:29.000
Yes, and yes. As we close out, each of you will share, kind of.

00:58:29.000 --> 00:58:38.000
Your reflection after this great conversation is… and as you head out into the rest of 2026.

00:58:38.000 --> 00:58:43.000
Um… Christy, why don't we start with you?

00:58:43.000 --> 00:58:54.000
Yeah, I, um… I just take away that, you know, we're in challenging times, and there's going to be threats to ourselves, to our teams, to our systems, to our patients, um, and their well-being.

00:58:54.000 --> 00:59:03.000
And we have our North Star. Our palliative principles will apply through all of these challenges, and for us, that's respect for.

00:59:03.000 --> 00:59:09.000
Patient and centered… patient and family-centered care, commitment to quality, justice, and equity.

00:59:09.000 --> 00:59:12.000
collaboration and interdisciplinary teamwork, adaptability, and being creative. Um, in these challenging times.

00:59:12.000 --> 00:59:17.000
Mm-hmm.

00:59:17.000 --> 00:59:19.000
Absolutely. Sean. Oh, go ahead, Ricky.

00:59:19.000 --> 00:59:28.000
And I think for me… sorry, to piggyback on what Christy said, I think for me, it's… It's what we've talked about before, is focusing on what we have control over.

00:59:28.000 --> 00:59:43.000
And then, and trying to, to, to really. Um, do the best that we can in that space, and then leave the things that we don't have control over to somebody else.

00:59:43.000 --> 00:59:45.000
Where are you at, Sean?

00:59:45.000 --> 00:59:50.000
Um… I wish, you know, I wish things weren't the way they are right now.

00:59:50.000 --> 01:00:04.000
Uh, I really do. Um, and I wish that… Uh, healthcare was a lot easier, and I wish we weren't facing the challenges that we were. Uh, but that… but… Or Ann, Christy, um, that's not the reality.

01:00:04.000 --> 01:00:11.000
Um, and… I do think we have a tremendous opportunity.

01:00:11.000 --> 01:00:17.000
as a field to make things better. And I agree with Ricky completely.

01:00:17.000 --> 01:00:22.000
If we start worrying about things that we can't control.

01:00:22.000 --> 01:00:26.000
Or trying to address things that are completely out of our control.

01:00:26.000 --> 01:00:31.000
We're not going to move forward. Yet, there are a lot of things.

01:00:31.000 --> 01:00:38.000
that are in our sphere of influence. And a lot of areas that we can control, or with a little stretch.

01:00:38.000 --> 01:00:43.000
we can have a say in. And that's an opportunity.

01:00:43.000 --> 01:00:48.000
And it is an opportunity for us as a field.

01:00:48.000 --> 01:01:00.000
to demonstrate why… We are… Needed. Um, and why we are leaders and why healthcare can't survive without us.

01:01:00.000 --> 01:01:09.000
And over the next year or two. that's where I think we need to be… Really, really focused.

01:01:09.000 --> 01:01:11.000
And recognize that it ain't going to be fun.

01:01:11.000 --> 01:01:17.000
And it's not fun right now. And… it feels overwhelming at some time.

01:01:17.000 --> 01:01:23.000
And we do have something we can do about it, and that's what we should be doing.

01:01:23.000 --> 01:01:28.000
Yep, that's where I'm at, too. I think for so many of the topics that we discussed today.

01:01:28.000 --> 01:01:41.000
Um… eh… I admire the leaders in our field, Jennifer Ballantin, who's been in the chat, Matt Gonzales, who say, we are afraid of AI, and there are all kinds of ethical considerations, so we should be the ones leading building out solutions.

01:01:41.000 --> 01:01:52.000
You know, we don't like that we live in a profit-driven system, um, and we feel that squeeze, and we have concerns for the quality of care that we and everyone else is able to provide for patients, so we need to dig in now more than ever.

01:01:52.000 --> 01:02:02.000
Um, and I think that's where we're at. Um, and I want to say that I'm grateful Christie and Ricky, um.

01:02:02.000 --> 01:02:07.000
For you in particular, joining, because I think it's… I'm grateful to be able to share with everyone else that we.

01:02:07.000 --> 01:02:15.000
are going to be collaborating, um, to try to support Drive Forward, advocate for these solutions.

01:02:15.000 --> 01:02:20.000
Because the last reflection I have from today is community is really important for our field right now.

01:02:20.000 --> 01:02:26.000
It's a tough time. The problems are hard. It's gonna take all of us, and it's gonna feel better doing it together.

01:02:26.000 --> 01:02:40.000
So I'm grateful to everybody for joining today. All of the chat is saved. I know there are questions we didn't get to. I know there are people who volunteered to give us feedback on the leadership program. I am excited to read through them, and we will get back to all of you.

01:02:40.000 --> 01:02:44.000
So, have a wonderful rest of your days. Thank you for being here.

01:02:44.000 --> 01:02:47.000
Um, and here we go into 2026, everyone!

01:02:47.000 --> 01:02:53.000
Thank youAbsolutely. ThankThanks so much