Growth of an academic palliative medicine program: Patient encounters and clinical burden

Rony Dev, Egidio Del Fabbro, Mikilisha Miles, Amy Vala, David Hui, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Context: Information regarding the challenges of clinical growth and staffing of palliative care programs is limited. Objectives: Our aim was to describe the growth and staffing structure of a palliative care program at a comprehensive cancer center. Methods: During fiscal years ending in 2000 through 2010, we recorded all billed palliative care consultations and follow-ups. To determine the yearly clinical burden per physician, advanced practice nurse (APN), and physician assistant (PA), we calculated the mean number of patient encounters per clinical full-time equivalents. Increase in absolute number of patient encounters and relative (%) growth from year to year were calculated. Results: Over the 10-year history of the program, the number of outpatient consultations tripled, whereas the inpatient consultations increased from 73 to 1880. In all cases, with the exception of the first year of operation, the vast majority of clinical activity was in the inpatient hospital setting. Growth in the ratio of inpatient consultations per operational hospital beds was noted during the first five years of the program followed by a more modest increase in the succeeding five years. In fiscal year 2010, palliative care physicians had 6.2 patient encounters per working day, and APNs/PAs independently evaluated and treated 4.0 additional patients. Conclusion: Over the 10-year history, there has been an increase in the number of patient consultations seen by our palliative care program. The clinical burden was manageable during the first three years but quickly became too burdensome. Active recruitment of new faculty was required to sustain the increased clinical activity.

Original languageEnglish (US)
Pages (from-to)261-271
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - Feb 2013
Externally publishedYes


  • Palliative care
  • program development
  • supportive care
  • workforce staffing

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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