Working life (palliative medicine)

This page provides useful information about the roles and responsibilities of doctors in palliative medicine, where they work, who they work with and what they feel about their role.

"Palliative medicine allows me to talk truthfully and openly about sensitive end-of-life issues with patients – something other specialties don’t often have the time or training to do well. This makes it an immensely satisfying discipline. Furthermore, it provides challenges in the medical management of complex symptom control problems and allows me the privilege of gaining insight into patients as more than medical cases. As a palliative medicine specialist, I build up an understanding of each person as a whole, and enable honest communications about end-of-life issues with patients, their families and often other healthcare professionals." - Consultant in palliative medicine

The range of work undertaken by specialists in palliative care varies according to how the local service is constructed. This is affected by the role of the voluntary sector (eg in the funding of posts), hospital and community facilities, the extent of integrated care arrangements and the decisions of commissioning groups.

More than with other specialties, consultants in palliative care often find that they have clinical leadership and managerial roles early on in their careers and often become involved in the strategic development of local services.

Doctors in palliative care also undertake a range of non- clinical activities known as supporting professional activities.  As with any doctor this would be expected to include personal development (CPD), audit and quality improvement, education and research. However, for palliative medicine, education is often a large commitment.

There are academic posts in palliative medicine; however many doctors focus energies on clinical services and teaching more than research but this is changing. Increasingly there are research opportunities in any setting through collaborative projects.

How your time is spent

Full-time consultants are normally contracted to work 10 programmed activities (PAs) including 1-2.5 supporting professional activities (SPAs) per week. SPA quota may vary according to the employing organisation although 2.5 is recommended by the College of Physicians. A PA relates to portions of  four hours.

Typically, they spend about two-thirds of their time on clinical work comprising  both direct bedside assessments in hospital or home, ward rounds, outpatient care indirect  patient care (case discussion with other professionals including telephone advice) and the documentation/communication relating to these.

They would also attend at least one formal multidisciplinary team meeting (MDT) each week.

On-call and working hours

Working hours are usually 8.30am to 5pm but can be longer if there is a need to communicate with family members who can only visit patients at the end of the working day. On-call requirements vary – some placements may have no on call, while others may require specialists to be on call around 20 per cent of the time. Over 65% of consultants say they are routinely on-call at weekends. This may entail hands on clinical responsibilities for inpatients in a hospice, or as part of a shared rota to provide advice and support to other teams in hospital and community settings. Generally, the specialty lends itself to a good work-life balance.

Less than full-time working is common in this specialty with over a half of women consultants and three-quarters of SAS doctors doing so. Less than full-time consultants are likely to spend little of their time doing research.

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