Doctors in palliative medicine provide holistic, quality-of-life care of patients with serious, advanced progressive illnesses and for whom curative treatment is no longer possible.
Nature of the work
Care of dying patients and those close to them is central to this specialty. Doctors in palliative medicine also provide supportive care at earlier stages in an illness, alongside active treatments and interventions.
While most medical professionals have responsibility for good palliative and end of life care, palliative medicine physicians provide support, guidance and expertise to other teams particularly in complex situations. They have an important role in the education of other professionals and for ensuring high standards of care in the organisations for which they work.
They encounter a range of diagnoses, although most referrals will be for patients with progressing or advanced cancer. An increasing proportion have other progressing or end stage conditions including heart failure, renal failure, advanced chronic obstructive pulmonary disease (COPD) and neurological conditions.
An in depth knowledge of the pathology and management of these conditions is essential and forms part of the curriculum in specialist training. Some doctors will develop a sub-specialty interest depending on their post and location. In general, palliative care for patients younger than 18 years is provided through paediatric palliative care specialists.
In some care settings, such as specialist inpatient units in hospitals or hospices, the palliative care physician is responsible for the medical management of the patient. However in the community and most hospital settings, the role is one of working alongside different teams and professionals with the GP or another specialist being directly responsible for the care.
They offer care that:
- strives to achieve the best quality of life for the patient for as long as possible
- involves managing and anticipating pain and other symptoms
- addresses the psychological, social and spiritual needs of the patient
- facilitates multi-professional support in order to provide joined-up care across care boundaries, enabling care at home and fewer avoidable admissions towards the end of life
- supports anticipatory planning with patients and professionals including advance planning in the last year of life
- supports end of life care that meets the needs and wishes of the individual and family
- supports the family and significant others during the patient’s illness and their bereavement
The tools of the specialty are communication, clinical assessment, decision-making and in depth knowledge of pharmacology.
Some physicians will undertake paracentesis (drawing off fluid form a natural cavity of the body) in hospice or home settings under guidance of portable ultrasound (very high frequency sound waves). They will be familiar with specialist pain techniques including management of epidural infusions (a local anaesthetic procedure for blocking pain) but this would be in conjunction with a pain specialist.
Where do doctors in palliative care work?
Consultants often work across hospice, community and hospital settings but would be based in one of these. There are posts exclusively based in a hospital, working with the multi-professional palliative care team across all wards and clinics which may include seeing patients on medical assessment units or with the acute oncology team that manages malignant diseases.
Posts based in a hospice usually include sessions for home visits and/or at the local acute trust. Outpatient clinics may be provided in hospital or hospice settings. Others may be based primarily with a community palliative care team. Trainees will rotate across all of these to gain different experience. Non-training posts are more likely to be located in one setting, such as a hospice.
In any setting, the role includes provision of palliative care advice to other professionals often by telephone.
Want to learn more?
Find out more about:
- the working life of someone in palliative medicine
- the entry requirements and training and development
- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.
NHS Employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
- Where the role can lead Expand / Collapse
This specialty provides limited opportunities to work in academic medicine (though usually with some clinical input).
Talking to consultants in the specialty and gaining experience in hospital, community and hospice settings during specialist training will help you decide whether you want to work in a hospital, in the community, in hospices or other specialist palliative care units; however as explained many roles have a foot in at least two settings.
Working in palliative medicine offers opportunities for consultants to become involved in strategy for improving and developing palliative and end of life care services at a local level and at a national level.
- Job market and vacancies Expand / Collapse
This section provides useful information about the availability of jobs, finding vacancies and where to find out more.
Job market information
Palliative medicine had 298 consultants and 181 specialty registrars in England (NHS Digital, 2016). Women make up 73% of the consultant workforce, and 88% of the higher speciality trainees in the UK (2014/15 RCP census, 2016).
At present there remains a shortfall in the required consultant numbers; as a specialty there has been no expansion in the last year but the number of training posts has not been reduced.About 40 trainees complete CCT training each year.
A survey of members of the Association of Palliative Medicine in 2011-12 showed that 6.4% of consultants, SAS doctors and registrars were from ethnic minority backgrounds, 78.1% from white backgrounds and 15.5% unknown.
The competition ratio for Core Medical Training (CT1), the first stage in the training (post-foundation), in 2015 was 1.7 (NHS Specialty Training, 2015).
The ratio of applicants to ST3 post in 2015 was 3.1 (124 applicants for 31 NTN and 9 LAT posts) (JRCPTB).
Read the Centre for Workforce Intelligence’s profile of the palliative medicine workforce in England. The report noted that Yorkshire and the Humber and London strategic health authorities (SHAs) appeared to be potentially over-supplied for both doctors in training and consultants, while the North East, East of England and South East Coast SHAs were under-supplied. There may be more vacancies in these under-served areas in the next few years.
The supply of consultants in palliative medicine (based on the RCP 2010 Census) over the next ten years is forecast to increase at a slightly higher rate than other specialties to nearly 600 FTE in 2020 (681headcount). (Source CfWI, 2011). The average number of consultant appointments made between 2008 and 2011 was 30 per year and this may increase in the future.
The number of consultants in palliative medicine retiring each year is expected to increase from 4-5 a year to 12 a year towards the end of the decade (APM Workforce Report for Palliative Medicine, 2012-2016). However, a number of variables are likely to affect the supply and demand for doctors in this specialty including the higher prevalence of cancer, the ageing population, the impact of the increase in the retirement age to 67 and the level of NHS funding.
Across the UK, almost as many consultants are employed by the charitable sector as by the NHS. (Across all specialties, fewer than 4% of posts are funded by the voluntary sector).
On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
All trainees apply through the online application system Oriel. You will be able to register for training, view all vacancies, apply, book interviews and assessment centres, and manage offers made to you.
Local Education and Training Boards (LETBs) will have details of training vacancies. Not all LETBs will offer new training posts in all specialties in all years.
All jobs will be advertised on the NHS Jobs website.
The BMJ Careers website also advertises vacancies.
- Further information Expand / Collapse