Anesthesiology provides perhaps the best preparation related to utilization of medications that comprise bread-and-butter palliative care. Overlap in anesthesia and palliative care practice is significant – both specialties require a facility in multimodal pain management, content expertise and comfort in both complex and high-dose opioid administration, ability to wield diverse anti-emetics and anti-anxiolytics and to recognize which are more likely to be effective in a given situation, and being adept in quickly developing a meaningful personal connection with vulnerable patients who have complex and multi-system pathophysiology. For patients with pain, anesthesiologists bring knowledge of interventions ranging from trigger point injections and ultrasound-guided blocks to celiac plexus neurolysis and intrathecal drug delivery systems. For patients at the end of life, anesthesiologists are experts in titration of medications and sedation and can help teach our palliative care colleagues about medications such as dexmedetomidine, particularly now that it is available as a generic and more widely accessible for use with palliative care patients.
“There are many ways for interested anesthesiologists either to receive more training in palliative care or to find opportunities to practice primary palliative care, particularly in hospitals and communities that lack palliative care specialists.”
When considering the future of anesthesia, palliative care practice opportunities and clinical needs are markedly increasing and – based on population trends, patient expectations and goals, and health system requirements to fulfill them – will continue to expand through 2030 and beyond. Since 2000, the number of hospitals with palliative care programs has more than doubled; there are now more than 7,600 board-certified palliative care physicians and 18,000 palliative care-certified nurses in the United States. Despite this, double-digit yearly growth in the need for palliative care clinicians over the preceding decade combined with the predicted “grey tsunami” of baby boomers reaching older age ensures excellent job security in palliative care for the foreseeable future. Existing data already support that nearly double the current number of palliative care clinicians are needed, particularly to ensure palliative care presence at for-profit and/or rural hospitals that are currently most likely to lack specialized palliative care. Anesthesiologists are well-suited to help to fill that gap and can bring considerable skills to an interdisciplinary team. There are many ways for interested anesthesiologists either to receive more training in palliative care or to find opportunities to practice primary palliative care, particularly in hospitals and communities that lack palliative care specialists. In addition to traditional one-year fellowships, more programs are developing competency-based fellowships that provide palliative care training while allowing fellows to continue to practice part time in their own subspecialty. In addition, and perhaps equally as important, anesthesiologists practicing other subspecialties, including, but not limited to critical care, neuroanesthesia, cardiothoracic anesthesia, pain medicine, and pediatric anesthesia, can readily incorporate palliative care practice contemporaneously with usual acute clinical care moreover, integrating palliative care training and skills into these subspecialty curriculums can provide a valuable addition for patients, anesthesiologists, and other physicians with which they work. For those of us practicing palliative care, the experience and opportunity is deeply meaningful and fulfilling. The future is bright for palliative care, and we encourage our fellow anesthesiologists to learn more and become involved in this important and growing field and to better recognize the potential value it brings to patients, their family members, and our clinical practice.