The population of aging and people with chronic illnesses is growing nationwide, and it is projected that there will be one palliative care physician for every 26,000 seriously ill patients by 2030. UCSF Fresno is among the larger Hospice and Palliative Medicine Fellowship (HPM) programs in the country, helping address the increasing demand for physicians trained to care for individuals with life-limiting illnesses and those nearing the end of life.
Four fellows are selected each year for the UCSF Fresno HPM Fellowship program. “We are considered a large program,” said Alireza Soleimani Fard, MD, UCSF Fresno HPM Program Director and UCSF Associate Professor of Palliative Medicine. “I did my fellowship here eight years ago, and at that time, we only had two fellows. Now, in the last five years, we have four fellows.” And having co-fellows is helpful, Dr. Fard said. “You learn a lot from each other.”
The UCSF Fresno HPM fellows are exposed to various pathologies across a multifaceted population. Fellows train at Community Regional Medical Center (Community Regional), the largest acute-care hospital and only level one trauma center and burn center in the San Joaquin Valley. They also go to Clovis Community Medical Center and the VA Fresno Medical Center.
They have outpatient exposure to palliative care (treatment and pain management for serious, life-limiting illnesses and providing emotional and social support for patients and families), including at the Community Cancer Institute (CCI) in Clovis. Fellows go to CCI twice a week to see patients who are diagnosed with cancer or sickle cell and manage their symptoms, which are pain, nausea, vomiting, loss of appetite, anxiety, agitation, and depression.
The HPM Fellowship provides an opportunity for a doctor to look at the whole prognosis for a patient instead of addressing a single life-limiting diagnosis, such as liver or kidney disease or cancer, Fard said. “I find that’s why the fellows are here; they want to provide support for their patients and the families throughout their journey.”
The Division of Hospice and Palliative Medicine is led by Division Chief Patrick Macmillan, MD, who helps and supervises fellows in hospitals and clinics and assists with research projects.
One of the challenges for many HPM fellowship programs is providing experience with hospice or end-of-life care. Still, the UCSF Fresno HPM Fellowship program works with two separate hospice agencies, including a unique arrangement at an inpatient unit inside Community Regional. “This is something you rarely see in other fellowships, such as having an inpatient hospice unit from a hospice agency inside a hospital. That is extremely rare,” Fard said.
He said the fellowship offers a full spectrum of hospice experiences. Fellows see hospice patients in nursing homes, skilled nursing facilities, patients’ homes, and inpatients at Community and Hinds Hospice homes in Fresno.
“Clinically, our fellows are so confident after they graduate from this fellowship; they know all aspects of hospice and palliative medicine,” Fard said. “I am one of those examples. As soon as I finished my fellowship here, the next month I started to work here as faculty.”
The UCSF Fresno HPM Fellowship is fully accredited. It attracts applicants from family and community medicine and internal medicine residency programs throughout the country as well as physicians from far-ranging disciplines such as emergency medicine and vascular surgery. Faculty also come from different medical backgrounds. There are family and community medicine-trained physicians, a psychiatrist, an internist, an emergency medicine physician, a neurologist, and a physiatrist.
The fellowship offers flexibility for fellows to schedule more time in a clinic or an outpatient setting, depending on their interests, so that they can get the most out of their one-year fellowship, said Fard.
Research is also an important component of the fellowship. Faculty and fellows have had several research projects published in hospice and palliative medicine.
Fellows are given time and support for a quality improvement (QI) project and a research project. Each month, there is a meeting with Muhammad Shoaib Khan, MD, a UCSF Health Sciences assistant clinical professor at the UCSF Fresno Department of Family and Community Medicine. Khan is the department’s Director of Research and Scholarly Activity.
Hospice and palliative care can be emotionally challenging, and the UCSF Fresno HPM Fellowship includes sessions on wellness and self-care. About once a month, fellows and faculty participate in wellness events, have dinner together, or engage in activities, such as excursions to Shaver and Huntington Lakes. “We are always available for them,” Fard said. “We support them throughout the fellowship.”
The friendliness of the fellowship is what attracted Fard to apply eight years ago. After his Family and Community Medicine residency in Houston, Texas, he applied for HPM fellowships in Georgia and Tennessee but wanted to go to California. He interviewed for a fellowship at Cedars Sinai Health Sciences University in Los Angeles, and at UCSF Fresno.
“This fellowship was my first choice,” Fard said. “I loved the system and the people. From day one, when I interviewed, I spoke to all the different people in the program, because it’s not just the physicians when you are thinking about a fellowship in hospice and palliative, you are thinking about the other colleagues, like a social worker, or nurse, or chaplain, because we learn as fellows from them as well,” he said.
“It’s fair to say, I know this program more than anyone else because I did fellowship here, I worked as a faculty, and the APD (associate program director) and now PD (program director). This program is really great.”
The UCSF Fresno Hospice and Palliative Medicine Fellowship program participates in the National Resident Matching Program (NRMP). All applications are handled through the Electronic Residency Application Service (ERAS) sponsored by the Association of American Medical Colleges. Applications are accepted from mid-July through mid-October.