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Training the Next Generation of Doctors in Palliative Care Is the Key to the New Era of Value-Based Care

Frist, William H. MD; Presley, Martha K. MD, JD

doi: 10.1097/ACM.0000000000000625

There is a common misperception that palliative care is just another term for hospice care. Although it includes hospice, palliative care is also the long-term coordinated care of the chronically ill, which is delivered at a cost savings. Why does it matter that the average American understand what palliative care means? Because the evidence shows that U.S. patients near the end of life are spending exorbitant amounts of money on health care they do not want and the country cannot afford.

To better understand why palliative care is an important issue in the current debate about health care reform, the authors first briefly review landmark legal cases in the area of end-of-life care. They then discuss the role of palliative care in conversations in the current health care climate and conclude by emphasizing the importance of integrating palliative care into the standard medical curriculum.

The authors predict that palliative care will be accepted in the United States as a much-needed and desirable field of medicine. Getting there, however, will require a multifaceted approach including payment reform, encouraging an open conversation among the U.S. public, and training physicians to offer the best possible care and guidance until a patient’s last breath.

Dr. Frist is former U.S. Senate majority leader and was a nationally acclaimed heart and lung transplant surgeon. He is currently chair of the executive board, Cressey & Company, Chicago, Illinois, adjunct professor of cardiac surgery, Vanderbilt University School of Medicine, and clinical professor of surgery, Meharry Medical College, Nashville, Tennessee.

Dr. Presley is assistant professor of clinical medicine, Vanderbilt University School of Medicine, and policy analyst, Office of Senator Bill Frist, Nashville, Tennessee.

Editor’s Note: This New Conversations contribution is part of the journal’s ongoing conversation on the present and future impacts of current health care reform efforts on medical education, health care delivery, and research at academic health centers, and the effects such reforms might have on the overall health of communities.

Funding/Support: None reported.

Other disclosures: Senator Frist is cofounder and chairman of the board of Aspire Health, a for-profit palliative care corporation. Dr. Presley will be a palliative care fellow at Vanderbilt University in July 2015.

Ethical approval: Reported as not applicable.

To read other New Conversations pieces and to contribute, browse the New Conversations collection on the journal’s Web site (, follow the discussion on AM Rounds ( and Twitter (@AcadMedJournal using #AcMedConversations), and submit manuscripts using the article type “New Conversations.” (See Dr. Sklar’s January 2015 editorial for submission instructions and for more information about this feature.)

Correspondence should be addressed to Dr. Presley, 2525 West End Ave., Ste. 1250, Nashville, TN 37203; e-mail:

© 2015 by the Association of American Medical Colleges