Rebuttal: Should palliative care be a specialty?

Clearly, palliative care could become a specialty or, as Dr Shadd has proposed, a subspecialty of family medicine. The real question is, Should it become a specialty? And will this generate a benefit of some sort? Will it help disseminate a relevant palliative approach across Canada? Will it engender immediate training for family physicians in this area? Our first social objective is to enable all of our citizens approaching the end of their lives to benefit from the palliative approach as quickly as possible, regardless of where they live.

Before we create a subspecialty that would reduce the number of people who actually deliver palliative care (as we would quickly rely exclusively on those accredited to deliver this care), should we not enhance the training and involvement of all family physicians? Family physicians work across a vast area, and there will never be enough subspecialists to meet the needs of patients. Do family physicians understand the urgency of trying to fill this need? Have all our faculties of medicine incorporated adequate training in palliative medicine into their curriculums? Have they demonstrated the conviction that all physicians should be comfortable with the palliative approach, regardless of their field of practice? As a society, we already have a tendency to solve problems by changing our structures and making them even more complex. What we need to do here is trust the excellent practitioners we are training and help them to take up this challenge. When we have done that, we can talk about creating a sub-specialty. But will we still need one?

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