The Hospice & Palliative Medicine Certification Program is co-sponsored by the American Board of Internal Medicine (ABIM), the American Board of Anesthesiology (ABA), the American Board of Emergency Medicine (ABEM), the American Board of Family Medicine (ABFM), and the American Board of Pediatrics. Diplomates from the following Qualifying Boards may apply for Hospice and Palliative Medicine Certification through ABIM: The American Board of Obstetrics and Gynecology (ABOG), the American Board of Physical Medicine and Rehabilitation (ABPMR), the American Board of Psychiatry and Neurology (ABPN), the American Board of Radiology (ABR), and the American Board of Surgery (ABS) and other ABMS surgical boards. The examination is administered to candidates from all Boards at the same time in the same testing centers. The American Board of Internal Medicine is responsible for administering the examination.
Note: This exam was offered for the first time in 2008.
Eligibility for Certification and Board Policies
The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification, November 2024 (pdf), governs ABIM's decision about eligibility for certification. The November 2024 edition supersedes all previous publications. ABIM reserves the right to make changes in fees, examinations, policies and procedures at any time without advance notice. Admission to ABIM's certification process is determined by policies in force at the time of application. ABIM is a member of the American Board of Medical Specialties (ABMS).
General Requirements
To become certified in the subspecialty of hospice & palliative medicine by ABIM, physicians must:
- At the time of application, be previously certified by ABIM in internal medicine or in their core discipline by an approved Qualifying Board. Note: Candidates from Co-sponsoring Boards should contact those Boards for information regarding certification requirements.
- Satisfactorily complete the formal training requirements;
- Demonstrate clinical competence, and moral and ethical behavior in the clinical setting;
- Hold a valid, unrestricted and unchallenged license to practice medicine; and
- Pass the Hospice & Palliative Medicine Certification Examination.
Fellowship training taken before completing the requirements for the MD or DO degree, training as a chief medical resident, practice experience, and attendance at postgraduate courses may not be credited toward the requirements for subspecialty certification.
To be admitted to an examination, candidates must have completed the required training in the subspecialty, including vacation time, by October 31 of the year of examination.
Candidates for certification in the subspecialties must meet ABIM's requirements for duration of training as well as minimum duration of full-time clinical training. Clinical training requirements may be met by aggregating full-time clinical training that occurs throughout the entire fellowship training period; clinical training need not be completed in successive months. Time spent in continuity outpatient clinic, during non-clinical training, is in addition to the requirement for full-time clinical training. Educational rotations completed during training may not be double-counted to satisfy both internal medicine and subspecialty training requirements. Likewise, training which qualifies a diplomate for admission to one subspecialty exam cannot be double-counted toward certification in another subspecialty, with the exception of formally approved pathways for dual certification.
Practice Pathway
Practice Pathways for admission to the Hospice and Palliative Medicine Certification Examination were available for the 2008, 2010 and 2012 administrations of the examination. After the 2012 administration of the Hospice and Palliative Medicine Certification examination, Practice Pathways were discontinued. All first-time applicants for admission to the examination after 2012 must fulfill the requirements of the Training Pathway below.
Training and Procedure Requirements
The training pathway for Hospice and Palliative Medicine candidates requires 12 months of satisfactorily completed clinical hospice and palliative medicine fellowship training* which meets the following criteria:
- Hospice & palliative medicine fellowship training undertaken July 1, 2010 and thereafter must be accredited by the Accreditation Council for Graduate Medical Education (ACGME). Hospice & palliative medicine fellowship training taken prior to July 1, 2010 must have been conducted within a program affiliated with a then accredited residency or fellowship program.
* Hospice and palliative medicine fellowship training which was credited toward the training requirements for admission to another ABIM examination, e.g., the ABIM Geriatric Medicine Certification Examination or the ABIM Medical Oncology Certification Examination, cannot be used to fulfill the training requirements for admission to the Hospice and Palliative Medicine Examination except for approved combined training pathways.
Required Months of Training and Procedures
The total months of training required, including specific clinical months, and requisite procedures are outlined below.
| Minimum Months of Training |
Clinical Months Required |
Procedures |
|---|---|---|
|
* For deficits of 35 days or less in required training time, ABIM will defer to the judgment of the program director and promotions or competency committee in determining the need for additional training. With program director attestation to ABIM that the trainee has achieved required competence, additional training time will not be required. Trainees cannot make a request to ABIM on their own behalf. |
||
| 12* | 12 | No required procedures |
Dual Certification Requirements – Geriatric Medicine and Hospice and Palliative Medicine
New in 2024, candidates seeking dual certification in geriatric medicine and hospice and palliative medicine may complete two years of accredited combined training, 16 months of which must be clinical training evenly divided between geriatric medicine and hospice and palliative medicine. Remaining non-clinical months may be reserved for research and/or leadership development. Combined training must be completed in a single institution which has accredited training programs in both disciplines.
During the entire two years, the fellow must maintain a continuity outpatient clinic structured in a way consistent with ACGME requirements for continuity clinic in the discipline. Time spent in continuity outpatient clinic, during non-clinical training, is in addition to the requirement for full-time clinical training.
Candidates must complete both years of required combined training before being admitted to either or both Geriatric Medicine and Hospice and Palliative Medicine Certification Examinations. Should the candidate transfer to another institution they would no longer be eligible for dual certification unless they meet the standard training requirements separately to apply for both exams
| Minimum Months of Training |
Clinical Months Required |
Procedures |
|---|---|---|
|
* For deficits of 35 days or less in required training time, ABIM will defer to the judgment of the program director and promotions or competency committee in determining the need for additional training. With program director attestation to ABIM that the trainee has achieved required competence, additional training time will not be required. Trainees cannot make a request to ABIM on their own behalf. |
||
| 24* | Geriatric Medicine - 8 |
No required procedures |
|
Hospice and Palliative Medicine - 8 |
No required procedures |
|
Clinical Competence Requirements
ABIM requires documentation that candidates for certification are competent in: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice.
Through its tracking process, FasTrack®, ABIM requires verification of fellows' clinical competence from a program director certified by ABIM in the discipline for which they are program director (other ABMS Board and Canadian certification is acceptable, if applicable).
As outlined in the Program Director Ratings of Clinical Competence table below, all fellows must receive satisfactory ratings of overall clinical competence. In addition, fellows must receive satisfactory ratings in each of the six ACGME/ABMS Competencies and the requisite procedures during the final year of required training. It is the fellow's responsibility to arrange for any additional training needed to achieve a satisfactory rating in each of the six ACGME/ABMS Competencies and overall clinical competence.
Program Director Ratings of Clinical Competence
Six ACGME/ABMS Competencies:
The resident/fellow is demonstrating satisfactory development of the knowledge, skill and attitudes/behaviors needed to advance in training. S/he is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, effective, patient-centered, timely, efficient and equitable care.
| Components and Ratings | Residents/Fellows: Not Final Year of Training |
Residents/Fellows: Final Year of Training |
|---|---|---|
|
* The six required competencies are: (1) patient care and procedural skills, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism and (6) systems-based practice. † At the discretion of the program director, training in the final year may be extended as necessary to achieve satisfactory ratings in overall clinical competence and/or the six ACGME/ABMS competencies. |
||
| Yes | Full credit | Full credit |
| Conditional on Improvement | Full credit | No credit; must achieve satisfactory rating before receiving credit † |
| No | Full credit | No credit; must repeat year |
Overall Clinical Competence
This rating represents the assessment of the resident/fellow's development of overall clinical competence during this year of training:
| Components and Ratings | Residents/Fellows: Not Final Year of Training |
Residents/Fellows: Final Year of Training |
|---|---|---|
| * At the discretion of the program director, training in the final year may be extended as necessary to achieve satisfactory ratings in overall clinical competence and/or the six general competencies. | ||
| Satisfactory or Superior | Full credit | Full credit |
| Conditional on Improvement | Full credit | No credit; must achieve satisfactory rating before receiving credit* |
| Unsatisfactory | No credit; must repeat year | No credit; must repeat year |
Candidates for Special Consideration
ABIM diplomates in internal medicine may be proposed for special consideration for admission to a subspecialty examination by the program director of an accredited fellowship program.
Guidelines for proposals are available in Proposing Candidates for Special Consideration.
Certification Using the Research Pathway
The ABIM Research Pathway is designed to integrate training in research and clinical internal medicine for those physicians who are seriously pursuing careers in basic science or clinical research. The value of the ABIM Research Pathway is that while it requires core clinical training, it concentrates on fostering a research experience that is comprehensive in terms of time, formal curriculum, and structured evaluation and feedback. These components are essential for professional growth and development and to promote continuous quality improvement.
Guidelines for certification using the research pathway are available in Research Pathway.
Information for Candidates Certified by Other Boards
The policy information above applies only to ABIM diplomates, or those from a Qualifying Board, who are seeking admission to the Hospice & Palliative Medicine Certification Examination via ABIM. Candidates from co-sponsoring boards should contact their primary certification boards with any questions regarding certification policies or eligibility to apply for admission to the examination.