Hospice and Palliative Medicine Fellowship

Lincoln Palliative Care Services

Our Palliative Care service is an interdisciplinary team providing supportive care to patients and families living with advanced illness. We focus on pain and symptom management, goals of care, directives, and advance care planning — preventing and relieving suffering and supporting the best possible quality of life regardless of the stage of disease or the need for other therapies.

Within NYC Health + Hospitals, Lincoln is among the top providers of palliative care. The consultation service has been active since 2004 and sees more than 1,000 inpatients a year, with 800+ ambulatory visits. The fellowship is fully accredited by the ACGME, and the program is certified by The Joint Commission as an Advanced Palliative Care Program.

Schedule and rotations

Teaching combines patient-based encounters, clinical case discussion, and a rich didactic schedule. Every patient encounter includes a detailed discussion with an attending physician or supervising provider, and conferences use a patient-based approach that integrates pathophysiology with clinical presentation and evidence-based management.

• Inpatient consultation service — Monday to Friday, 8 am–4 pm
• Outpatient ambulatory clinic — Tuesdays and Fridays, 9 am–12 pm, 9A Cancer Center

Didactic sessions

• Multidisciplinary Solid Tumor Board — Wednesdays, 8 am (2C3-578): subspecialty-led discussion of cancer cases, diagnosis, treatment, and prognosis.
• Interdisciplinary Team (IDT) and Bereavement Rounds — Wednesdays, 9:30 am (5C192): case discussion with all team members, plan-of-care development, nursing, pastoral care, social work, and hospice referrals; bereavement support and condolence card signing.
• Morbidity and Mortality Conference — Wednesdays, 10 am (5C192), quarterly, led by fellows.
• Lecture series — Thursdays, 10 am (5C192): pain and symptom management, prognostication and treatment of advanced illness, communication, hospice referral, bioethics, and medical humanities. Fellows run a quarterly journal club.
• Self-Care Rounds — alternating first Thursdays, 1 pm, with the Lincoln Hospital Wellness Team.
• Grand Rounds — weekly adult and pediatric grand rounds in collaboration with Weill Cornell Medical College.
• LiveOnNY Clinical Case Collaboration Series — interdisciplinary case conference with the local organ procurement organization across Health + Hospitals sites.
• CAPC curriculum review and board review (monthly); research and quality improvement meetings (quarterly); Palliative Care Committee (quarterly); Ethics Committee (semi-annual).

The one-year fellowship

Inpatient consultation service (minimum 6 months). Fellows see a diverse population with significant psychosocial, supportive, and symptom-management needs. Consults come from across the institution — medical and surgical floors, ICUs, the emergency department, and inpatient pediatrics — for patients with advanced and life-threatening illness across cardiology, pulmonology, infectious disease, oncology, hematology, neurology, nephrology, geriatrics, surgery, trauma, rheumatology, and gastroenterology. Fellows manage pain, dyspnea, nausea, delirium, and terminal agitation; lead complex family meetings; complete health care proxy documents; discuss advance directives and resuscitation preferences; and gain thorough experience with withdrawal of life-sustaining treatment under institutional protocols. They learn the acute management of palliative emergencies (spinal cord compression, brain metastases, SVC syndrome, malignant bowel obstruction), rotate through pediatrics for pediatric palliative care including sickle cell pain management, participate in Ethics Committee meetings and consultations, provide bereavement therapy with the interdisciplinary team, and lead journal clubs and M&M conferences.

Ambulatory care experience. Lincoln’s well-established palliative care clinic expands access for patients with advanced, debilitating illness — advanced heart failure, cancer, neurodegenerative disease, advanced lung disease, and end-stage renal and liver failure. The fellow’s clinic experience is longitudinal across the year, following patients from inpatient consultation through clinic and eventually hospice referral, under one-on-one attending mentorship with social work and nursing support. Fellows master opioid initiation, titration, and rotation; non-opioid management of acute and chronic pain; and the management of fatigue, anxiety, nausea, pruritus, hiccups, spasms, depression, and constipation, together with patient and family education, goals-of-care conversations, and delivering difficult news.

Long-term care (minimum 4 weeks) at the Elizabeth Seton Pediatric Center, rounding with Dr. Alvin Moyer and the interdisciplinary team, addressing symptom control, goals of care, surrogacy, and advance directives, and presenting on a pediatric palliative care topic.

Hospice care (10 weeks) with the VNS Health Home Hospice program, including a minimum of 25 home visits, work with hospice liaisons and inpatient hospice units, a case log reviewed as clinical vignettes, and collaboration with the hospice bereavement program. Interested fellows can rotate at Harlem Hospital with VNS Health to learn hospice administration and the role of hospice medical director.

Electives (6 weeks) — 2–4 weeks of chronic pain and palliative care consultation at Harlem Hospital, plus options in oncology, geriatrics, developmental pediatrics, addiction medicine, anesthesia pain management, hospitalist medicine, PM&R, critical care, cardiology, or research.

Vacation — 4 weeks.