From The Chair

June 2016

Pieces of the Puzzle

I often hear friends and colleagues in the field of pediatric palliative care talking about where they can find their "professional home" - often with a sense of longing or less-than-complete satisfaction, or even of outright disappointment.

If I may, let me devote this column to first unpacking the notion of a "professional home", then to looking briefly at and gently holding the feelings that give rise to our desire for such a home, and finally for the majority of this column to suggesting how different organizations present opportunities for each of us to put the jigsaw puzzple of our professional lives together over the course of our hopefully long and satisfying careers.

When people talk about a "professional home", they seem to have several related ideas in mind. First, a professional home is an established professional organization. Second, most of your important peers both locally and nationally are members of this organization: the organization enjoys a good reputation within your field, and you can look upon this home as a good place for social networking. Third, the organization provides you with opportunities to advance your career, present your work, make valuable contributions, and assume leadership positions. All of these features help develop and polish the C.V. metrics of your career. Lastly, really to seal the deal, when you go to the meetings sponsored by this organization, you get a warm feeling of support and belonging. You have found your professional home.

Ideally, this organization is so totally awesome you enter into a completely monogamous relationship with this organization and no other. You have no need to travel to other meetings, pay dues to other organizations, or sit through talks or presentations leaving your bored or irritated. You never need to wonder if you are in a professional home relationship with an organization that is less than ideal, or if the grass would somehow be greener elsewhere.

Boy, do I get all of this. When I was starting out in my professional career, I remember, and to this day still feel in different ways, the anxiety and insecurity of whether I would ever have a long and satisfying career. I desired reassurance and encouragement, as well as practical guidance and collaborative help, and looked to many sources to provide these including mentors, senior faculty, peers at my own stage of career development, and professional organizations. As time went by, though, I began to grow a bit more circumspect about my longings. Would I ever feel sufficiently secure about my career to have no anxiety about how the future would unfold? How realistic was it to hope one person or entity could meet all my needs? Perhaps hardest to acknowledge, does my dissatisfaction and lack of fulfillment reflect less on other individuals or organizations, and more on my own insecurities?

I then began to experiment with expecting less, and to my suprise have received more. I started to view my wide range of needs as being a puzzle in need of many different solutions. Sometimes a mentor or organization is not a good fit, and we should move on to find new individuals or organizations more conducive to our career development. Dissatisfaction and lack of fulfillment should not be ignored for long, and sometimes the best solution is an external change. Sometimes talks and presentations really are not that good, and we should walk out... but not always. Sometimes, these feelings are clues to changes the way we relate, and guides to how we might better manage our careers.

For the rest of this column, let me spell out my particular version of how I am jigsaw-puzzling together my own career. As an academic general pediatrician in a hospital-based setting with a school of medicine faculty appointment, I view my career in a particular way. I need to think about the mainstays of how I have been and will continue to be evaluated: the quality of clinical care I provide to my patients and their families; my effectiveness and ratings as a teacher of medical students, residents, fellows, and other trainees; my research scholarship, including number quality of publications and grant support; and how well I serve in the various administrative roles I hold.

I am not a pediatric palliative care nurse, social worker, chaplain, child life specialist, or any of a dozen other professional roles held by my non-physician colleagues devoted to the care of children we serve, and will not discuss professional organizations for those disciplines. Nor am I a pediatrician with expertise in oncology, critical care medicine, or any of numerous other sub-specialties involved in the care of our shared patients, and will not discuss professional organizations for those fields. With these caveats, I would like to discuss several of the organizations relevant to our speciality, begging forgiveness if my views offer slight.

The American Academy of Pediatrics (AAP), and more specifically our Section on Hospice and Palliative Medicine (SOHPM), provides several potential pieces of my own career puzzle. As this column appears in our section's newsletter, I shall consider the Section in some detail. First, the SOHPM listserv provides a community of dialogue and support, with a broad range of uses from clinical calls for suggestions or help to more general discussions or concerns. Is it perfect? No. Is every question or comment pithy and apt, sensible and sensitive? Absolutely not. Having started in this field before there was any such listserv, however, I am very grateful for its existence. Second, the AAP sponsors two large meetings which present different opportunities. The Pediatric Academic Societies (PAS) meeting each spring is where I have long gone to present my research, and I have noticed with great pleasure how the number of offerings in pediatric palliative care research, quality improvement, and educational offerings have grown substantially over the past 3 years. PAS is widely recognized in academic pediatric circles, by both generalists and sub-specialists. The National Convention and Exhibit (NCE) in the fall is an educational extravaganza with many chances to offer educational programs largely intended for general pediatrician audiences. Our SOHPM mounts a special program at the NCE each year, with opportunities to present abstracts regarding case reports, descriptions of novel programs, quality improvement projects, and research findings; abstract prizes are awarded, with particular focus on those early in their careers. The AAP also offers leadershipand legislative advocacy training, which our SOHPM executive committee is working to make more available to members.

The American Academy of Hospice and Palliative Medicine (AAHPM) offers a different set of possibilities. The AAHPM has been crucially important in the formation of hospice and palliative medicine (HPM) as a sub-speciality in all speciality boards, and is the most sensible place to think about training of fellows in HPM, with development of general training standards for medical students and residents. The AAHPM hosts an annual national assembly bringing together the full range of age and specialty in HPM clinical care, research, and quality improvement, affording many opportunities to present findings from one's research, mount workshops, and expand one's HPM horizons beyond the pediatric realm. AAHPM also offers great mentorship, leadership training, and other programs.

The National Hospice and Palliative Care Organization (NHPCO) was one of the foundational organizations of HPM and is similar to AAHPM, but with more emphasis on hospice and community based palliative care. NHPCO offers many of the same things discussed above, as well as a variety of webinars, but seems to me to be closer to the community setting, providing state-level advocacy training that is very important, for example, including HPM in state Medicaid programs.

The Center to Advance Palliative Care (CAPC) has radically advanced the way hospital-based palliative care programs think about the business of providing such care, providing data and a structure of argument in making the business cases for providing palliative care to the general population. While the business case and public awareness campaigns for pediatric palliative care do not translate neatly from the adult world, we have much to learn from CAPC and can do more collaborating with them.

The last entities I would like to mention here are the many non-institutional organizations of small numbers of like-minded caregivers: various ad hoc groups who form their own listserv, or hold special interest sessions, or get together in any way even when the group may be only 2 individuals. Indeed for me most national meetings are in fact a series of small personally organized meetings in quick succession. Such meetings have often been the most valuable contributors to my career and professional satisfaction.

Ultimately, as the field of pediatric palliative care matures, I suspect no single organization will rise to the top, serving as a one-size-fits-all comprehensive provider of all our professional needs. We are far more likely to find increasing specialization of our organizations, and will need to take pieces of what every organization have to offer, cobbling them together and making the best use of each as we progress forward in our individual careers and as a collective field of interdisciplinary colleagues.

Chris Feudtner, MD, PhD, MPH, FAAP

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