Inside the Launch of The Surgical Palliative Care Society

After more than a decade practicing surgery, Pringl Miller, MD, FACS, noticed a change in her patients.

Dr. Miller began seeing older and sicker patients, people who required more urgent decision making and symptom management.

“With my patients’ needs shifting, I moved into acute care surgery, but I felt a gap in my ability to provide the advanced communication and supportive care my patients needed,” Dr. Miller said. “As a surgeon, I always aim to mitigate suffering, but these efforts often center on technical skills, not words or touch.”

Dr. Miller took action. In 2016, she entered a one-year fellowship in hospice and palliative medicine at University of Chicago Medicine.

“I thought to myself, ‘This will be amazing. I’m going to be a better surgeon and have job offers left and right,’” she said.

But, after completing the fellowship in 2017, no such offers materialized. In fact, no jobs combining surgery and palliative care seemed to exist. Dr. Miller was shocked at the lack of opportunities to marry these specialties.

Melissa Red Hoffman, MD, ND, FACS, also encountered few professional opportunities to combine the two disciplines.

“When I first became interested in palliative care as a young surgical resident, I wasn’t sure where to turn,” said Dr. Hoffman, an acute care surgeon with fellowship training in hospice and palliative medicine, in Asheville, N.C. “I struggled with finding mentorship and often felt out of step with my surgical colleagues. I really wanted to create a space where surgeons could also be palliative care providers.”

In May 2021, Drs. Miller and Hoffman, along with Buddy Marterre, MD, made a big move toward that goal. The three surgeons launched the Surgical Palliative Care Society (SPCS; www.SPCSociety.org), an interdisciplinary professional forum dedicated to “integrating high-quality palliative medicine principles and practices into the care of surgical patients through mentorship, education, research, quality improvement and advocacy.”

Bringing Specialties Together

Despite this surgery–palliative medicine disconnect, the specialties share deep roots. Fifty years ago, Balfour M. Mount, MD, a urologic oncologist, introduced and championed the field of palliative medicine, a specialty that aims to enhance quality of life for patients and families who are facing potentially life-limiting conditions. In the late 1990s, Geoffrey Dunn, MD, and Robert Milch, MD, both general surgeons, brought the concept of palliative medicine to the attention of the American College of Surgeons, and in 2003, the ACS spearheaded a committee dedicated to surgical palliative care (Ann Palliat Med 2015;4[1]:5-9).

Still, palliative care and surgical care rarely intersect in practice. A recent analysis in JAMA Surgery found that although palliative care consultations were “associated with better overall care, communication, and support in the last month of life,” only 3.75% of 95,204 patients undergoing high-risk procedures had a consultation (2020;155[2]:138-146).

Part of this disconnect comes down to the roles both specialties embody.

“How can you hold someone’s hand at the bedside one minute and then put a scalpel to their body the next?” Dr. Miller said. “Making this transition can be jarring.”

The personal losses of Drs. Marterre and Hoffman as teens made this shift from the OR to the bedside more intuitive.

“When I was 16, I held my father’s hand as he died,” Dr. Marterre said. “As a surgeon, I did complex surgeries—liver transplants, Whipples, major liver resections—but always found myself drawn to the bedside of patients facing their final days. I really got to know these patients intimately and found their bravery amazing.”

At 19, Dr. Hoffman’s father was killed while traveling in Cairo. As she pursued a career in medicine, she found herself wanting to bring comfort to families watching their loved ones die.

“I aspired to embody the kind of surgeon who knows how to make difficult decisions in the OR but who can also hold a family’s hand and weep with them when a surgery does not go well,” Dr. Hoffman said. But, she added, every provider will have their own motivation and way of balancing the role of surgeon and palliative care physician.

Another element of the disconnect falls to training. In the United States, only about 90 surgeons possess dual board certification in surgery and hospice and palliative medicine. Drs. Hoffman, Marterre and Miller—all members of this unique group—wanted to bring more clinicians into the palliative care fold.

In October 2019, the surgeons began making plans over a dinner at the ACS Clinical Congress in San Francisco. By the end of the evening, they had decided to form the SPCS.

“Our aim was to bring together a multidisciplinary group of providers, not just surgeons, at all levels of training and collaborate in a way that simply doesn’t exist yet,” Dr. Miller said. “We, as providers, need to support each other in normalizing both high-quality surgical and palliative care in employment opportunities and in daily practice.”

The surgeons envision a group that includes nurses, social workers, chaplains, pharmacists and respiratory therapists. To foster this spirit of inclusivity, the SPCS embraces a nonhierarchical leadership dynamic: no president, just six council members, each with an equal voice.

The surgeons found inspiration for this structure from an unlikely source: honeybees.

Dr. Marterre, a master beekeeper, has spent years watching honeybee colonies at work—thousands of worker bees cooperating to build a nest, find food and raise their young. These colonies organize themselves around swarm intelligence and cooperative behaviors that prioritize the needs of the hive.

“It turns out, if done correctly, this structure is more efficient than a hierarchical one and builds on the principles inherent to palliative care—empathy, active listening and collective decision making,” Dr. Marterre said.

To engage providers, the surgeons plan to host educational webinars and online forums throughout the year, create a mentoring program that bridges the divide between surgery and hospice and palliative medicine. The Society’s first informal gathering will occur on Friday, Aug. 23 at 7 a.m., at the Southeastern Surgical Congress, in Atlanta. Once the American College of Surgeons resumes in-person meetings, the SPCS plans to hold their annual meeting in conjunction with the College’s Clinical Congress every October.

“Momentum towards integrating surgery with palliative medicine is building, as the data proves the patient and family benefit, so we’re hoping to capitalize on this wave of interest,” Dr. Miller said [Am Surg 2020;86(11):1436-1440].

This article is from the July 2021 print issue.