The Hospice and Palliative Medicine Physicians Certification Programs across Countries/Regions

Abstract

As the demand for end-of-life care increases, the development of a well-structured training and certification system for palliative medicine specialists is becoming increasingly important. In South Korea, a certification system for palliative care physicians has been in place since 2019, managed by the Korean Society for Hospice and Palliative Care. To further develop this certification system and training process, this review aims to describe hospice and palliative medicine certification programs across eight countries/regions—the United States, the United Kingdom, Australia, Japan, Taiwan, Hong Kong, and South Korea—to identify key differences and draw insights for enhancing Korea's physician training and certification system. Most countries/regions recognize hospice and palliative medicine as medical subspecialty and provide standardized training and certification pathways. Training durations range from 1-year fellowships to multiyear structured programs with clinical experience. Japan’s tiered certification system offers a flexible approach based on care settings and physicians’ expertise. However, Korea’s system lacks in-depth clinical experience and government recognition, limiting its sustainability. To strengthen palliative care in Korea, it is essential to enhance training duration, expand clinical exposure, and foster multispecialty collaboration. A tiered certification system adapted to Korea’s healthcare environment and supported by government policy could improve both the quality and reach of palliative care services. These findings can inform future policy and educational reforms to ensure more effective and sustainable training of palliative care professionals in Korea.

INTRODUCTION

Hospice palliative care is a specialized medical field aimed at improving the quality of life of patients with terminal diseases and helping both patients and their families receive dignified care.

Therefore, cultivating palliative care specialists with expertise in this field is a highly important task at both national and societal levels. In response to these societal and professional demands, there is a need to strengthen the competencies of healthcare professionals in the field of end-of-life care and to establish competency standards [1]. Particularly, it is essential to officially recognize hospice and palliative medicine as a medical specialty for physicians [2].

Certification systems serve several key purposes across all medical fields. These include ensuring high-quality patient care, defining the minimum competencies a physician must possess in the field, and adapting to ongoing advancements in knowledge and evidence [3]. Many countries/regions have introduced hospice and palliative medicine specialist certification systems to encourage more physicians to enter the field and provide the necessary expertise [4]. However, certification structures, procedures, and training periods differ between countries and regions.

Several models are available for certifying medical professionals. One approach involves designing a dedicated training program for the field and awarding a specialist qualification upon successful completion. Another approach involves physicians working in related specialties completing additional palliative medicine education before receiving certification. In such cases, certification may be designated as a subspecialty or specific competency area [5].

The Korean Society for Hospice and Palliative Care (KSHPC) implemented a palliative care certification system in 2019, granting palliative care certification to physicians who complete prescribed education and pass the exams administered by the society, with renewal available every 5 years upon meeting certain qualifications [6].

Now, after five years, it is time to reflect on and further develop this certification system and training process. Therefore, this paper describes hospice and palliative care certification programs in eight countries/regions—the United States, the United Kingdom, Australia, Korea, Japan, Taiwan, and Hong Kong—where palliative care is actively practiced. Based on this comparison, this paper aims to explore the direction for the development of Korea’s hospice palliative care training system and propose more effective and sustainable strategies for cultivating palliative care professionals, considering Korea’s healthcare environment and characteristics.

CURRENT CERTIFICATION PROGRAMS ACROSS COUNTRIES/REGIONS

1. United States (USA)

Hospice and Palliative Medicine was recognized as a medical subspecialty in 2008. A 1-year accredited fellowship in palliative care is required for board certification [7]. Physicians must first complete a primary specialty, such as internal medicine or family medicine, before specializing in palliative medicine. A typical palliative medicine fellowship program comprises rotations in an inpatient palliative care consultation team, outpatient palliative care, acute palliative care units (if available), inpatient hospice care, home hospice care, pediatric palliative care, and several electives. Fellows are also required to participate in quality improvement or research projects.

Board certification is granted upon passing a specialized exam in Hospice and Palliative Medicine, which was first offered in 2008. The American Board of Internal Medicine is responsible for administering the examinations. The hospice and palliative medicine certification program is co-sponsored by the American Boards 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 (ABP) [7]. 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 [7].

To maintain certification, physicians must meet annual continuing medical education (CME) requirements (100 points every 5 years) and either pass a Maintenance of Certification exam every 10 years or participate in the Longitudinal Knowledge Assessment pathway.

2. United Kingdom (UK)

Palliative Medicine is recognized as an independent specialty in the United Kingdom, with certification overseen by the Royal College of Physicians (RCP). Specialty training was first introduced in 2010. Entry into palliative medicine training is possible after the successful completion of a 3-year Internal Medicine Stage 1 training program [8].

Physicians must then complete a 4-year specialist training program in palliative medicine, undertaken alongside Internal Medicine Stage 2 training. This program includes diverse clinical settings, such as patients’ homes, emergency departments, hospices, acute hospital wards, and specialist hospital units (e.g., oncology and renal units). To meet curriculum requirements, trainees may spend up to 12 months in relevant internal medicine rotations (e.g., geriatric medicine), including participation in acute unselected medical takes [8].

Upon completion, they are awarded a Certificate of Completion of Training (CCT), qualifying them as palliative medicine specialists. Trainees typically undertake a Specialty Certificate Examination in palliative medicine during the penultimate year of specialty training. Members of the Royal Colleges of Physicians are responsible for administering the examinations [8].

Palliative medicine specialists, like other specialists, must undergo General Medical Council (GMC) revalidation every 5 years, along with an annual appraisal of their continuing professional development (CPD) activities [9].

3. Australia

Palliative Medicine has been recognized as a medical specialty in Australia since 2005. The Australasian Chapter of Palliative Medicine (AChPM), within the Royal Australasian College of Physicians (RACP), is responsible for accreditation and advanced training. To enter the advanced training program, candidates must hold current medical registration, be appointed to an approved training position, and either have completed 36 months of RACP Basic Training (including examinations) or be fellows of another recognized medical college, such as the Royal Australian College of General Practitioners [10].

The advanced training program spans 3 years of full-time equivalent training, including 24 months of core training and 12 months of non-core training. Core components include specialist palliative care inpatient units, community settings, teaching hospitals, and cancer care. Non-core components include related specialties and elective training. Trainees must also complete a research project, a case study, and several required online modules. Trainees who began training in 2023 or later must complete a cultural competence course. A workshop on communication skills is recommended [10].

After completing all requirements and receiving approval from the Training Committee, trainees may apply for Fellowship of the RACP and/or Fellowship of the Australasian Chapter of Palliative Medicine, depending on their entry pathway. To maintain specialist status, physicians must complete 50 h of CPD (Continuing Professional Development) annually [11].

4. Japan

In Japan, palliative care is not recognized as an independent specialty; however, additional certification is provided by the Japanese Society for Palliative Medicine (JSPM). Physicians from various fields, such as internal medicine, surgery, and anesthesiology, are required to complete at least 2 years of additional palliative care training at accredited institutions. Certified palliative care specialists are expected to participate in clinical practice, counseling activities, education and training, and clinical research [12].

Training to become a palliative care specialist in Japan requires experience in diverse environments. Specialized palliative care services in Japan are primarily provided through palliative care wards, palliative care teams, specialized outpatient clinics, and home-based palliative care. Although cancer remains the primary focus, palliative care specialists must accumulate clinical experience across various settings, and training in palliative care for noncancerous diseases is also required [13].

JSPM recently (November 2023) restructured its certification system into three levels in an effort to enhance the quality and accessibility of palliative care. The new certification system consists of a JSPM-Certified Physician, Certified Diplomate, and Certified Faculty (Table 1). To renew certification, certified physicians must earn at least 30 points, while, Certified Diplomate, and Certified Faculty must earn at least 50 points within the 5 years prior to renewal, including attendance at a minimum of one academic conference and one certification seminar [13].

Table 1.

The Three Tiers of Certification Offered by the Japanese Society for Palliative Medicine.

Certification level	Requirements	Roles & responsibilities
Certified physician	- Minimum 7 years of clinical experience - At least 6 months managing ≥50 palliative care patients - Submission of 5 case reports - Attendance at JSPM seminars and meetings - Completion of training course - Written exam	Provide fundamental clinical palliative care services
Certified diplomate	- Minimum 5 years of palliative care experience - 2 years of training at an accredited institution - Submission of 20 case reports - Academic contributions - Seminar attendance - Written and oral exams	Mentor and supervise trainees, support clinical practice, maintain care quality in palliative care settings
Certified faculty	- Must hold diplomate certification - Experience publishing research or mentoring others - Completion of a JSPM training course - Involvement in ≥2 educational activities	Oversee training programs, manage curricula, supervise trainee education, guide clinical research

5. Taiwan

Since 2001, the Taiwan Academy of Hospice and Palliative Medicine (TAHPM) has overseen the certification and education of palliative care specialists [14]. Physicians first complete training in primary specialties such as internal medicine, family medicine, or oncology and obtain specialist qualifications in these fields. They must then undergo additional specialized training through hospice and palliative care fellowships. Physicians who complete the required training and pass the certification exam can become certified palliative care specialists [15].

As part of the certification training, physicians must complete 3 months of clinical training at an accredited training hospital and participate in the official educational programs provided by TAHPM [15]. TAHPM collaborates closely with the Taiwan Association of Hospice Palliative Nursing (TAHPN) to support hospice and palliative care education and training programs. As part of these specialized educational courses, physicians must complete over 80 h of hospice and palliative care lectures and clinical practice [15].

After fulfilling all education and training requirements, physicians must pass a certification exam to be recognized as palliative care specialists in Taiwan. Approximately 70% of certified palliative care specialists in Taiwan are family medicine specialists. To maintain certification, physicians are required to obtain 120 CME credits over a 6-year period [16].

6. Hong Kong

Palliative Medicine was first established as a specialty under the Hong Kong College of Physicians (HKCP) in 1998 and later under the Hong Kong College of Radiologists (HKCR) in 2002. Both colleges are constituent specialty colleges of the Hong Kong Academy of Medicine (HKAM). Moreover, their training programs are recognized by the Medical Council of Hong Kong for specialist registration in palliative medicine (MCHK) [17].

The HKCP training program comprises 3 years of accredited, structured basic training in internal medicine, followed by 3 years of supervised, accredited training in palliative medicine. To qualify for specialist certification, trainees must complete at least one dissertation and pass the exit assessment [18]. The HKCR training program consists of 4 years of accredited structured basic training in Clinical Oncology, followed by 4 years of supervised, accredited training in palliative medicine alongside clinical oncology. Trainees must complete a dissertation and pass the Palliative Medicine Board Examination for specialist certification [19]. To maintain specialist registration with the Medical Council of Hong Kong, certified specialists are required to accumulate a minimum of 90 CME points every 3 years and meet other college-specific requirements [20].

Other specialties are interested in palliative medicine but face challenges because of the lack of trainers within their respective fields. Currently, the Family Medicine community is organizing an intermediate-level palliative medicine training program for its fellows and trainees and inviting palliative medicine specialists to provide the training.

7. Singapore

Palliative Medicine has been recognized as a medical subspecialty in Singapore since 2006. The training program is accredited by the Joint Committee on Specialist Training (JCST) under the Specialist Accreditation Board. Physicians from base specialties, such as internal medicine, geriatric medicine, oncology, pediatrics, and family medicine, enter a 2- or 3-year advanced training program, which includes rotations across hospitals, hospices, and home care services. Elective posts may include oncology, ICU, pain medicine, and psychiatry [21].

Trainees must complete supervised clinical training, maintain a logbook, submit case reports, and pass a summative exit exam. As of July 2024, Singapore’s advanced palliative medicine training has transitioned to the Accreditation of Postgraduate Medical Education Singapore (APMES) model. The new palliative medicine residency retains the core structure of diverse clinical rotations. However, it incorporates a modernized assessment framework emphasizing Entrustable Professional Activities (EPAs), enhanced viva voce stations, and a summative portfolio evaluation. To maintain certification, specialists must attend at least four peer-review sessions annually [22].

Physicians without formal subspecialty training may also work in palliative care after completing shorter programs such as 3-day certificate courses and the Graduate Diploma in Palliative Medicine, a 1-year part-time program offered by the National University of Singapore [21].

8. South Korea

In South Korea, palliative care is not recognized as a specialty by the government, but operates under a certification system managed by the KSHPC. The KSHPC oversees the certification process, which includes educational programs, workshops, and certification exams [6].

To become a KSHPC-certified physician, applicants must hold a specialist qualification in a primary specialty and have at least 2 years of experience treating terminally ill patients or at least 1 year of working at a hospice institution designated by the Ministry of Health and Welfare. To obtain certification, applicants must complete at least 18 h of training approved by the KSHPC and pass the certification exam [6]. The training required for certification may be replaced by a standardized education program for healthcare professionals at designated hospice and palliative care institutions, implemented by the National Hospice Center under the authority of the Ministry of Health and Welfare [23]. Maintaining certification requires earning a minimum of 30 CME points every 5 years.

Physicians working at designated hospice institutions must complete mandatory training organized by the Ministry of Health and Welfare. This training includes theoretical lectures (online), practical education (offline), and additional training (home-based care, counseling, and pediatric care). To maintain certification, physicians must complete at least 4 h of continuing education annually, as approved by the Korean Medical Association [23].

Under these regulations, South Korea implemented a palliative care certification system in 2019, with many of the certified physicians coming from family medicine and oncology backgrounds. From 2019 until the present (as of March 2025), 185 physicians have received certification, and currently, 134 certified physicians remain valid, including those who have completed their renewals.

DISCUSSION

This paper describes palliative medicine training programs across various countries/regions and explores future directions for training palliative medicine specialists or certified physicians in Korea (Table 2).

Table 2.

Comparison of the Hospice and Palliative Medicine Certification Programs across Countries/Regions.

Country/ Region	National board certification	Certification authority	Training duration	Certification maintenance	Strengths(S), Weaknesses(W), and Future Direction(F)
United States	Yes (Subspecialty)	ABIM, ABA, ABEM, ABFM, ABP	1 yr	100 CME/5 yrs or Certification exam/10 yrs or participate in the LKAP	(S) Well-established clinical practice of specialized cancer palliative care. (S) High-quality training across various settings. (S) Participation of research project. (W) Few research fellowships available. (F) Development of more research fellowships available in the USA to train future generations of academic palliative care clinicians is needed.
United Kingdom	Yes (Independent specialty)	Royal College of Physicians	4 yrs	CPD/5 yrs	(S) Robust clinical practice in both cancer and non-cancer palliative care. (S) High-quality training across various settings. (W) A long time to complete training.
Australia*	Yes (Independent specialty)	AChPM, within the RACP	3 yrs	CPD 50 h/yr	(S) Robust clinical practice in both cancer and non-cancer palliative care. (S) High-quality training across various settings. (S) Completion of research project. (W) A long time to complete training. (W) There is a shortage of palliative medicine physicians.
Japan	No	JSPM	6 months(CP) to 2 yrs(CD)	CP: 30 CME and the Certification Renewal Exam/5 yrs; CD and CF: 50 CME/5 yrs	(S) A three-tier certification system to enhance the quality and accessibility of palliative care. (W) Relatively short training duration. (F) Limited experience in non-cancer cases. (F) Need for formal specialty recognition. (F) Faculty development in soft skills, research, and teaching required.
Taiwan	Yes (Subspecialty)	TAHPM	3 months	120 CME/6 yrs	(S) Robust clinical practice in both cancer and non-cancer palliative care. (S) Government support including policy and reimbursement. (W) Short training duration. (W) Limited engagement of certified specialists in actual practice.
Hong Kong	Yes (Subspecialty)	HKCP/HKCR	4 years	90 CME/3 yrs	(S) Well-established cancer & non-cancer palliative care practice. (W) Long training duration. (W) Limited eligibility (only oncology trainees) and Educational needs of non-specialists unmet. (W) Need for collaboration (among regulatory, academic and professional bodies) for broader education.
Singapore	Yes (Subspecialty)	JCST under the SAB	2~3 years	At least, 4 peer-review sessions/yr	(S) Robust clinical practice in both cancer and non-cancer palliative care. (S) High-quality training across various settings. (S) Adoption of a modern APMES model in July 2024, incorporating diverse rotations and EPAs-based assessment.
South Korea	No	KSHPC	≥1~2 years hospice experience + 18 h education by KSHPC or 60 h education by NHC	CME 30/5 yrs	(W) Lack of structured clinical practice training. (W) Expertise in non-cancer palliative care remains limited because of insufficient case experience.

Except for Japan, most countries/regions recognize palliative medicine as a subspecialty and have adopted national certification systems, albeit with varying training and certification requirements. Although Japan does not have a nationally recognized palliative medicine specialist system, it has implemented a structured certification framework with clearly defined requirements. Notably, Japan differentiates palliative medicine specialists based on their level of expertise and care settings, providing a model that could inform Korea’s approach.

As international examples demonstrate, the advancement of palliative medicine expertise requires a structured training framework, well-defined certification criteria, and continuous professional development programs. Since 2019, Korea has operated a certified physician system. However, as it remains a society-led initiative rather than a government-recognized specialty, it lacks financial incentives, formal recognition, and policy support. The absence of such recognition, coupled with Korea’s ongoing medical workforce crisis [24], has contributed to a steady decline in the number of applicants and recertifying physicians. Given Korea’s current medical system and policy landscape, a more robust and sustainable approach to training and continuing education in palliative medicine is urgently required.

The certification program administered by the KSHPC mandates a minimum of 1 year of clinical experience in hospice and palliative medicine, with the submission of relevant documentation. However, the accurate verification of such clinical experiences remains a significant challenge.

Even in the United States, where a 1-year fellowship in palliative medicine is required, concerns have been raised regarding the adequacy of training duration. Therefore, in addition to a well-structured and comprehensive curriculum, an adequate duration of practical clinical training is essential. However, further research is required to determine the appropriate training duration.

The growing interest in end-of-life care in South Korea has led to the publication of several policy reports, including the Development of a Community-Based End-of-Life Care Model [25], the Current Status and Challenges of Promoting a Well-Dying Culture [26], and Trends and Challenges in Well-Dying Discussions for Future Societal Preparedness [27]. These reports highlight the emergence of primary care-based home healthcare and end-of-life care services, underscoring the urgent need for palliative care education within primary care in South Korea.

Japan’s recently revised certification system, which differentiates the roles of palliative care education and certified specialists according to the level of care within local communities and healthcare institutions, presents a policy model that aligns well with national healthcare objectives. Similar models have been proposed in previous studies [28,29], emphasizing the structured development of primary, secondary, and tertiary palliative care education. Therefore, adopting a similarly tiered certification system in Korea could serve as an effective approach for strengthening palliative care education. Government support and collaboration are essential for the successful implementation and sustainability of such certification programs.

To establish a well-structured palliative medicine certification system, South Korea should build on the experiences gained from the certification programs of various countries that are currently in operation. Several key steps must be considered to achieve this goal.

• Interdisciplinary Collaboration: Multiple specialties involved in palliative care, including cancer-related and non-cancer palliative medicine as well as pediatric palliative care, should collaborate to develop an integrated training curriculum.

• Standardization and Expansion of Education and Training: Education should be standardized, and training should include more structured clinical rotations with modules covering various care settings and non-cancer palliative care.

• Expansion of Training Hospitals: Training hospitals should play a more active role in providing diverse clinical experience and ensuring that trainees are exposed to a broad spectrum of palliative care patients.

• Sustained Professional Development: Continuous education and research opportunities should be provided to enhance the expertise of palliative medicine specialists and support the development of optimal patient-centered care models.

Ultimately, this process should lead to the establishment of a government-recognized subspecialty certification system, ensuring a stable framework for training high-quality palliative care professionals. However, considering that countries/regions such as the United States, Australia, and Japan are also experiencing a shortage of palliative care specialists [10,30,31], it is essential to design a system that supports, rather than hinders, the development of palliative care professionals in Korea.

This paper is limited in that it focuses on the current status of specialist certification systems in selected countries/regions without sufficiently addressing implementation challenges or ongoing policy developments. Future research should include a deeper qualitative analysis and review of policy processes.

CONCLUSION

In conclusion, the system for training palliative medicine specialists in Korea should be designed by referencing the systems of various countries and regions while fully considering Korea’s healthcare delivery system, legal restrictions on hospice and palliative care institutions, absence of a structured training system, lack of policy incentives, shortage of palliative care professionals, and the sociocultural context surrounding palliative care. In particular, expanding training capacity is essential to meet the increasing societal demand. This system should not merely serve as a barrier to entry but rather establish a structured, quality-assured, and quantitatively adequate certification framework that aligns with the characteristics of different stages of medical care. This approach will facilitate broader access to high-quality palliative care services for patients and their families. This paper seeks to contribute to ongoing policy discussions intended to improve the training and certification systems for palliative medicine specialists in Korea.