They’re often imagined that way: one discipline operates, and the other is called when operating is over. In practice they share a purpose, the relief of suffering, and most of the hardest questions in surgical care. What is this treatment for? What will it ask of the person receiving it? And how do we decide, together, whether it’s worth it?
Palliative care is extra support for anyone living with a serious illness, at any stage, alongside whatever treatment you’re receiving, including surgery. These are the explanations I most often wish I had more time to give at the bedside.
If you or someone you love is living with a serious illness and facing surgery, you can ask for palliative care at any point: before an operation, in the hospital, or during recovery. It doesn’t replace your surgical team. It adds support for symptoms, for hard decisions, and for what matters most to you.
This is general information to help you ask good questions. It isn’t medical advice for your situation; please talk with your own care team.
Palliative care is specialized care focused on relieving the symptoms and stress of serious illness, for patients and for the people around them. It is appropriate at any age and at any stage of a serious illness, and it can be provided alongside treatment aimed at cure, including surgery.
For anyone living with serious illness or injury, at any point: at diagnosis, during treatment, in recovery, or near the end of life. It works alongside surgery, chemotherapy, dialysis, or intensive care rather than replacing them.
A form of palliative care for the last months of life, when the focus has turned to comfort and quality of life rather than treatment aimed at cure. In the United States, hospice generally requires a prognosis of six months or less if the illness follows its expected course.
All hospice care is palliative care; most palliative care is not hospice. Asking for palliative care doesn’t mean stopping treatment or giving up. It adds a layer of support focused on what matters most to the patient.
The two fields are more closely related than their reputations suggest. The term palliative care was coined by a surgeon: Balfour Mount, a urologic cancer surgeon in Montreal, introduced it in 1974 when he founded the palliative care service at the Royal Victoria Hospital (McGill Palliative Care). Surgery also carries its own long palliative tradition: operations performed not to cure but to relieve, such as bypassing an obstruction, draining an infection, stabilizing a fracture, or restoring the ability to eat or breathe.
A palliative operation and palliative care are not the same thing, though. One is a procedure. The other is a way of practicing that attends to suffering, prognosis, and the patient’s goals before, during, and after any procedure, including the decision not to operate.
A surgical resident on Instagram was recently surprised to learn that surgeons can train in hospice and palliative medicine. Nothing had been missed for lack of looking. The possibility had simply never been presented. That is a different kind of educational gap from the ones we usually discuss. It isn’t about what we teach. It’s about which futures we make visible, and it belongs to the same family of questions as the hidden curriculum.
Palliative care isn’t simply what happens when surgical treatment ends. It can be integral to determining whether, when, and how we operate.
Palliative principles also inform how we communicate, manage symptoms, navigate uncertainty, and understand what patients hope to accomplish through treatment. This part of the page covers where palliative care shows up in surgical care, how I came to it, and the different ways surgeons can build palliative expertise into their work.
Surgical patients face some of medicine’s most consequential decisions, often quickly, often under uncertainty, and often with families who had no warning. Palliative care shows up across the whole surgical course.
Helping older and seriously ill patients weigh what an operation can realistically offer, including the best case, the worst case, and the most likely recovery, against what they hope to protect.
Sudden, catastrophic injury leaves no time to prepare. Early and honest communication with families, careful prognosis in the first hours and days, and attention to what the patient would have wanted.
Time-limited trials of intensive treatment, regular family meetings, and recognizing when treatments are no longer moving a patient toward goals they would choose.
Prognostic uncertainty, intense pain and symptom burden, and long recoveries make palliative skills essential from the first day, for survivors as much as for patients who will not survive.
Palliative operations for obstruction, bleeding, or pain; decisions about when another operation serves the patient’s goals; and symptom management at every stage.
Older adults living with serious illness who arrive with an acute surgical emergency, often without any prior conversation about their goals, when the decision to operate carries the highest stakes.
None of these requires a fellowship. All of them can be learned, which is the point of the pathways below.
I first found my way to palliative care in medical school at UCSF, inspired by pioneering physicians like Dawn Gross and Steve Pantilat in palliative care, and Louise Aronson in geriatrics. During general surgery residency at the University at Buffalo, I spent a year completing a fellowship in Hospice and Palliative Medicine (2022–2023) before returning to finish surgical training. I wrote about beginning that fellowship, and the belief behind it, in the essay below.
On beginning a fellowship in Hospice and Palliative Medicine, and the lifelong belief that a surgeon’s duty to heal does not end at the operating table.
Dawn, Steve, and Louise have all written books, too: Dawn Gross’s Heart Sounds, Steve Pantilat’s Life After the Diagnosis, and Louise Aronson’s Elderhood and A History of the Present Illness. Dawn’s and Louise’s are also on my Books page.
Today my work sits where these fields meet: clinical surgery, palliative medicine, communication, and education, with longer-term interests in burn care and surgical critical care. There is more of the story on the About page, and in what I’m thinking about now.
Palliative expertise for surgeons isn’t all-or-nothing. Between learning a few communication techniques and completing a full fellowship lies a real spectrum, and different points on it suit different surgeons at different stages of a career.
The skills every surgeon uses: discussing prognosis and goals, managing common symptoms, leading a family meeting, recognizing when to involve a specialist. Strengthened through courses, certificates, mentorship, and practice.
Expertise in complex symptoms, conflict, and care near the end of life, from clinicians with formal Hospice and Palliative Medicine (HPM) training. Subspecialty board certification requires an accredited fellowship.
Most surgeons need the first. Some will want the second. Both are legitimate ways to bring palliative care into surgery, but only accredited fellowship training leads to subspecialty board eligibility. A certificate or master’s degree, on its own, does not.
A course in goals-of-care conversations. One of the most useful trainings I’ve done was VitalTalk’s. It isn’t labeled palliative care, but it is palliative care, and it’s also a set of skills every clinician needs, in every specialty.
See VitalTalk’s current courses for dates and fees.
Residency teaching, palliative care rotations, mentorship from palliative care colleagues, and deliberate practice in family meetings. This is where most surgeons start, and where much of the learning keeps happening.
Short courses in serious-illness communication and symptom management, many offering CME. Examples include VitalTalk’s courses, among them Best Case/Worst Case, a framework developed for conversations about surgery and its alternatives, and the clinical courses of the Center to Advance Palliative Care, mostly available through member organizations.
Structured graduate-level study without leaving practice. The University of Colorado Anschutz Interprofessional Palliative Care Graduate Certificate, for example, is 12 credits, online, and can be completed in about nine months.
Deeper interprofessional training in palliative care. That same certificate’s credits count toward CU Anschutz’s Master of Science in Palliative Care.
A 12-month, ACGME-accredited fellowship. Surgeons can enter after three clinical years of residency, taking a year away from clinical training as I did, or after completing residency. With primary certification from the American Board of Surgery, fellowship graduates can pursue subspecialty certification in HPM; since 2022, surgeons apply for it through the American Board of Internal Medicine.
For physicians who can’t leave a practice, a family, and a community for a year. CU Anschutz’s Community Hospice and Palliative Medicine Fellowship is an ACGME-accredited, part-time, largely online pathway completed over three to four years alongside the Master of Science in Palliative Care, for physicians at least five years beyond residency by the time they finish. Completing both is required for board eligibility. Its participants have included a practicing trauma surgeon and surgical ICU director.
Each step is a complete answer for someone. Few surgeons need all of them.
Programs named here are examples, not endorsements or a complete list. Requirements change: confirm current details with each program, with the American Board of Surgery, and with ABIM before committing. Last checked October 2026.
I’m writing a longer piece for The Listening Surgeon, working title A Palliative Care Training Ladder for Surgeons, on what each of these pathways involves in practice and on the structural barriers that make additional training so hard for surgeons already established in their careers.
It will be linked here when it’s published.
Surgeons who work across these fields arrive by very different routes: a patient, a mentor, a research year, a career already well underway. I’m gathering some of those stories, shared with permission, for this page and the companion article.
If you’re a student or resident wondering whether palliative training could fit into a surgical career, a practicing surgeon weighing a pathway, or someone building surgical palliative care where you work, I’d love to hear from you, and to hear how you found your way here.
How many trainees would choose this path if someone had shown them it existed?