What Physicians Are (Actually) For On Specialist Palliative Care Teams

If you think the physician on a Specialist Palliative Care team is the captain, you’ve already missed the plot. Our role is counter‑cultural: we make space, translate, and selectively intervene—then get out of the way. That’s how teams deliver the outcomes the literature promises.

Why teams, not heroes

Interdisciplinary Palliative Care teams—physician included—consistently improve symptom burden, quality of life, multiple end‑of‑life metrics, and cost of care. Single‑discipline “specialist palliative” and primary palliative care trials have not shown those benefits as reliably.

That claim is not arrogance; it’s truth. Eduardo Bruera’s 2024 editorial frames these outcomes and underscores why hospital and cancer center teams need deliberate interdisciplinary structures led by a trained Palliative Medicine specialist. "Lite" palliative care simply doesn't deliver.

The water we swim in

Medical training (well, all education, but let's stay focused) teaches three curricula: formal (what’s stated), informal (what’s modeled), and hidden (what’s embedded in systems). Physicians absorb messages like perfectionism, saviorism, and submission to hierarchy—which directly conflict with high‑functioning Palliative Care teams.

Haidet & Stein detail how these hidden messages show up as “premises” (e.g., outcome trumps process; uncertainty is to be avoided; hierarchy is necessary) that undermine teamwork and communication. Like all core messages in our psyche, they serve us until they don't.

The palliative care workforce also must face demographic reality: we are predominantly White, female, and mid-career (and we have little-to-no reliable SOGI data). This composition is not incidental—it traces back to the origins of hospice and palliative care as a countercultural movement led by women in a patriarchal medical system. While that maternalistic ethos shaped our discipline’s relational strengths, it also means our teams often lack racial, ethnic, and gender diversity. These gaps matter. They influence whose voices are centered, how cultural humility is practiced, and whether patients from marginalized communities experience trust and equity in care. And they impact which patients are comfortable seeing our teams. Acknowledging this imbalance is not about blame; it’s about responsibility—building pathways to teams that look more like the populations we serve and dismantling structural barriers that keep our field homogenous.

What the physician is for

Here’s the physician’s job on a Specialist Palliative Care team—stripped of heroics:

1. Speak “physician‑ese” across the hospital and broker decisions: Translate prognosis, risk, and trade‑offs into the dialect primary teams trust, while protecting team voices (PharmD, LCSW, Chaplain, NP/PA) that actually solve the patient’s problems. Shared leadership models expect the appointed “leader” to be treated as a peer and cede situational leadership to the person with the relevant expertise.
2. Take the complex cases that truly require physician intervention: Not everything is a doctor problem. When it is—refractory symptoms, gnarly pharmacology, high‑stakes prognostication, safety concerns—step in decisively. Then step out. That “give the work back” stance is straight from adaptive leadership: keep distress tolerable, focus attention, and mobilize rather than control.
3. Guard the process as much as the outcome: If you privilege speed and hierarchy over process, you kill team learning. Edmondson’s “teaming”—teamwork on the fly—requires psychological safety, explicit purpose, and transparent reasoning. In hospitals, our teams form and reform daily; process discipline is not optional.
4. Model uncertainty with competence: Admit what is unknown and make your inferences visible. Use the Ladder of Inference: surface the data you’re selecting, the meanings you’re assigning, and the conclusions you’re drawing—then invite challenge. It’s the fastest way to short‑circuit unnecessary, unhealthy conflict.

Frames to keep teams sane

• The stages of team development are critical: Forming, Storming, Norming, Performing, Adjourning. Know which stage you’re in, and tailor leadership behaviors accordingly—normalize conflict in Storming; give decisions back to the group in Performing; close the loop in Adjourning.
• Teaming beats static “team” rigidity: In the hospital, you rarely get stable membership. Work like a jazz ensemble with clear purpose, crisp boundaries, and constant learning. (Bonus points: the ACGME is all about teaming lately.)
• Adaptive leadership > control: Distinguish technical from adaptive problems. Most Palliative Care challenges are adaptive—values, trade‑offs, identity, family systems—so mobilize the team and the system rather than offering lone‑expert fixes.

What to stop doing

• Stop getting in the way of the experts around you: When the PharmD can manage methadone rotations, don’t dabble—amplify. If the LCSW is leading family systems work, don’t re‑frame it as “medical” to control it. Shared leadership means you are situationally dependent on others.
• Stop rewarding speed over process: Your “decisive” pronouncement might feel efficient; it usually suppresses input and worsens care. Psychological safety and structured inquiry are not indulgences.
• Stop talking about "your" team: palliative care folks love to talk about how "words matter," but often fail to examine their non-clinical word choices. The Fellow on the team (or the NP, or the Chaplain) are not "yours." And, while I'm on this soap box, you're not on the team, you're a part of it. Flatten and share.

Where the physician adds unique value

• Struggle to translate those palliative concepts back to other physicians, speak Physician-ese. Join me in trying (and generally failing) to explain the relevance of relational autonomy and strong objectivity to your well-meaning, neighborhood Cardiologist.
• Complex symptom therapeutics and risk management: Opioid rotation across renal/hepatic compromise; NMDA‑targeted strategies; co‑morbid delirium; QT‑risk polypharmacy; anticoagulation trade‑offs; device deactivation. That’s squarely physician work, in collaboration.
• Prognostication that aligns decisions with reality: We're not seeking clairvoyance, but disciplined uncertainty. Then convert that into goals‑aligned action with the team.
• Systems navigation at 30,000 feet: We see bed flow, consult triggers, policy constraints, and safety signals. Use that vantage to remove barriers so the team can do the work.
• Teach those rotating medical students, residents, and fellows by actively leading away from the hidden curriculum. Set an expectation that they learn from and defer to the other experts on the team.

The workforce reality check

We are staring at an enormous “workforce valley”—a projected decline in specialty Palliative Care physicians until ~2045 without policy change. The fix is not one more heroic physician; it’s sustained fellowship growth, payment reform, and robust interprofessional teams. Plan accordingly.

Bottom line

On Specialist Palliative Care teams, physicians are most useful when we do three things well: translate, intervene on true physician problems, and protect the team’s learning. If we default to hierarchy, perfectionism, and saviorism, we sabotage the outcomes we claim to value. The work is shared. Act like it.