Palliative Care Director - Michael Nisco
Michael Nisco, MD, MBA, DABFP, DABHPM Director of the Hospice & Palliative Medicine Fellowship Program for UC San Francisco Medical School, Fresno, CA Medical Director, Saint Agnes Medical Center Hospice & Palliative Care Services, Fresno, CA
Serving as one of the board of directors of the NHPCO this past year has been a great honor. I am so privileged to be working with so many amazing people, all amazing advocates for improving hospice and end of life care.
My path to becoming a physician specialist in hospice and palliative medicine began with my mom’s inspiration. As a nurse my mother’s career during her life inspired me to choose a career in medicine. It was her death that moved me to become a hospice physician. Following her death, and with the encouragement of my wife, I stopped mid-career and became a trainee again at one of the first programs accredited by the American Academy of Hospice and Palliative Medicine, The Harvard Center for Palliative Care.
When I left Boston and first arrived in California’s Central Valley, I experienced an amount of culture shock that was every bit as remarkable as what I had experience during the 5 years I spent practicing medicine in China. Boston was a community rich in resources, with many palliative medicine specialists who collaborated with each other and with hospice agencies to provide a full continuum of palliative care services to the community. Fresno however didn’t have a single hospital or hospice agency with a palliative care specialist. In fact, I quickly discovered that I was the only full-time fellowship-trained palliative care specialist in California’s Central Valley region. I also discovered that while this is a rich agricultural area full of wonderful diversity and culture, it also suffers from being the most impoverished region in The United States.
Since coming to Central California, I have worked with several local hospices and medical centers to develop palliative care services, and to integrate hospice into the hospitals’ cultures. The hospitals are all very different; an academic teaching hospital, a county hospital, a state-funded district hospital, a nonprofit Catholic hospital. The different cultures necessitated very different approaches to palliative care team implementation, building on the strengths of each facility. By partnering with a hospice and a hospital administrator co-lead at each location, we successfully implemented palliative care teams at each of the hospitals, which now collectively see more than 3,000 new patients/year.
Since there was such a shortage of palliative medicine physicians in the region, I also worked with UCSF Medical School to successfully implement an accredited palliative care physician fellowship training program. As the director of this fellowship program, I have been training fellows for the past four years, all of which now continue to practice in the Central Valley.
I have also served as the president of the Central Valley Coalition for Compassionate Care, which is collaboration between hospices, home health and palliative care agencies to improve awareness and education of end of life issues for the California Central Valley region. On the national level, I serve on the AAHPM international and communities committees, and on the NHPCO ethics committee and education committee for the 2011 MLC. My international involvement includes serving as the official ambassador to China for the International Association for Hospice and Palliative Care.
In recent years, our national hospice community has experienced increasing regulatory, financial and political pressures. In the years ahead, we are facing many serious challenges such as a looming physician and nursing shortage, an overhaul of the Medicare system, increased regulation of hospice services and DEA scrutiny of opioid use among others.
As a Spanish, and Chinese speaking physician practicing in the most underserved region of the country, I will bring an insightful sense of diversity and be a strong voice for the underserved. I have a very successful track record of bridging differences, such as those that exist between hospices and hospitals, physicians and nurses, health care providers and administrators and between people of different cultures. The diversity of my experiences have given me an excellent understanding of the clinical, administrative, and relevant political issues to successfully represent the perspective of palliative care as well as all hospice providers.
It would be an honor to be elected to continue to serve as a board member for the NHPCO.