Who Is My Hospice Physician? A Descriptive Study of the US Hospice Medical Director Workforce

In 2024, the Centers for Medicare & Medicaid Services (CMS) began requiring hospices to report their hospice medical director (HMD), enabling the first national study of this workforce.

To 1) characterize the specialty and subspecialty certifications of HMDs; 2) quantify the number with HMD certification; 3) assess the extent to which HMDs serve multiple hospices; and 4) examine the transparency of HMDs on hospice websites.

We queried the 2025 CMS Hospice All Owners file for HMDs. Resulting names were searched in Doximity and other sites to identify training background. Resulting names were also linked to HMD certification data from the Hospice Medical Director Certification Board (HMDCB). Finally, a random sample of 295 hospices was selected for web-based analysis of HMD information.

We identified 2,387 HMDs across 2,914 agencies. Fewer than half of U.S. hospices reported HMDs to CMS. HMDs were certified in 23 specialties, most commonly Internal Medicine (47.6%). HMDs were certified in 28 different subspecialties, including 17.8% (n=424) with certification in Hospice and Palliative Medicine (HPM); 12.6% (n=301) were HMDCB certified. Regarding multi-agency affiliations, 85.0% (n=2,030) served one hospice, 13.2% (n=314) served 2-4 hospices, and 1.8% (n=43) served ≥ 5 hospices (maximum 29). In a 10% random sample (n=295), approximately 88% of hospices did not list their HMD online.

HPM board certification and formal HMD certification were uncommon, raising questions about how physicians are prepared for the clinical and leadership responsibilities of hospice medical directorship.