The rapid growth of palliative care in the USA has been markedly slowed by restrictions and changes in funding. Despite this, a census in 1989 showed that nearly 200 000 patients were being cared for by hospice programmes employing nearly 20 000 staff in paid positions. Programmes have had to adapt to altered funding requirements. The greatest remaining problem is physicians' ignorance of the specialty of hospice/palliative medicine. The ignorance can be overcome by establishing palliative care as a medical subspecialty (as in the UK) and introducing it into the curricula of medical schools.
