Our Program

Welcome to our program! Living with a serious or advanced disease can be overwhelming for patients and their families. We are committed to training physicians with the knowledge, skills, and compassion to provide outstanding, holistic care to care for these patients and their families.

The Asheville Hospice and Palliative Medicine Fellowship is a collaboration between Four Seasons Hospice and Palliative Care, CarePartners, the Asheville VA Medical Center, Mission Health, and the Mountain Area Health Education Center (MAHEC). 

Four Seasons and CarePartners are nationally recognized, community-based hospice and palliative medicine organizations. Mission Health is a regional hospital system which is owned by HCA. It has long been nationally recognized for delivering high quality care at low cost. The Asheville VA is one of the highest performing medical centers in the VA health system. MAHEC is an innovative leader in post-graduate training, specializing in training graduates to care for patients in rural communities.

For over thirty years, our partners have been leaders in clinical innovation and education in Western North Carolina. Our partners serve 18 counties spanning an area the size of Massachusetts, much of which is underserved. Our patients hail from urban settings, like Asheville, to isolated, rural communities in the heart of Appalachia.

Our program brings the strengths of our member organizations together with our unique patient population to create a stimulating and exciting training experience for physicians striving to develop, enhance, and refine their knowledge and skills in hospice and palliative medicine.

Our fellows develop particularly deep experiences in home hospice and long-term care through our longitudinal curriculum. This unique curricular strategy allows fellows to expand upon and deepen the knowledge gained in their core rotations by spending a half day each week seeing patients in their homes or nursing homes. 

In addition to weekly home or long-term care visits, fellows will have a half day of clinic in the Supportive Oncology clinic of Mission Cancer Center. 

The Hospice Home Care program maintains a census of more than 180 patients and includes patients living in skilled nursing facilities, assisted living, and private homes. Patients have a wide variety of diagnoses and come from varied geographic and socioeconomic spectra—from mansions in urban Asheville to trailers in rural Cherokee.

In addition to their community-based work, our fellows have the opportunity to care for patients in CarePartners’ 27-bed inpatient hospice unit, located in Asheville and Four Seasons’ Elizabeth House, an inpatient hospice unit in East Flat Rock. During these rotations, fellows will learn to provide complex, advanced symptom management and end-of-life care.

Fellows are also integral members of Mission’s Palliative Care team, an interdisciplinary team that serves Mission’s flagship 760-bed regional hospital. The team sees over 2,500 consults per year and is well integrated to care across the hospital. This includes an advanced heart failure clinic. 

Our novel curriculum includes a “flex month” which allows fellows to customize their education and focus additional time in a core area of particular interest to their future careers. This “flex month” occurs at the end of the fellowship year, allowing fellows to refine their skills prior to embarking on their solo careers. Areas of specialization include: Palliative Care Consultation, Hospice Home Care, and Inpatient Hospice Care.

Specialty experiences provide exposure to relevant knowledge regarding the practice of Hospice and Palliative Medicine, including Pediatrics, Interventional Pain Management, Radiation Oncology, and Oncology. A wide range of electives are available for further exploration and education.

Quality teaching is critical to quality education. In all settings, fellows are instructed by experienced hospice and palliative medicine physicians. In addition, fellows have the opportunity to work with interdisciplinary teams at all clinical sites during their fellowship year. Community faculty provide exceptional teaching with clinical rotations and electives in a broad range of specialties. 

Fellows have dedicated and protected time each week to attend conferences covering a wide range of core topics in hospice and palliative medicine. Our commitment is to help fellows develop the knowledge, attitudes, and skills to succeed and thrive throughout their careers.


Sample Rotation Schedule
Orientation       One Week
Palliative Care Consult Four Weeks
Interventional Pain/Rad Onc Two Weeks
Palliative Care Consult Four Weeks
Hospice Home Care Four Weeks
Inpatient Hospice Care Four Weeks
Vacation Three Weeks
Palliative Care Consult Four Weeks
Pediatrics Two Weeks
Palliative Care Consult Four Weeks
Oncology Two Weeks
Hospice Home Care Three Weeks
Inpatient Hospice Care Four Weeks
Flex Month* Four Weeks
Elective Four Weeks
*Flex month: Fellows may choose to spend additional time
with the Consult Service, Home Care, and/or Inpatient Care,
based on career goals and educational need.


In addition to teaching on core clinical topics in hospice and palliative medicine, fellows meet weekly for 2-4 hours for conferences/workshops to discuss the following:

Journal Club/Critical Review:  An integrated series providing training and experience in critical review of the Hospice and Palliative Care medical literature.

Research Seminars: Teaching seminars on research and academic skills combined with a practical project in an area of scholarly activity.

Topics in Self Care and Spirituality:  An exploration of the stresses and challenges of clinical practice in Hospice and Palliative medicine with a focus on spirituality, self-reflection, and the development of strong and effective coping and self-care skills. These sessions are co-taught by bereavement, chaplaincy and core faculty.

Practice Management/Program Administration:  Real world training on the core skills of effective billing, coding, documentation and schedule management, combined with training to be effective in the role of Medical Director of a Hospice and Palliative Care Program.

Communication Skills:  Effective communication is a critical skill in Palliative Medicine. Topics include: Discussing Prognosis, Identifying and Responding to Emotion, Communicating with the Angry Patient, and more.

Palliative Care Book Club: A relaxed discussion with colleagues about a book or movie with a theme related to the end of life. This is designed as an enjoyable way to explore and reflect upon life and our work.
Palliative Care Immersion course: Fellows have the opportunity to participate in the nationally recognized, highly interactive Four Seasons Palliative Care Immersion Course, a comprehensive, week-long, educational curriculum aimed at developing competencies and skills in Palliative Care.  Details can be found here: https://www.fourseasonscenterofexcellence.com/immersion-courses/overview


We accept applications electronically through the ERAS program only. You can upload your application, references, and other supporting materials there.

Applicants must have completed an ACGME or AOA-accredited residency program in Anesthesiology, Emergency Medicine, Family Medicine, Internal Medicine, Neurology, Obstetrics and Gynecology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry, Radiation Oncology, or Surgery, have DEA certification and be eligible to obtain a license to practice medicine in North Carolina through the N.C. Medical Board.

Additionally, MAHEC requires a full copy of applicant’s medical school degree, current licensure information, 3-letters of recommendation including one from their residency program director, a personal statement, and an onsite interview in Asheville.

Questions regarding the application process should be directed to Mary Purdy at 828-771-3545 or via mary.purdy@mahec.net.

International Medical Graduates

Special laws and regulations apply to international medical graduates who wish to enter the United States to undertake graduate medical education. MAHEC's policies and procedures regarding graduates of international medical schools comply with federal and state laws and regulations and MAHEC's commitment to graduate medical education.

Graduates of medical schools outside the United States and Canada must have a currently valid certificate from the Education Commission for Foreign Medical Graduates (ECFMG). Applicants must successfully pass both Step 1 (basic medical) and Step 2 (clinical knowledge) of the United States Medical Licensing Examination (USMLE).

While MAHEC does not sponsor a visa, the international medical graduate applicant must also possess a current/valid visa option or other status governed by the US Immigration Regulations to participate in a GME program.

Finally, the North Carolina Medical Board requires that physicians who are graduates of schools that are not accredited by the LCME or the AOA (foreign medical schools) must be individually certified by the Educational Commission for Foreign Medical Graduates, have successfully completed at least three years of accredited graduate medical training, and have passed the USMLE or its equivalent to be eligible for application for full licensure. An international medical graduate must complete all other application requirements required by MAHEC and the GME program.

Stipend and Benefits

Stipend: $57,910.00


Professional liability insurance
Health insurance for fellow (family coverage optional at additional cost)
Term life insurance
Disability insurance
Licensure fee
North Carolina Medical License fee
DEA Registration fee
Vacation/Leave: Three weeks
Professional Education: $750 for CME related expenses including books, subscriptions and costs for attending professional meetings.

Stipend and benefits are subject to annual adjustments.

Resident Manual

Resident Fellow Contract Letter of Agreement