Mainstreaming palliative care.

PALLIATIVE CARE HAS ARRIVED. The field has been officially recognized by both the American Medical Association (AMA) and the American Board of Medical Specialties (ABMS). While this is indeed a time to take great pride in being a palliative care professional it is also the time to take stock of the field of palliative care, examine where we are, identify where we want to be, and plan how best to get there. As the field of palliative care moves into a new phase in its life cycle it faces some very real threats. The transition from a young field operating in a few select locations and dominated by a handful of visionaries and pioneers into an established field with a presence in every health care institution and run by pragmatic clinicians is a challenging one. This gap or chasm between these two stages in the life cycle of the field is an important one and must be the primary focus of any long-term development plan. The field of palliative care in the U.S. is now entering this chasm. Once the field successfully crosses the chasm, it will then emerge as a robust field with a mainstream market and great potential for sustainability (Fig. 1). WHY IS CROSSING THE CHASM A RISKY PROCESS?