Most hospices want to keep the patient’s primary (referring) doctor involved during end-of-life (EOL) care because he knows the patient and already has a supportive relationship with the family. His knowledge is essential because first, it’s his decision when to refer to hospice; and second, both his signature and that of the hospice Medical Director are required to certify that his patient has a life expectancy less than six months if the disease runs its usual course.
However, many physicians are uncomfortable managing some of the symptoms, such as pain or delirium, which are common at the EOL, and therefore sometimes ask the hospice Medical Director to assume responsibility for some or all of the care.
Another reason why the hospice may be asked to take over care is that when a hospice nurse calls the primary doctor’s busy office for advice about an urgent problem, the physician isn’t always able to return the call as quickly as the family would hope. And since the hospice Medical Director is legally responsible to ensure that symptoms are controlled in a timely fashion, the nurse will therefore call him if the primary physician is unable to return their call in a reasonable time.
Apparently, a few larger hospices do require that their patients be treated by only the hospice physician, but I’m not aware of any in this area.
Regardless who is involved, the goal is that every patient receives the best and most appropriate care to allow them a comfortable and dignified life as death approaches.