The decision to enroll her father in hospice care came easily for Janet Abrahm, MD. Abrahm, a palliative care doctor and former oncologist, helped her father — an internist who died of prostate cancer at home — understand the program’s benefits, such as family bereavement services, and that he could be readmitted to the hospital if needed. 

“Most doctors don’t know that,” said Abrahm, who is also a professor of medicine at Harvard Medical School in Boston and the author of Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer. “They think it’s a one-way street, I imagine — that you put somebody in hospice and then that’s it.” Other than oncologists and geriatricians, she added, many physicians “don’t see that much death in a year.”

The level of engagement physicians have with death in their practice may inform how they want to die — and how they counsel loved ones facing a serious illness. But a new study suggests even as they face end-of-life decisions through the lens of their expertise, physicians can also be swayed by the same financial, familial, and existential burdens afflicting their patients. 

Physicians were only modestly more likely than other groups to die at home or in hospice, rather than in a hospital, according to the Annals of Internal Medicine analysis. Using CDC mortality data of 11 million adult deaths between 2020 and 2023, researchers found about 44% of physicians died at home or in hospice compared to roughly 41% of the general population, 41% of other highly educated groups (lawyers, engineers, scientists), and 42% of other health care practitioners. The pattern held across the six leading causes of death: cancer, lower respiratory diseases, heart disease, Alzheimer’s disease, stroke, and COVID-19. The researchers excluded unanticipated deaths, such as traumas. 

“I don’t think we want to miss seeing that a high proportion of people die outside the hospital, at home or in hospice. That is arguably a pretty remarkable accomplishment over the course of the past generation,” said Farr Curlin, MD, the Josiah C. Trent professor of medical humanities at Duke University, in Durham, North Carolina, who was not involved in the study. Many physicians who recommend hospice to patients with advanced illness appear to be “practicing what they preach,” he said 

The study also reflects the unforeseeable nature of conditions such as heart failure, which may cause sudden fatal complications before hospice can be organized, said Curlin, who is also the co-director of Duke Divinity School’s Initiative on Theology, Medicine, and Culture. A significant spike in home and hospice deaths could indicate too few patients are being granted an opportunity to bounce back. 

Physicians often feel that patients or their families want excessive life-sustaining treatment, Curlin said. But the findings suggest physicians facing advanced illness or death, like their patients in similar circumstances, “probably often err on the side of seeing if some further treatment might turn the corner.” 

Hospice is an end-of-life program aimed at providing comfort and quality-of-life for people expected to live for 6 or fewer months. Available at home or in a facility through private insurance or as a Medicaid or Medicare benefit, it requires patients to forgo life-extending treatment, but they can reenter the hospital if needed and then re-enroll in hospice. 

Recent public awareness campaigns — including the “Being Mortal” project from the Hospice Foundation, in 2016-2017, and the National Hospice and Palliative Care Organization’s “Moments of Life” effort, launched in 2014— have encouraged conversations about end-of-life care preferences. But, “there is a lot of under-education” about different options, “and so it’s possible that people who make an opinion in either direction might just not have all the possible information, said Vishal Patel, MD, MPH, lead author of the new study and a resident physician at Brigham and Women’s Hospital, in Boston.

Variable Findings on Where Doctors Die 

Results of previous research on physicians’ end-of-life preferences have varied. Compared to the new analysis, some smaller studies found even less difference between where physicians and other groups died. A 2016 study found inpatient hospital death slightly less likely among physicians (38%) compared to the general population (40%), but equally likely compared to other health professionals and those with a similar level of postsecondary education.

A 2025 study based on in-depth interviews with 45 physicians in Belgium, Italy, and the United States hinted at how physicians with different specialties may approach their own death. Palliative care physicians reflected heavily on their end-of-life preferences, but general practitioners and other medical specialists did not. While all groups largely preferred to die at home, a small number of physicians said they’d become accustomed to medical environments and would be fine with dying in a hospital. 

“The knowledge and experience of healthcare may inform physicians that dying at home may not be what they would want for them or their families,” said Melissa Wachterman, MD, MPH, an assistant professor of medicine at Harvard Medical School. “Having seen patients die at home, sometimes I think, ‘that’s the way I would want it to be’ and other times I see it and think, ‘there’s a lot about this that would not fit with what I would want.’”

The CDC data driving the new analysis did not distinguish between medical specialties, but specialties could be added within the next five to 10 years, Patel said. At that point, “it may be interesting to see if physicians who deal more closely with the end of life, like intensive care or palliative care physicians, might have a stronger signal for that outcome than, like, dermatologists,” he said, referring to dying at home or in hospice. 

Medical Expertise vs End-of-Life Realities 

Dying at home is the most desired end-of-life choice among people in the United States. By 2017, 31% of Americans died at home, making it the most common site of death for the first time since the early 20th century. The pandemic led to an 11% increase in hospital deaths in 2020 that had yet to abate by 2023.

“Many people may express their preference to be at home as something that’s comforting. I think the reality of actually executing that is far more challenging,” said Stephanie Harman, MD, a palliative care physician and clinical professor of medicine at Stanford, California, who cared for her father-in-law at home in his final weeks. 

Physicians’ end-of-life plans can be shaped not only by their own families, Harman said, but also what they hear from patients caring for dying loved ones at home. “I definitely have the experience of a number of physicians saying, ‘For that last stage in my life, I don’t want to be in my home. I would prefer to be somewhere else, because I worry about the impact of that on my family,’” Harman said. 

Compared to the general population, physicians may also have a more realistic idea of how dying in a hospital has improved over the past few decades, Wachterman said. The rise of palliative care has softened the in-hospital death experience. Instead of “tubes and lines and interventions and aggressive care,” patients with advanced illness can opt for care aligned with their values, preferences, and goals, she said. 

Meanwhile, when people die with in-home hospice care, their families shoulder more of the burden. Hospice agencies, which are often reimbursed by Medicare, earn more from sending people home, Wachterman said. Except during a crisis, hospice covers only intermittent care from home health aides, sometimes as little as 2 hours per day, Abrahm said. 

While Abrahm’s father was receiving hospice care at home, her parents used their savings to cover the cost of round-the-clock private caregivers in addition to what hospice provided, she said. The expense of dying at home may deter many physicians, despite their income far exceeding median family earnings. 

“Maybe some years ago, folks in higher earning professions could afford this kind of care at home,” Harman said. “If you don’t have your own nuclear family or your extended family nearby, that changes the cost.” Most physicians are White, which — combined with their high income — makes them less likely to live near family who could help supplement hospice services. 

Still, “cost is not the only driver,” Harman said. A physician facing serious illness grapples with dual identities of professional and patient as they make decisions about how they want to die. “That is also a challenge and may lead to decisions that are more based in being human, versus having all the expertise of whatever specialty they are in,” she said.

As to physicians’ readiness for their own death, maintaining too much critical distance from patients’ end-of-life decisions could be a mistake, Curlin said. Physicians often give information and data, while being careful not to influence a family’s decision. But making informed recommendations toward or away from hospice, and hearing how patients and families respond, can expose physicians to how people negotiate death and find meaning in their final stages. 

“It’s like you go a deeper layer into the human experience of coming toward the end of your life and dealing with advanced illness,” Curlin said. “I think that will prepare the physician, or should anyway, to better approach their own advanced illness and their own death.” 

The sources in this story reported no relevant financial conflicts of interest. 

Sarah Amandolare is a freelance journalist in New York City.