Imagine practicing palliative care in an integrated health care system with an established system of concurrent care hospice, with a nationally supported VITAL TALK-based goals of care program, and with the freedom to use a variety of non-pharmaceutical treatments and modalities.  We work collaboratively with specialty and primary care colleagues.  Teaching includes didactic sessions for residents, fellows, and faculty, in addition to direct supervision of goals of care discussions. Plans for hospice and palliative medicine fellows from the University of Iowa are ongoing.The Outpatient service provides direct outpatient care, e-consults, and Telehealth appointments Monday-Friday (8 am to 4:30 pm). We see an average of 20 heart failure and oncology patients in concurrent care