Dr. John Mulder currently serves as the Executive Director for Trillium Institute, Chief Medical Consultant for Hospice and Palliative Care for Holland Home, and the Executive Director of Palliative Services for University of Michigan Health-West in Grand Rapids, MI. We talk about how he got started in palliative care, well before it was a recognized subspecialty, how the specialty has changed, and he helps to clear up some confusion about who should be referred to palliative care. We also discussed how more palliative care referrals can improve outcomes and decrease the cost of care and what systemic changes can help. Dr. Mulder has an appointment as Assistant Professor in the Department of Family Medicine at Michigan State University College of Human Medicine where he serves as the Director of the Division of Palliative Medicine, and he is currently the Director of the Mercy Health Grand Rapids Hospice and Palliative Medicine Fellowship Program.