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Critical Care Medicine in the United States

Addressing the Intensivist Shortage and Image of the Specialty*

Halpern, Neil A. MD, FCCM1,2,3; Pastores, Stephen M. MD, FCCM1,2,3; Oropello, John M. MD, FCCM4,5; Kvetan, Vladimir MD, FCCM6,7,8

doi: 10.1097/CCM.0b013e318298a6fb
Point of View Article

Intensivists are increasingly needed to care for the critically ill and manage ICUs as ICU beds, utilization, acuity of illness, complexity of care and costs continue to rise. However, there is a nationwide shortage of intensivists that has occurred despite years of well publicized warnings of an impending workforce crisis from specialty societies and the federal government. The magnitude of the intensivist shortfall, however, is difficult to determine because there are many perspectives of optimal ICU administration, patient coverage and intensivist availability and a lack of national data on intensivist practices. Nevertheless, the intensivist shortfall is quite real as evidenced by the alternative solutions that hospitals are deploying to provide care for their critically ill patients. In the midst of these manpower struggles, the critical care environment is dynamically changing and becoming more stressful. Severe hospital bed availability and fiscal constraints are forcing ICUs to alter their approaches to triage, throughput and unit staffing. National and local organizations are mandating that hospitals comply with resource intensive and arguably unproven initiatives to monitor and improve patient safety and quality, and informatics systems. Lastly, there is an ongoing sense of professional dissatisfaction among intensivists and a lack of public awareness that critical care medicine is even a distinct specialty. This article offers proposals to increase the adult intensivist workforce through expansion and enhancements of internal medicine based critical care training programs, incentives for recent graduates to enter the critical care medicine field, suggestions for improvements in the critical care profession and workplace to encourage senior intensivists to remain in the field, proactive marketing of critical care, and expanded engagement by the critical care societies in the challenges facing intensivists.

1Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

2Department of Medicine, Weill Cornell Medical College, New York, NY.

3Department of Anesthesiology, Weill Cornell Medical College, New York, NY.

4Department of Surgery, Mount Sinai School of Medicine, New York, NY.

5Department of Medicine, Mount Sinai School of Medicine, New York, NY.

6Jay B. Langner Critical Care System, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY.

7Department of Anesthesiology, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY.

8Department of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY.

* See also p. 2827 and 2828.

All of the authors provided important intellectual input to the article.

Dr. Halpern is certified in internal medicine (IM) and critical care medicine (CCM). Drs. Pastores, Oropello, and Kvetan are certified in IM and pulmonary and critical care medicine. Dr. Oropello is also certified in neurocritical care by the United Council for Neurologic Subspecialties. All practice CCM full time. Drs. Pastores and Kvetan are members of a task force organized by the Society of Critical Care Medicine in collaboration with the American College of Chest Physicians and American Thoracic Society charged with generating a consensus statement to address the critical care educational pathways in IM. Dr. Halpern consulted for Cardiopulmonary Corp, Instrumentation Lab, and Airstrip Technologies and has stock options with Pronia Medical Systems. Dr. Pastores received support for travel from MCCRC. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins