The recent European Society of Intensive Care Medicine (ESICM) Statement on structure, organization and training guidelines of Intensive Care Medicine (ICM) in Europe  explains that ICM, with the exception of Spain, is a multidisciplinary speciality. That exception is untrue, because even though there is an independent speciality (primary intensivists), ICM in Spain is also practised by many professionals (mainly anaesthesiologists) who govern intensive care units (ICUs) and work independently in critical care in more than 75 Spanish hospitals. The problem with the existence of primary intensivists is that they attack the multidisciplinary approach to ICM, because they try to become the exclusive players in the care of the critical patient, a role that does not belong to them exclusively, neither in fact nor by right. The experience in Spain is very negative both for anaesthesiologists, who have problems working in some ICUs and in maintaining their training, and for primary intensivists, who suffer work burnout and unemployment. The recently initiated experience in Switzerland of trying to make compatible the simultaneous existence of a primary and nonprimary speciality (a primary speciality after 6 yr of training, and a supra-speciality to internal medicine and anaesthesiology with a training time of 7 yr) is a fallacy. Some Swiss anaesthesiologists consider they have lost ICUs because it is not possible for them to maintain skills in both fields: surgical anaesthesia and ICM. Moving to ICM from anaesthesiology will progressively disappear: maintaining the two specialities over time will require spending a number of consecutive months every 2-3 yr in ICUs (covered by a recognized specialist) through a career, which will be increasingly difficult. Perhaps other countries where ICUs are not very academic will follow. I firmly believe that it is not possible to maintain a multidisciplinary approach with the existence of a primary speciality in ICM. The multidisciplinary model of harmonization of the teaching and practice of ICM in Europe recommended by the European Union of Medical Specialists (UEMS) requires the disappearance of primary intensivists.
Department of Anaesthesia and Critical Care Medicine; University of Navarra; Navarra, Spain
1. De Lange S, Van Aken H, Burchardi H. European Society of Intensive Care Medicine statement: Intensive care medicine in Europe - structure, organisation and training guidelines of the Multidisciplinary Joint Committee of Intensive Care Medicine (MJCICM) of the European Union of Medical Specialists (UEMS). Intensive Care Med