title: Picking up the pieces: towards a better future for critical care medicine in three South American countries.
abstract: The demand for intensivists is increasing around the world, not only to meet the needs of a growing aging population, but also to fill positions in the intensive care unit now occupied by other specialists, since there is compelling evidence that the presence of critical care practitioners improves patient outcomes. Notwithstanding this, the shortage of intensivists is a problem recognized throughout the world. In this article, we discuss these issues in Argentina, Brazil, and Uruguay, three upper-middle income Latin American countries where critical care has been a medical specialty for decades and intensive care unit coverage traditionally has followed the 24/7 model. The lack of intensivists is multifactorial: the specialty is not taught to medical students; there is a general perception of a negative lifestyle compared with the practice of other medical specialties, due mainly to the constant 24-hour shift work; and there is general dissatisfaction with incomes, which has forced many intensivists into multijob schemes. The expected-and feared-consequences are the 40 to 70% vacant posts in residencies of critical care. Despite these drawbacks, scientific societies and colleges are intensely committed, pointing out these problems to the press, calling the health authorities for action, and permanently generating educational activities. Surprisingly, 83% of surveyed intensivists would choose critical care medicine again, evidencing the strong vocational component in its practice, which seems to predominate over negative aspects.
authors.affiliation: Critical Care Department, Hospital Interzonal de Agudos General San Martin de La Plata, 1 y 70, 1900 La Plata, Buenos Aires, Argentina. estenssoro.elisa@gmail.com.ar
authors.forename: Elisa
authors.initials: E
authors.lastname: Estenssoro
authors.forename: Carmen Silvia
authors.initials: CS
authors.lastname: Valente Barbas
authors.forename: Arturo
authors.initials: A
authors.lastname: Briva
mesh_terms: D000328:Adult; D001118:Argentina; D001938:Brazil; D002568:Certification; D003422:Critical Care / Q000458:organization & administration / Q000592:standards / Q000639:trends*; D005260:Female; D005544:Forecasting; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D014583:Uruguay; D000078329:Workforce