title: Critical care medicine in the United States: addressing the intensivist shortage and image of the specialty.
abstract: 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.
authors.affiliation: 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.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Halpern
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pastores
authors.forename: John M
authors.initials: JM
authors.lastname: Oropello
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kvetan
mesh_terms: D003422:Critical Care; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007388:Internal Medicine / Q000193:education; D007588:Job Satisfaction; D009042:Motivation; D010560:Personnel Selection; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000523:psychology / Q000600:supply & distribution*; D012456:Salaries and Fringe Benefits; D012955:Societies, Medical; D014481:United States; D000078329:Workforce; D016526:Workload / Q000191:economics / Q000523:psychology