"Critical care professional societies and their members have felt the tremendous strain caused by the depletion of critical care resources and the increased patient demand for critical care services. These trends have forced critical care in the United States to enter into an extremely vulnerable state, leaving our critical care professionals and their patients equally as vulnerable," said report co-author Mark A. Kelley, MD, FCCP, Henry Ford Hospital, Detroit, MI. "The Critical Care Workforce Partnership is appealing to both the medical profession and public policy makers to take action against these alarming trends in critical care before the consequences become insurmountable."
In 2000, the Committee on Manpower for Pulmonary and Critical Care Services (COMPACCS), including members of the ACCP, ATS, and SCCM, published a study predicting that critical care specialists would not be able to meet the demands of the aging population in the United States and that the effects of the manpower shortage would reach crisis proportions in 2007. To address this imminent critical care issue, the three medical societies and the AACN formed the Critical Care Workforce Partnership and a supporting task force on Framing Options for Critical Care in the United States (FOCCUS). In the current report, the Partnership and FOCCUS task force expand on the COMPACCS prediction, citing that waning interest in the critical care profession will greatly reduce the future number of critical care providers, making it difficult to meet the overwhelming patient demand for critical care services.
To overcome these challenges, the FOCCUS task force offers the following recommendations for the critical care medical profession: adopt common standards for critical care to ensure uniformity, promote quality, and rationalize resources; use information technology to promote standardization and improve efficiency in critical care; advise policymakers to develop incentives to attract health-care professionals to critical care; and encourage policymakers to sponsor research that defines the optimal role of a critical care specialist in the delivery of critical care.
In their accompanying white paper, the four critical care professional societies urge public policy makers to assist in the implementation of the FOCCUS recommendations in order to improve the efficiency and number of critical care providers and manage the demand for critical care services. To improve efficiency, policy makers are encouraged to redistribute the current critical care workforce, explore ways to relieve the burden on the current workforce, and simplify medical reimbursement for critical care services. To increase the number of critical care providers, policy makers are asked to support graduate medical education initiatives, permitting more medical students to train in critical care programs, and to expand the J-1 visa waiver program, allowing foreign physicians to extend their critical care practice in the United States.
Additionally, policy makers are advised to address patient demand by expanding research on the delivery critical care services for the elderly and Medicare beneficiaries and educating Americans on the benefits and limitations of critical care medicine.
"The limited number of physician residency and fellowship trainee opportunities combined with increasing medical school costs and decreasing Federal funds for physician training, will have a severe impact on the future number of critical care physicians," said Richard. S. Irwin, MD, FCCP, President of the American College of Chest Physicians. "Although the United States government has acknowledged the impending shortage of critical care providers, policy makers must begin public discussions on this issue and support the redesign of critical care practice and improve the supply of its professionals."
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. ACCP represents more than 15,700 members who provide clinical respiratory, critical care, and cardiothoracic patient care in the United States and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.