The Critical Care Workforce:  A Study of the Supply and Demand for Critical Care Physicians

Key Acronyms

Foot Notes

[1] Green TP. What is best for patients is best for the intensive care unit.  Critical  Care Medicine. 2001; 29(10): 2038-39.

[2] Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J, for the Committee on Manpower for Pulmonary and Critical Care Societies. Current and Projected Workforce Requirements for Care of the Critically Ill and Patients With Pulmonary Disease: Can We Meet the Requirements of an Aging Population? JAMA. 2000; 284: 2762-2770.  See also: Schmitz R, Lantin M, White A. Future Needs in Pulmonary and Critical Care Medicine. Abt Associates Inc. study conducted for the American College of Chest Physicians, American Thoracic Society, and Society for Critical Care Medicine. November, 1998.

[3] Burchardi H and Moerer O. Twenty-four hour presence of physicians in the ICU. Critical Care 2001; 5:131-7.

[4] Buchardi and Moerer, 2001.

[5] See, for example, Physician Supply and Demand Projections: 2000 to 2020. HRSA report prepared by The Lewin Group and Altarum, 2005.

[6] Blumenthal D. New Steam from an Old Cauldron — The Physician-Supply Debate. N Engl J Med. 2004; 350:1780-1787.

[7] Blumenthal (2004).

[8] COGME Eighth Report. Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Rockville, MD: Public Health Service, 1996.

[9] Grosso LJ, Goode LD, Kimball HR, Kooker DJ, Jacobs C, and Lattie G. The subspecialization rate of third year internal medicine residents from 1992 through 1998. Teach Learn Med. 2004; 16(1):7-13.

[10] Clayton C. Presentation at the Alliance for Academic Internal Medicine—Lewin Forum on the Future of the Healthcare Workforce. September 14, 2004. Washington, DC.

[11] Council on Graduate Medical Education, Sixth Report. Managed Health Care: Implications for the Physician Workforce and Medical Education. Rockville, Md.: Public Health Service, 1995.

[12] Council on Graduate Medical Education, Fourth Report. Recommendation to Improve Access to Health Care through Physician Workforce Reform. Rockville, Md.: Public Health Service, 1994.

[13] Council on Graduate Medical Education, Draft Report. Physician Workforce Policy Guidelines for the U.S. 2000-2020, 2003.

[14] Institute of Medicine. Primary Care: America’s Health in a New Era. Washington, DC: National Academies Press, 1996.

[15] Cooper, Richard A. There's a Shortage of Specialists: Is Anyone Listening? Acad Med. 2002 77: 761-766

[16] Angus et al. (2000).

[17] Society of Critical Care Medicine. Patient and Family Resources: History of Critical Care. SCCM Web site. http://www.sccm.org/patient_family_resources/history_critical_care/index.asp.

[18] Tobin MJ and Hines E. Pulmonary and Critical Care Medicine: A Peculiarly American Hybrid? Thorax. 1999; 54: 286-287.

[19] This is partly related to the relatively recent emergence of critical care as a specialty. Fifty percent of physicians trained in pulmonary and/or pulmonary-critical care are certified in critical care; however, these physicians spend about half as much time in the ICU as their colleagues that were trained only in critical care (Angus 2000).

[20] Society of Critical Care Medicine. Patient and Family Resources: History of Critical Care. SCCM website. http://www.sccm.org/patient_family_resources/history_critical_care/index.asp

[21] Angus et al. (2000).

[22] Tobin and Hines (1999).

[23] Al-Asadi L, Dellinger R, Deutch J, Nathan S. Clinical impact of closed versus open provider care in a medical intensive care unit. American Journal of Respiratory & Crit Care Med. 1996;153:A360.

[24] Young M, Birkmeyer J. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract. 2000;3:284-289.

[25] Angus et al. (2000).

[26] Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review. JAMA. 2002;288:2151-2162.

[27] Al-Asadi L. et al. Clinical Impact of Closed Versus Open Provider Care in a Medical Intensive Care Unit. American Journal of Respiratory & Crit Care Med. 1996; 153:A360

[28] Kelley MA, Angus D, Chalfin DB, Edward D, Ingbar D, Johanson W, Medina J, Sessler CN, and Vender JS. The Critical Care Crisis in the United States: A Report from the Profession. Chest. 2004 125: 1514-1517

[29] Young and Birkmeyer (2000).

[30] Rothschild JM. “Closed” Intensive Care Units and Other Models of Care for Critically Ill Patients. AHRQ. 1999. p. 413. Chapter 38.  In “Making Health Care Safer: A Critical Analysis of Patient Safety Practices” AHRQ Evidence Report/Technology Assessment Number 43.

[31] Personal communication to the authors from Peter Pronovost.

[32] Pronovost PJ, Waters H, and Dorman T. Impact of Critical Care Physician Workforce for Intensive Care Unit Physician Staffing. Curr Opin in Crit Care. 2001; 7(6):456-9.

[33] Young M and Birkmeyer J. Potential Reduction in Mortality Rates Using an Intensivist Model to Manage Intensive Care Units. Eff Clin Pract. 2000; 3:284-89.

[34] Results from the COMPACCS survey indicate that in 1997 an estimated 10,244 physicians in the United States practiced as pulmonary and/or critical care specialists. Less than one tenth (9.3 percent) received their primary training in anesthesiology or surgery, and just over one half (53 percent) were certified in critical care.

[35] Rothschild (1999, p. 413).

[36] Pediatric intensivists are excluded from this study;  688 new certifications in pediatric critical care were granted in the 1990’s, more than any other pediatric subspecialty except: neonatology, infectious diseases, and emergency medicine.

[37] AMA’s Physician Characteristics and Distribution in the U.S., Editions 2000-2001, 2001-2002, 2002-2003, 2003-2004.

[38] Brotherton SE, Rockey PH, and Etzel SI. US Graduate Medical Education, 2003-2004. JAMA. 2004; 292:1032-1037.

[39] Appendix: Graduate Medical Education. JAMA 2004;292:1089—1097.

[40] JAMA medical education issues (Appendix II—Graduate Medical Education) 1996-2003.

[41] Guntupalli KK and Fromm RE. Burnout in the internist-intensivist. Intensive Care Med. 1996; 22:625-630.

[42] The eight age categories are ages 0-4, 5-17, 18-24, 25-44, 45-64, 65-74, 75-84, and 85 and older.

[43] As with the physician supply estimate, this count uses American Medical Association and American Osteopathic Association Masterfile data on physicians’ activity status for physicians younger than age 75.

[44] Al-Asadi et al. (1996).

[45] Rothschild (1999, p. 414).

[46] Angus et al. (2000), op. cit.,  state that pulmonologists provide about 53 percent, and intensivists 47 percent of all ICU hours. They report critical care and pulmonary specialists working 61 hours per week for 48 weeks (2,933 hours per year),  with non-pulmonary internal medicine-based intensivists spending 46.2 percent of their total clinical time, or 1,353 hours per year in ICUs.  Adjusting 18 million annual ICU days  by 0.75 hours of intensivist and pulmonologist time per ICU day  leaves 13.5 million ICU days per year;  further adjusting  ICU days by the fraction of patient care days CCMs provide (46.9 percent), and applying the  hours worked per year by CCMs in ICUs yields  approximately 4,685 total intensivists  in demand in base year 2000.  Two-thirds of this number equals 3,100 intensivists required in 2000.   (Rounding accounts for slight discrepancies in calculations.)

[47] Pingleton SK. Committee on Manpower of Pulmonary and Critical Care Societies. CHEST. 2001; 120(2): 327-8.

[48] Pronovost et al. (2002).

[49] Angus et al. (2000).

[50] National Advisory Committee on Rural Health and Human Services. http://ruralcommittee.hrsa.gov/QR03.htm

[51] Ewart GW, Marcus L, Gaba MM, Bradner RH, Medina JL, and Chandler EB. The Critical Care Medicine Crisis: A Call for Federal Action. Chest. 2004; 125: 1518-1521.

[52] Pronovost et al. (2002).