Critical care medicine in the united states: Addressing the intensivist shortage and image of the specialty*

Neil A. Halpern, Stephen M. Pastores, John M. Oropello, Vladimir Kvetan

Research output: Contribution to journalArticlepeer-review

103 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2754-2761
Number of pages8
JournalCritical care medicine
Issue number12
StatePublished - Dec 1 2013


  • Critical care
  • Intensive care unit
  • Intensivist
  • Medicine
  • Physician
  • Professional societies
  • Shortfall
  • Specialty education
  • Staffing
  • Workforce

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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