Critical Care

Critical-care medicine is a relatively new but increasingly important medical specialty. Physicians with training in critical-care medicine are referred to as intensivists. The specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, anesthesiology, or surgery. Board certification in critical care medicine is available through all three specialty boards. Nurse intensivists receive their training after basic education through ASTNA.

Paramedics are certified to levels of CCEMTP or FP-C. Intensivists-physicians with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU, including intensivists. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care. This has led the Leapfrog Group to make a primary recommendation that all ICU patients be managed or co-managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. However, there is a critical shortage of intensivists in the United States, and most hospitals lack this critical physician team member.

Patient management in intensive-care differs significantly between countries. In Australia, where Intensive Care Medicine is a well-established speciality, ICUs are described as 'closed'. In a closed unit the intensive-care specialist takes on the senior role where the patient's primary doctor now acts as a consultant. The advantage of this system is a more coordinated management of the patient based on a team who work exclusively in ICU. Other countries have open Intensive Care Units, where the primary doctor chooses to admit and, in general, makes the management decisions. There is increasingly strong evidence that 'closed' Intensive-Care Units staffed by Intensivists provide better outcomes for patients.