It is impossible to practice “part-time critical care.” Critical care requires a full-time commitment; it is labor intensive, requiring long hours at the bedside with frequent and repeated evaluations of the patient, and the capacity to respond rapidly and decisively to emergencies. This is impossible for even the most dedicated private practitioner or surgeon to achieve, as most of their time is spent in their offices and/or operating rooms far from the ICU. Consequently, the practitioner “portions off” the patients’ care to a number of organ-specific subspecialists. This usually results in fragmented and conflicting treatment strategies. Furthermore, both accountability and responsibility are also portioned off, with no physician assuming ultimate responsibility for the patients’ care. The patient then drifts aimlessly through treacherous waters, having either the physiologic reserve to swim back to shore, or being ultimately taken by the sea.