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Communications to the Editor |

The Intensivist Shortage : Put Patients Before Politics FREE TO VIEW

J. Brian Hancock, MD; Tiffany Medlin Osborn, MD
Author and Funding Information

American College of Emergency Physicians, Dallas, TX

Correspondence to: J. Brian Hancock, MD, St. Mary’s Hospital, Saginaw, MI 48608; e-mail: bhancock@acep.org



Chest. 2005;127(6):2293. doi:10.1378/chest.127.6.2293
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Published online

To the Editor:

Emergency physicians are deeply concerned about the critical care crisis.13 Annually, 1.4 million patients are admitted to the ICU through emergency departments.4Lack of ICU beds is the most common factor driving emergency department overcrowding and ambulance diversion.5

The authors of the recent CHEST series on this topic13 are so concerned that they want the federal government to relax its immigration laws so foreign medical graduates can be recruited into American critical care fellowships. Ironically, our country already has a potentially ample supply of qualified and interested candidates for critical care training: graduates of emergency medicine residency programs.

Unfortunately, only a minority of critical care fellowships accept emergency medicine residency graduates for training.67 Despite an intensivist shortage described as “dramatic, alarming, compelling, unprecedented and threatening,”13 the American Board of Internal Medicine proposes limiting access further by eliminating slots program directors previously could fill with non-internal medicine applicants. All this will do is create more unfilled slots.

The few emergency physicians who manage to complete a critical care fellowship are barred from taking a US certifying examination. This is the major reason why emergency medicine graduates do not seek formal training in critical care, according to an informal survey of the Emergency Medicine Residents’ Association estimated 5,000 members (C. Elie, MD; personal communication; May, 2004). The American Board of Medical Specialties has been asked to reconsider their position on numerous occasions, but has declined to do so.

Before asking Congress to change our immigration laws, shouldn’t the American Board of Internal Medicine and the American Board of Medical Specialties drop their opposition to critical care training and subsequent board certification for residency-trained emergency physicians? There is a nationwide shortage of properly trained intensivists that must be addressed. It is time to put patients before politics.

Kelley, MA, Angus, D, Chalfin, DB, et al (2004) The critical care crisis in the United States: a report from the profession.Chest125,1514-1517. [CrossRef] [PubMed]
 
Irwin, RS, Marcus, L, Lever, A The critical care professional societies address the critical care crisis in the United States.Chest2004;125,1512-1513. [CrossRef] [PubMed]
 
Ewart, GW, Marcus, L, Gaba, MM, et al The critical care medicine crisis: a call for federal action; a white paper from the critical care professional societies.Chest2004;125,1518-1521. [CrossRef] [PubMed]
 
McCaig, LF, Burt, CW National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary.Adv Data2004;340,1-34. [PubMed]
 
Report puts spotlight on inpatient holds: the No. 1 reason for ED overcrowding.ED Manag2003;15,61-63. [PubMed]
 
Milzman, DP, Rubin, S, Moskowitz, L Consideration of adult critical care training for emergency physicians.Acad Emerg Med1999;6,345-348. [CrossRef] [PubMed]
 
Huang, DT, Gunnerson, KJ, Kimball, EJ, et al Emergency medicine residents’ access to critical care fellowships [abstract]. Crit Care Med. 2003;;31 ,.:12. [CrossRef] [PubMed]
 

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References

Kelley, MA, Angus, D, Chalfin, DB, et al (2004) The critical care crisis in the United States: a report from the profession.Chest125,1514-1517. [CrossRef] [PubMed]
 
Irwin, RS, Marcus, L, Lever, A The critical care professional societies address the critical care crisis in the United States.Chest2004;125,1512-1513. [CrossRef] [PubMed]
 
Ewart, GW, Marcus, L, Gaba, MM, et al The critical care medicine crisis: a call for federal action; a white paper from the critical care professional societies.Chest2004;125,1518-1521. [CrossRef] [PubMed]
 
McCaig, LF, Burt, CW National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary.Adv Data2004;340,1-34. [PubMed]
 
Report puts spotlight on inpatient holds: the No. 1 reason for ED overcrowding.ED Manag2003;15,61-63. [PubMed]
 
Milzman, DP, Rubin, S, Moskowitz, L Consideration of adult critical care training for emergency physicians.Acad Emerg Med1999;6,345-348. [CrossRef] [PubMed]
 
Huang, DT, Gunnerson, KJ, Kimball, EJ, et al Emergency medicine residents’ access to critical care fellowships [abstract]. Crit Care Med. 2003;;31 ,.:12. [CrossRef] [PubMed]
 
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