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Renli Qiao, MD, PhD, FCCP; Mark J. Rosen, MD, Master FCCP; Rongchang Chen, MD, FCCP; Sinan Wu, MD; Darcy D. Marciniuk, MD, FCCP; Chen Wang, MD, PhD, FCCP
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine (Dr Qiao), Keck School of Medicine, University of Southern California; the American College of Chest Physicians (Dr Rosen); First Affiliated Hospital of Guangzhou Medical College (Dr Chen), Guangzhou Institute of Respiratory Diseases; Beijing Hospital (Dr Wu), Ministry of Health; the Division of Respirology, Critical Care and Sleep Medicine (Dr Marciniuk), University of Saskatchewan, Royal University Hospital; and the Chinese Thoracic Society (Dr Wang), Beijing Hospital, Ministry of Health, Beijing Institute of Respiratory Medicine, National Clinical Research Centre for Respiratory Medicine.

Correspondence to: Mark J. Rosen, MD, Master FCCP, 2595 Patriot Blvd, Glenview, IL 60026; e-mail: mrosen@chestnet.org


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1434-1435. doi:10.1378/chest.14-0593
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Published online
To the Editor:

We read with great interest the correspondence about our recent commentary in CHEST1 that proposed establishing the subspecialty of pulmonary and critical care medicine (PCCM) in China. Drs Du and Weng cite the importance of critical care as a specialty in China, that “general” ICUs achieve equivalent or superior survival rates compared with “specialty” units, and that critical care is best delivered in a multidisciplinary environment. They correctly point out that ICUs may be led by physicians from various backgrounds, including anesthesiology, emergency medicine, and pulmonary medicine. However, we disagree with the implication that intensivists with training and experience in PCCM would not embrace a multidisciplinary approach. Indeed, the program requirements for accreditation for US fellowships in PCCM state, “critical care medicine is multidisciplinary in nature [and] the program must provide opportunities to manage adult patients with a wide variety of serious illnesses and injuries requiring treatment in a critical care setting.”2 Training requirements in PCCM explicitly call for the knowledge and skills outside of respiratory medicine that Drs Du and Weng deem necessary. We can all agree that regardless of the primary specialty of who leads the critical care team, proper training and experience are required; Du and colleagues3 have noted that there are currently no formal accredited fellowship training programs in critical care medicine (or other subspecialties) in China.

Dr Huang and colleagues share concerns that respirologists/intensivists would not espouse the importance of an interdisciplinary approach to critical care and remind us that critical care is a recognized Chinese specialty that started in surgical units. However, despite decades of evolution, there is still a severe shortage of critical care physicians.4

We do not maintain that only PCCM specialists should lead critical care units. All intensivists must have similar knowledge and skills and an interdisciplinary approach, regardless of their primary specialty, and achieving that requires rigorous training and certification. In the United States, the great majority of ICU physicians are subspecialists trained and certified in both pulmonary and critical care medicine.5 These physicians continue to fill a void left by diminishing numbers of anesthesiologists, surgeons, and internists who choose a practice consisting of only critical care. We believe that recognition by China of PCCM as a subspecialty, with a standardized curriculum, training path, and certification process, will dramatically increase the number of well-trained and skilled physicians urgently needed to care for the growing numbers of critically ill patients. We look forward to collaborating with our “pure” intensivist colleagues in advancing the science and practice of critical care medicine for the benefit of our patients.

References

Qiao R, Rosen MJ, Chen R, Wu S, Marciniuk D, Wang C; on behalf of the CTS-ACCP Pulmonary and Critical Care Medicine Workgroup. Establishing pulmonary and critical care medicine as a subspecialty in China: joint statement of the Chinese Thoracic Society and the American College of Chest Physicians. Chest. 2014;145(1):27-29.
 
ACGME program requirements for graduate medical education in pulmonary disease and critical care medicine (internal medicine). Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/156_pulmonary_critical_care_int_med_07132013.pdf. Accessed February 17, 2014.
 
Du B, Xi X, Chen D, Peng J; China Critical Care Clinical Trial Group (CCCCTG). Clinical review: critical care medicine in mainland China. Crit Care. 2010;14(1):206.
 
Wang C, Xiao F, Qiao R, Shen YH. Respiratory medicine in China: progress, challenges, and opportunities. Chest. 2013;143(6):1766-1773.
 
Duke EM. Health Resources & Services Administration, US Department of Health & Human Services. Report to Congress: the critical care workforce: a study of the supply and demand for critical care physicians. Requested by Senate report 108-81, Senate report 109-103, and House Report 109-143. Health Resources & Services Administration website. http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed June 23, 2013.
 

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References

Qiao R, Rosen MJ, Chen R, Wu S, Marciniuk D, Wang C; on behalf of the CTS-ACCP Pulmonary and Critical Care Medicine Workgroup. Establishing pulmonary and critical care medicine as a subspecialty in China: joint statement of the Chinese Thoracic Society and the American College of Chest Physicians. Chest. 2014;145(1):27-29.
 
ACGME program requirements for graduate medical education in pulmonary disease and critical care medicine (internal medicine). Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/156_pulmonary_critical_care_int_med_07132013.pdf. Accessed February 17, 2014.
 
Du B, Xi X, Chen D, Peng J; China Critical Care Clinical Trial Group (CCCCTG). Clinical review: critical care medicine in mainland China. Crit Care. 2010;14(1):206.
 
Wang C, Xiao F, Qiao R, Shen YH. Respiratory medicine in China: progress, challenges, and opportunities. Chest. 2013;143(6):1766-1773.
 
Duke EM. Health Resources & Services Administration, US Department of Health & Human Services. Report to Congress: the critical care workforce: a study of the supply and demand for critical care physicians. Requested by Senate report 108-81, Senate report 109-103, and House Report 109-143. Health Resources & Services Administration website. http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed June 23, 2013.
 
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