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Editorials: Point and Counterpoint |

Rebuttal From Dr Rubenfeld

Gordon D. Rubenfeld, MD
Author and Funding Information

CORRESPONDENCE TO: Gordon D. Rubenfeld, MD, Program in Trauma, Emergency and Critical Care, Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Room D108c, Toronto, ON M4N 3M5, Canada


Copyright 2016, . All Rights Reserved.


Chest. 2016;149(3):629-630. doi:10.1016/j.chest.2015.11.028
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I read with interest the argument by Dr Davidson about growing “Little Critical Care” in lieu of some of the options proposed to address the looming critical care physician workforce gap. He argues against reducing demand for intensivist physicians through regionalization, telemedicine, advance practice clinicians, and hospitalists at small hospitals. His points are compelling. By removing intensivists, we take skilled physicians away from the bedside and potentially harm patients. In an inverse of the hospitalist-as-intensivist model, he argues that intensivists should fill the hospitalist gap at these sites. He suggests that “intensively caring” for patients in an ICU by an intensivist provides value even if they are not critically ill. Except for the unexpected dig at health services research methods upon which his arguments rely, I share his passionate advocacy for improved critical care training and innovation. I find myself with very little to rebut. In this US election year of promises, this modest proposal for “intensivists in every hospital” reminds me of the 1928 Republican promise to deliver “a chicken in every pot.” Who can argue with that?

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