In my view, current shortages at various hospitals mandate providing more intensivists. Qualitatively, an argument to reduce numbers of physicians with advanced training, skills, and experience in a complicated high-mortality and morbidity field seems wrong. Quantitatively, there is neither expert consensus nor accepted evidence regarding how many ICU doctors are enough for the United States's various regions of populations unequally distributed with respect to advanced age and underlying illness. Experts estimating US physician requirements obtain quite different results, depending upon the established methodology used. Domestic epidemics such as HIV, SARS, MERS, and Ebola, requiring intensivists to save lives, are not predictable. Having continually practiced some ICU medicine since completing training in 1983 and having passed the American Board of Internal Medicine examining process for Critical Care when first offered in 1987, and at subsequent 10-year intervals in 1997 and 2007, I present why the United States needs more locally-based physician intensivists, describe how pursuit of revenue has undermined the mission of nationwide critical care improvement, and suggest how to correct the problematic trend that would concentrate money, power, and staffing in dominant hospital systems instead of creating safe systems for optimizing care in communities where the patients are found.