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Editorials: Point and Counterpoint |

COUNTERPOINT: Does the United States Need More Intensivist Physicians? No

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):625-628. doi:10.1016/j.chest.2015.11.031
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The current “debate” about the need to train more intensivists is, of course, not really a debate. If the models that predict the growing demand for critical care services are valid and every patient in an ICU bed needs an intensivist to improve outcome, and if health care is organized in the future as it is now and society is willing to pay for this service, there is little doubt that there will be a lack of trained intensivists by 2025. I will argue that even if these assumptions are true, and it is unlikely that they are, intensivists should focus our efforts in other areas to improve outcomes for the critically ill and let others argue for strategies to increase our numbers. First, the models that estimate the number of intensivists required to optimize health outcomes contain significant uncertainties and assumptions. Second, critical care workforce projections rely on models of future care that are not financially sustainable for the United States. Third, specialty-specific models do not address the inherent trade-offs involved in training one type of physician at the expense of others. Finally, strategies to reduce demand for critical care services and increase quality of care without intensivists are available and present clear opportunities for leadership by intensivists.

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