Practice Economics

Little Progress Made Training Hospitalists to Stem Shortage of Intensivists


What would the status be for a hospitalist who could train for one year to become a critical care intensivist to address the shortage of intensivists? I’m one of the hospitalists who love critical care but cannot do two more years out for critical care training.

—Amadeo Rivera, MD

Has there been any progress in the 2012 SCCM/SHM proposal to train hospitalists as intensivists?

—Stephen M. Pastores, MD, Memorial

Sloan-Kettering Cancer Center, New York, N.Y.

Dr. Hospitalist responds:

While the conversation surrounding the shortage of intensivists and how hospitalists could help seemed to reach its pinnacle in 2012, there hasn’t been much movement in any direction since then.

As you may recall, SHM and the Society of Critical Care Medicine (SCCM) published a joint position paper in the Journal of Hospital Medicine in June 2012 in which they proposed a one-year critical care fellowship for hospitalists with at least three years of experience.

Since only one year of clinical rotations is required for critical care board eligibility, and there already exists a one-year track for other medical subspecialists (e.g. nephrology, infectious disease), most of us in hospital medicine thought the recommendation would have been much better received. Well, you guessed it. The following month, the leadership of the American College of Chest Physicians and the American Association of Critical-Care Nurses wrote in an editorial that a one-year fellowship was inadequate for hospitalists to gain competence in critical care medicine. Since then, there has not been much progress, at least not publicly, toward a standardized, streamlined, and accredited process for hospitalists to achieve critical care certification in one year.

Nevertheless, employing a standard search engine (Google) and terminology, I was able to locate one U.S.-based training program offering a one-year critical care medicine fellowship program recognized by the Accreditation Council for Graduate Medical Education for candidates with a background in anesthesiology, surgery, or internal medicine.

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