Hospitalists need critical care training pathway

Dear Editor,

It is with great interest that we read the article “Hospitalists trained in family medicine seek critical care training pathway” by Claudia Stahl.1 We would like to thank the authors for the article and at the same time emphasize the relevance and necessity of critical care knowledge for hospitalists taking care of critically ill patients.

It is a well-known fact that hospitalists provide an ICU level of services, especially in community hospitals. There are step-down or intermediate-care units across large hospitals, which also are staffed mostly by hospitalists. So we strongly support the family medicine track having a critical care training pathway, and at the same time encourage internal medicine graduates to pursue a critical care certification program. It not only is helpful, but at times also proven to be beneficial for hospitalists who care for critically ill patients to have critical care knowledge.

Dr. Venkatrao Medarametla

Dr. Venkatrao Medarametla

There was lot of excitement in 2012 when SHM and the Society of Critical Care Medicine (SCCM) issued a joint position paper proposing an expedited, 1-year, critical care fellowship for hospitalists with at least 3 years of clinical job experience, instead of the 2-year fellowship.2 However, there was a quick backlash from the American College of Chest Physicians (ACCP) and the American Association of Critical-Care Nurses (AACN), who criticized the “inadequacy” of 1 year of fellowship training for HM physicians3, and so the excitement abated.

It may not be possible for hospitalists to take 2- to 3-year breaks from their career to pursue a critical care fellowship. There are certain courses, like Fundamental Critical Care Support (FCCS) and critical care updates for hospitalists; however, the duration of these courses is not enough to give the exhaustive training that we need. Many hospitalists work week-on/week-off schedules, and we are willing to invest some of our off time to pursue a year-long course. We believe a year-long course, if structurally sound, might be able to teach the skill sets to provide quality care to our critically ill patients.

Considering the paucity of available critical care training, we believe there is a strong necessity to develop long-term critical care training targeted at hospitalists caring for critically ill patients. Whether you are a family medicine graduate, an internal medicine graduate, or an advanced practitioner, once you are a hospitalist you are a hospitalist for life – irrespective of your future practice – as you continuously strive for quality of patient care and patient safety and satisfaction.

Primary author

Venkatrao Medarametla, MBBS

Assistant Professor of Medicine, University of Massachusetts Medical School

Medical Director, Intermediate Care Unit, Baystate Medical Center

Hospital Medicine, Baystate Medical Center

[email protected]

Secondary authors

Prasanth Prabhakaran, MD

Sureshkumar Chirumamilla, MD

Hospital Medicine, Baystate Medical Center



2. Siegal EM, Dressler DD, Dichter JR, Gorman MJ, Lipsett PA. Training a hospitalist workforce to address the intensivist shortage in American hospitals: a position paper from the Society of Hospital Medicine and the Society of Critical Care Medicine. J Hosp Med. 2012;7:359-364.

3. Baumann MH, Simpson SQ, Stahl M, et al. First, do no harm: less training ≠ quality care. Chest. 2012;142:5-7.

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