Critcal Care Workforce
CRITICAL CARE AT THE CROSSROADS:The Aging of America and the Increased Need for Critical Care Services:
An issue brief from The American College of Chest Physicians
A Crisis in Critical Care
The United States faces an unprecedented, and largely unrecognized, crisis in qualitycritical care services for the sickest patients. Today, there are insufficient numbers of qualified doctors and nurses to provide specialized care in intensive care units (ICU) forcritically ill patients – including people who've suffered heart attacks, traumatic injury,shock, burns, or exposure to toxic agents.
Pulmonary/critical care physicians are trained to have the particular skills and knowledgerequired to diagnose and treat such urgent, life-threatening illnesses within an ICU setting.
While the aging of America's population will only increase the demands for critical careservices, current training programs will not produce a sufficient number of qualifiedphysicians to meet projected needs.
If the current trend continues, a severe shortage of these specialists will occur by 2007and worsen until 2030. This means that in the years ahead, it is unlikely that patients withcritical illnesses will receive the care they need.
(JAMA 2000; 248:2762-2770 [Dec. 6, 2002])
Critical Care Specialists: On the Front Lines in Fighting Terrorism
The shortage of trained specialists could also hinder the availability of appropriatemedical care in the case of a major disaster, including a terrorist attack. In the event of anattack using chemical or biological agents, or cases in which trauma or burns are widespread, it is imperative that qualified specialists are available to direct the care of victims. Without an expert team to manage triage of incoming cases, emergencydepartments can become overwhelmed and unable to accommodate new patients – a necessity in times of crisis.
Critical Care Saves Lives and Reduces Health Costs
Studies show that when care is provided or supervised by trained specialists, patientoutcomes improve and medical costs are reduced. Data indicate that the presence of a full-time ICU medical director, in partnership with a nurse manager, can dramatically decrease the length of both ICU and hospital stays and prevent patient deaths.
What Should Be Done?
The American College of Chest Physicians, as a member of the Critical Care WorkforcePartnership is recommending the following federal initiatives to lawmakers in order to address this crisis:
- Increase funding for the graduate medical education (GME) program that providessupport for training of residents and fellows. Existing caps on GME positions should be waived specifically for pulmonary and critical care training.
- Increase funding for Title VII health professional training grants.
- Expand loan forgiveness and accelerated deductions of interest on student loans toencourage students to enter medical and nursing programs.
- Increase funding for nursing education programs and loan forgiveness programs underTitle VIII of the Public Health Service Act.
- Encourage a review of mandatory overtime practices that might adversely impact nursesand other members of the patient care team.
- Improve working conditions in critical care units to alleviate the high stressenvironment where "burnout" is pervasive.
- Critical care physicians are trained in a number of specialties, including pulmonarymedicine, internal medicine, anesthesiology, surgery, or pediatrics, and most undergo subspecialty training for at least six years beyond medical school. Critical care nurses arealso specially trained to respond to life-threatening situations.
- Today, only one out of three critically ill patients is treated by a physician trained incritical care – and yet research shows that when care is provided by trained specialists, itresults in fewer deaths, fewer days in the hospital, and lower health costs.
- The US is not producing enough pulmonary or critical care physicians to meet theprojected demand from the growth of the over-65 population. By 2007, a shortage ofphysicians trained to care for the critically ill will be evident...by 2030, it will be severe.
For more information on critical care, please contact us or visit our Web site: www.chestnet.org
What Is the Critical Care
Workforce Partnership?
The Critical Care Workforce Partnership is a coalition of medical organizations that collectively represents more than 100,000 health-care professionals who are specialists incritical care. It includes the American College of Chest Physicians, The AmericanThoracic Society, The American Association of Critical-Care Nurses, and the Society of Critical Care Medicine.
We have joined forces to help inform policy makers and other key audiences of thecomplex issues associated with shortages of critical care physicians, nurses, pharmacists,and respiratory therapists specially trained to care for the critically ill.
We share a commitment to improving the availability, quality, and cost-effectiveness ofmedical care for critically ill patients. We are also working to educate health-careprofessionals in critical care, to promote effective and safe systems of patient care, and to ensure an adequate workforce of trained critical care professionals.
We are dedicated to maintaining the world's finest system for providing critical care services – for current and future generations of Americans.