Physician training in critical care in the United States: Update 2018

Abstract

Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001-2017). The number of critical care fellowship training programs has increased 22.6%, with a 49.4% increase in the number of on-duty residents annually, over the last 16 years. This is in contrast to the period of 1995 to 2000 when the number of physicians enrolled in critical care fellowship programs had decreased or remained unchanged. Although more than 80% of intensivists in the US train in internal medicine critical care Accreditation Council for Graduate Medical Education-approved fellowships, there has been a significant increase in the number of residents from surgery, anesthesiology, pediatrics, emergency medicine, and other specialties who complete specialty fellowship training and certification in critical care. Matriculation in neurocritical care fellowships is rapidly rising with 60 programs and over 1,200 neurocritical care diplomates. Critical care is now an increasingly popular fellowship in all specialties. This rapid growth of all critical care specialties highlights the magnitude of the heterogeneity that will exist between intensivists in the future.

Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians

“…10 Although our survey identified a fair number of practice settings employing ED intensivists, advanced critical care training for the EP is still in the minority. 11 These alternative care models, while highly variable in structure, provide more specialized opportunities for the critical care medicine-trained EP and support for both the EM and ICU inpatient teams and potentially improved outcomes for critically ill ED boarding patients. 12…”

Intensivist and COVID-19 in the United States of America: a narrative review of clinical roles, current workforce, and future direction

“…Increasing fellowship training and opportunities: just like how increasing fellowship programs answered the concerns for shortages of intensivists in 2000, the current situation must help devise ways to increase post-graduate training programs in critical care in the country [ 47 ]. Although there has been an increase in fellowship programs for critical care in the last 16 years [ 47 ], the demand and supply chain continues to be strained.…”

“…Increasing fellowship training and opportunities: just like how increasing fellowship programs answered the concerns for shortages of intensivists in 2000, the current situation must help devise ways to increase post-graduate training programs in critical care in the country [ 47 ]. Although there has been an increase in fellowship programs for critical care in the last 16 years [ 47 ], the demand and supply chain continues to be strained. At present, there are 5 specialty critical care fellowship programs approved by accreditation council for graduate medical education (ACGME) and include anaesthesiology, pulmonology, general surgery, internal medicine, and paediatrics.…”

Critical Care During the Coronavirus Crisis—Reflections on the Roles of Anesthesiologists in Meeting the Challenges of the Pandemic

“…1 This development followed an unsuccessful attempt to create a unified board certification process for all critical care physicians from various backgrounds, including anesthesiology, internal medicine, pediatrics, and surgery. 1,2 Since the introduction of board certification, the participation of anesthesiologists in critical care has not kept pace with that by other specialists from emergency medicine, internal medicine, and surgery who have expanded their role in adult critical care, including cardiothoracic critical care. [1][2][3] This lack of growth prompted concerns about the future of anesthesiologists in critical care both in the 1990s and early in the new millenium.…”

“…1,2 Since the introduction of board certification, the participation of anesthesiologists in critical care has not kept pace with that by other specialists from emergency medicine, internal medicine, and surgery who have expanded their role in adult critical care, including cardiothoracic critical care. [1][2][3] This lack of growth prompted concerns about the future of anesthesiologists in critical care both in the 1990s and early in the new millenium. 1,3 It is likely that the participation of anesthesiologists in critical care throughout the United States continues to be highly variable depending on multiple factors, including sex, opportunities, and location.…”