Training Hospitalists to Address the Intensivist Shortage
Training Hospitalists to Address the Intensivist Shortage
Hospital medicine and critical care medicine share similar competencies and values. Eighty-five percent of practicing hospitalists are internists, who have historically been well trained to manage acutely ill hospitalized patients. Categorical internal medicine (IM) training emphasizes acute inpatient medicine, with residents spending approximately two-thirds of their training time in the hospital. Many of the cognitive skills required for practicing critical care medicine are encompassed in categorical IM training, as well as in the Core Competencies in Hospital Medicine. Furthermore, hospitalist staffing models are specifically adapted to meet the needs of acutely ill patients. With their consistent presence in the hospital (many programs provide 24:7 in-house coverage), hospitalists see patients several times a day if necessary and can respond to their acute needs in real time. In many institutions, hospitalists are tasked as first responders to in-house emergencies, often covering ICUs when intensivists are unavailable.
Most importantly, hospital medicine and critical care medicine are philosophically aligned. Both disciplines are defined by their location of practice rather than by an organ system or constellation of diseases. Both specialties embrace hospital-based process improvement, lead multidisciplinary teams, and champion quality and safety initiatives. Hospitalists and intensivists routinely collaborate to improve hospital care through shared protocol implementation, patient throughput management, and quality improvement initiatives. The ideology and mechanics of high-performing hospitalist and intensivist programs are extremely similar.
Potential Value of Hospitalists in the ICU
Hospital medicine and critical care medicine share similar competencies and values. Eighty-five percent of practicing hospitalists are internists, who have historically been well trained to manage acutely ill hospitalized patients. Categorical internal medicine (IM) training emphasizes acute inpatient medicine, with residents spending approximately two-thirds of their training time in the hospital. Many of the cognitive skills required for practicing critical care medicine are encompassed in categorical IM training, as well as in the Core Competencies in Hospital Medicine. Furthermore, hospitalist staffing models are specifically adapted to meet the needs of acutely ill patients. With their consistent presence in the hospital (many programs provide 24:7 in-house coverage), hospitalists see patients several times a day if necessary and can respond to their acute needs in real time. In many institutions, hospitalists are tasked as first responders to in-house emergencies, often covering ICUs when intensivists are unavailable.
Most importantly, hospital medicine and critical care medicine are philosophically aligned. Both disciplines are defined by their location of practice rather than by an organ system or constellation of diseases. Both specialties embrace hospital-based process improvement, lead multidisciplinary teams, and champion quality and safety initiatives. Hospitalists and intensivists routinely collaborate to improve hospital care through shared protocol implementation, patient throughput management, and quality improvement initiatives. The ideology and mechanics of high-performing hospitalist and intensivist programs are extremely similar.
