ICU Staffing Shortages Linked to Aging Population

An ongoing crisis identified more than a decade ago is taking a toll on pulmonary and critical care medical providers. That was the focus of a symposium yesterday looking at the continuing shortage of intensive care unit (ICU) doctors, nurses, respiratory therapists and others as the U.S. population ages and the demand for services grows.

“Incidences of respiratory failure, severe sepsis and other critical illnesses increase dramatically when people reach the age of 65 and older,” said Shannon Carson, M.D., co-chair of session A4, “A Critical Crisis: Addressing ICU Staffing Changes.” “As a large portion of the population moves into that age group, the need for critical care services is dramatically increasing.”

The Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS) released a pivotal ICU workforce study in 2000. The study, co-sponsored by the ATS, warned of progressive shortages of critical care healthcare providers over the next 30 years. Dr. Carson compared the COMPACCS study to current workforce data and concluded that little has been done to address the problem of the number of intensivists in the United States since it was identified.

“Not a great deal has changed in our understanding of the crisis, hence the urgency of this discussion,” he said.

The number of clinicians trained in critical care medicine has increased only slightly over the last two decades, but the number of patients needing those specialized services has greatly increased, and will continue to grow. Dr. Carson said the training of pulmonary and critical care physicians, as well as the current ICU staffing model, has not kept pace with demand.

The same elements that draw people into the field of critical care—an exciting, fast-paced environment and exposure to challenging casees—are some of the same issues that limit clinicians interested in the ICU.

“Critical care is a demanding and stressful field, or at least it’s perceived that way by internal medicine residents, and that won’t change in the near future,” said Dr. Carson, who is associate professor of medicine and director of the pulmonary and critical care fellowship program at the University of North Carolina.

The primary path to critical care medicine remains through internal medicine residency and pulmonary and critical care fellowship training programs, he said.

Issues covered in the symposium included ICU staffing, work hour concerns, therapist shortages, burnout, post-traumatic stress disorder, workplace safety, and the effectiveness and dissemination of innovations in the ICU to fill staffing gaps.

“The number of board-certified intensivists has not changed very much since COMPACCS, but the number of patients and the number of beds has increased,” Dr. Carson reiterated. “So hospitals have been making greater use of physician extenders, hospitalists and electronic solutions to meet these needs.”

Symposium faculty members recommended using nurse practitioners and physician assistants as extenders to help alleviate staffing shortages, as well as greater use of hospitalists in smaller medical centers.

“The hospitalist specialty has grown significantly in the period that has elapsed since COMPACCS,” Dr. Carson said. “Those physicians have been assuming a larger degree of responsibility for ICU patients, particularly in small- and medium-sized hospitals across the country.”

The role of board-certified intensivists as ICU directors in these settings will be to make sure that evidence-based practices are taking place, he said.

“Therefore, training methods in systems-based practices should improve in fellowship training programs, and large-scale programs modeled on the Keystone Collaborative should be implemented,” Dr. Carson explained. “Additionally, the ATS should take an active role in developing productive interactions with the hospitalist profession to optimize critical care practices.”

Another important innovation is the use of electronic ICU monitoring technologies and telemedicine, which allow critical care physicians to manage the care of ICU patients.

“We discussed whether these solutions will be adequate to help meet the critical care demand, in addition to increasing the number of trained intensivists,” Dr. Carson said.