Workforce needs and training in pulmonary and/or critical care medicine

Abstract

A consistent feature of discussions of health care reform has been the assertion that there is an oversupply of specialists.' Although there is some data that address the issue of physician workforce,2 there is not universal agreement as to how the information should be interpreted and acted upon.3'4 Given these uncertainties and the need to chart a clear course for training in critical care medicine and in pulmonology that is consistent with the anticipated needs for specialists in these areas, accurate data on which to base projections are essential. Therefore, on January 16 to 17, 1995, the American Thoracic Society, American College of Chest Physicians, Society of Critical Care Medicine, and the Association of Pulmonary/Critical Care Training Program Directors met to discuss future needs for training in pulmonary and critical care medicine. In addition to representatives of each society, the meeting was also attended by representatives of the American Board of Internal Medicine (ABIM), individuals who have performed studies of workforce needs for other subspecialties, and physicians who have conducted prior studies of workforce needs in pulmonary and critical care medicine. The workshop addressed two concerns: (1) workforce needs (numbers of trainees) and (2) quality of training. These two areas have not been addressed for a significant period of time by societies with a specific interest in either pulmonary or critical care medicine. The rapid changes in healthcare delivery and the implications of these changes for training were additional stimuli to hold this meeting. Although each society could develop its own recommendations for training, it was believed that *From the American Thoracic Society (Dr. Hunninghake, president); the American College of Chest Physicians (Dr. Mark, president); the Society of Critical Care Medicine (Dr. Rainey, president); and the Association of Pulmonary/Critical Care Training Program Directors (Dr. Fish, president). This article has also appeared by prior agreement in the official journals of the American Thoracic Society and the Society of Critical Care Medicine and is a joint report on the meeting of the ACCP, ATS, SCCM, and APCCTPD, January 16-17 at ACCP National Headquarters in Northbrook, Illinois, at which issues relating to this article's topic were discussed. these recommendations would not be as effective as recommendations that were endorsed by all societies with an interest in pulmonary and critical care training. The importance of joint recommendations was reinforced in a discussion by Dr. Harry Kimball, president of the ABIM, who also noted that it was the responsibilities of the societies interested in pulmonary and critical care to address these issues. He further noted that recommendations coming from these groups would be very influential in developing policy. It was acknowledged that critical care, as a discipline, is unique compared with other internal medicine areas in that it is practiced by noninternal medicine physicians, eg, surgeons, anesthesiologists, and pediatricians. In addition, although most of the internal medicine physicians who practice critical care are also trained in pulmonary medicine, other internal medicine subspecialists as well as general internists are trained and certified in critical care medicine. Finally, the practice of critical care crosses traditional boundaries, eg, internal medicine-based critical care physicians often work in surgical or mixed medical-surgical ICUs.