The Shortage of Critical Care Physicians

UPDATE: I have been working as a Medical Scribe for several Hampton Roads area hospitals for almost two months. I am still licensed as an EMT, but after working medical transport for about two years, I felt that it was time for a change and jumped at the opportunity to see a new side of medicine by working directly in the local emergency rooms. I plan to work as a Scribe throughout the remainder of my undergraduate career and am considering volunteering as an EMT with the city of Virginia Beach to keep up my skills and credentials.

While working in the Emergency Room today, I ran into one of the medical school students at EVMS with whom I used to work medical transport. We caught up a bit and started talking about critical care fellowships given that he was a fourth-year medical school who has decided on an Emergency Medicine Residency. He told me that he was also interested in Critical Care, but told me that it wasn’t really an option for him given that there were very few routes that one could take in order to becoming a Critical Care Fellow. Those being: Internal Medicine, Surgery, Anesthesiology, and Pulmonology.

Naturally, I felt slightly disheartened at this news as I have a tremendous interest in Family Medicine and was disappointed that the door to critical care medicine, which I was also considering as a sub-specialty for later on in my career, seemed to be closed before I even began. So I did a little research of my own.

Before working with Dr. Haleem on her research project while she was completing her final year of her Family Medicine residency at EVMS, I was heavily considering Internal Medicine. As I worked more closely with her, I began to learn about some of the advantages of Family Medicine over Internal Medicine that could be more generally reduced to the fact that Family Medicine physicians can do more and see a wider variety of patients. Dr. Haleem even told me that several of her classmates who chose residencies in Internal Medicine now regret their choice and wish that they chose Family Medicine instead.

With these facts and anecdotes in mind, it was naturally a great surprise when I learned that my friend was absolutely correct. The majority of critical care fellowships are granted to Internal Medicine residents regardless of some of the strong advantages that Family Medicine residents seem to have over them. For whatever reason, Family Medicine just does not seem as glamorous to most as it probably should. In spite of the impending shortage in practicing physicians that we can expect to see in the coming years, the number of PCPs have been on a steady decline–physicians seem to prefer to specialize instead of choosing to manage the specialists.

When I shadowed Dr. O’Donnell in the MICU, one of the things that will always stay with me is the way that Dr. O’Donnell managed the patients’ care by way of weighing the needs of the patients with the appropriate medical response by way of the multitude of resources available. As a Pulmonologist and Critical Care specialist, Dr. O’Donnell was able to use his skills to determine what the patient needed and then made the decision if/when a specialist needed to be called in for a consult. The patient was always at the center, it was never the disease or illness; and Dr. O’Donnell was the one who kept everyone grounded.

With one patient in particular who was incredibly sick, there were specialists from all over the place who were brought in: Infectious Disease, Cardiology, Surgery, Pathology. Each of them offered a unique perspective that contributed to the identity of the patient’s illness; but Dr. O’Donnell was the one who was responsible for putting the pieces together. Pulmonary medicine and critical care are closely entwined; and the physicians who practice this type of medicine are some of the best in their field–a long-held belief of mine that was also corroborated today by my friend, “they are staggeringly brilliant–a cardiologist only focuses on the heart; but a pulmonologist focusing on the entire system: heart and lungs combined.”

Given the responsibilities required of the Critical Care physician, it makes perfect sense that Internal Medicine be one of the main gateways to the field; but what about Family Medicine? Wouldn’t it make sense that the physician trained in multiple aspects of medicine and in varying age groups be just as well, if not better suited in a medically intensive environment such as the ICU? Yet for whatever reason, Family Medicine isn’t often considered.

Thankfully, however, as I’ve come to find today, the marriage of Family Medicine and Critical Care is not one that only I have come to contemplate. In a published letter and review that I found in the US Library of Medicine, the abstract yielded a glimmer of hope,”Family Practice is the second largest collective group of physicians in the United States-second only to internal medicine. In most of rural America, where there are limited physicians serving the population, family practitioners fill the gap and provide services otherwise unavailable to those patients. This group that can potentially be trained in critical care and help solve the crisis has been prevented from doing so.”

After digging a little more, I’ve found that some programs linking Family Medicine and Critical Care have already started to be born. One of particular interest is the Advanced Hospital Medicine Fellowship hosted by the Swedish Hospital in Seattle.

While I know that I am still many years away from deciding my medical specialty, Family Medicine is one that I continue to hold very dear; and it’s nice to keep as many doors open as possible as I continue to revise and envision the path I pursue throughout my medical career.

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