Intensive-care Medicine - Medical Specialties

Medical Specialties

Critical-care medicine is a relatively new but increasingly important medical specialty. Physicians with training in critical-care medicine are referred to as intensivists. The specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, pediatrics, anesthesiology, or surgery. Board certification in critical care medicine is available through all four specialty boards. Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respriatory therapists, and physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care. This has led the Leapfrog Group to make a primary recommendation that all ICU patients be managed or co-managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. However, there is a critical shortage of intensivists in the United States, and most hospitals lack this critical physician team member.

Other members of the critical care team may also pursue additional training in critical care medicine. Respiratory Therapists may pursue additional education and training leading to credentialing in Adult Critical Care (ACCS) and Neonatal and Pediatric (NPS) specialties. Nurses may pursue additional education and training in critical care medicine leading to certification as a CCRN by the American Association of Critical Care Nurses. Paramedics are certified to levels of CCEMTP or FP-C. Nutrition in the intensive care unit presents unique challenges and critical care nutrition is rapidly becoming a subspecialty for dieticians who can pursue additional training and achieve Certification in Enteral and Parenteral Nutrition through the American Society for Parenteral and Enteral nutrition (ASPEN). Pharmacists may pursue additional training in a postgraduate residency and become certified as Critical Care Pharmacists.

Patient management in intensive-care differs significantly between countries. In Australia, where intensive-care medicine is a well-established speciality, ICUs are described as "closed". In a closed unit the intensive-care specialist takes on the senior role where the patient's primary physician now acts as a consultant. The advantage of this system is a more coordinated management of the patient based on a team who work exclusively in ICU. Other countries have open ICUs, where the primary physician chooses to admit and, in general, makes the management decisions. There is increasingly strong evidence that "closed" intensive-care units staffed by Intensivists provide better outcomes for patients.

In veterinary medicine, critical-care medicine is recognized as a specialty and is closely allied with emergency medicine. Board-certified veterinary critical care specialists are known as criticalists, and generally are employed in referral institutions or universities.