Analysis of the variations between Accreditation Council for Graduate Medical Education requirements for critical care training programs and their effects on the current critical care workforce

Adult critical care medicine (CCM) is ill prepared for the demands of an aging US population. Sources have acknowledged a severe shortage of intensivists, yet there has been minimal discussion on the lack of critical care training opportunities. Inconsistencies in training options have led to fragmentation of how critical care services are provided to the US adult population. Significant differences exist between CCM without pulmonary and pulmonary critical care (PCCM) training as it relates to critical care coverage, patient population, and procedural skill of a trainee. The Internal Medicine Residency Review Committee appears more aligned with the PCCM vision of training rather than the CCM; thus, many PCCM programs are more available than pure CCM. Internal medicine offers the greatest pool of candidates to practice full-time CCM, yet there are minimal opportunities for internists wanting to go into straight CCM without also receiving pulmonary training. However, because many PCCM physicians spend a significant amount of time outside critical care, current PCCM training options do not meet the demand for critical care physicians. In this article, we review the barriers to critical care training opportunities and expanding the intensivist workforce and propose reasonable and practical solutions.