To the Editor: I am surprised that Dr Pronovost
and colleagues1 did not mention 2 trends
that are exerting a powerful influence on ICU care in the United States.
The first of these trends is the rapidly growing hospitalist movement.
Approximately 7000 hospitalists practice in the United States, a number projected
to grow to 19 000 in the next few years.2 Several
studies have demonstrated significant improvements in efficiency and outcomes
when hospitalists care for general hospitalized patients.3 A
second trend is the projected massive shortage (35% by 2030) of intensivists
in the United States.4 This magnitude is
so large that even substantial increases in ICU training programs cannot stanch
it for the foreseeable future.
Wachter RM. Intensivist Consultation and Outcomes in Critically Ill PatientsIntensivist Consultation and Outcomes in Critically Ill Patients. JAMA. 2003;289(8):985–987. doi:10.1001/jama.289.8.985a
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