To the Editor.—
The recent article by Bone and Elpern1 concerning the expense of intensive care treatment addresses a major problem with our nation's health care bill. Contemporary medicine has been moving toward more, rather than less, intensive care treatment. In recent years, most of the relevant medical and surgical subspecialties have developed board examinations and certification in critical care—at least in part to remain "competitive" with other specialties that were doing the same. In my field, pulmonary medicine, fellows now routinely take a third year of training to sit for the critical care board examination. My own hospital has 110 "monitored beds" out of a total complement of 517 adult medical and surgical beds. It is difficult to imagine a scenario where this growing body of board-certified critical care "specialists" and the manufacturers of their equipment will not be bringing pressure to maintain or increase utilization of costly
Cohn JR. The Intensive Care Unit—Industrial Complex. Arch Intern Med. 1992;152(2):417. doi:10.1001/archinte.1992.00400140151036
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