Subspecialty Careers: Critical Care Medicine
The Discipline
Critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease. Critically ill patients require intensive care by a coordinated team. The critical care specialist (intensivist) may be the primary provider of care or a consultant. The intensivist needs to be competent not only in a broad range of conditions common among critically ill patients but also with the technological procedures and devices used in the intensive care setting. The care of critically ill patients raises many complicated ethical and social issues, and the intensivist must be competent in areas such as end-of-life decisions, advance directives, estimating prognosis, and counseling of patients and their families.
Procedures
Important procedural skills for the critical care medicine specialist include advanced cardiac life support, arterial blood gas sampling and interpretation, bedside pulmonary function, mechanical ventilation, placement of arterial and central venous lines, insertion of temporary pacemaker, endotracheal intubation, placement of pulmonary artery catheter, and interpretation of waveforms.
Training (via Internal Medicine)
Training in critical care medicine is most commonly pursued as part of a combined 3-year subspecialty fellowship in pulmonary and critical care medicine, after which the trainee is eligible for subspecialty certification in both pulmonary medicine and critical care medicine. In addition, a physician interested in critical care medicine can pursue training by alternative routes besides linking critical care with pulmonary medicine training. Such alternative routes include:
- A two-year accredited fellowship in critical care medicine after internal medicine residency.
- Two years of fellowship training in advanced general internal medicine (that include at least six months of critical care medicine) plus one year of accredited fellowship training in critical care medicine.
- Two years of accredited fellowship training in a subspecialty of internal medicine (three years for cardiovascular disease or gastrointestinal disease) plus one year of accredited clinical fellowship training in critical care medicine.
Training Positions
For the 2012-2013 academic year, there are 34 Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs in Critical Care Medicine with 200 active positions.
Certification
The American Board of Internal Medicine, ABIM, offers certification in critical care medicine. Certificates of Added Qualifications are also awarded from the American Board of Surgery, American Board of Pediatrics, and the American Board of Anesthesiology.