Why Critical Care Medicine Is Important to the Future of Anesthesiology

Perspective of a Nonintensivist:
Why Critical Care Medicine Is Important to the Future of Our Specialty
Ronald D. Miller, M.D.
ASA April 2006 Newsletter (Extracts)

• The creation of critical care units and evolution of critical care medicine (CCM) as a specialty were originally brought about by anesthesiologists.
• In 2004 ASA President-Elect appointed a Task Force on the Future Paradigms of Anesthesia Practice to address the projected evolution of anesthesiologists’ clinical practices over the next 20 years.
• Based on a broad base of information, however, the task force concluded that tertiary care hospitals of the future will be increasingly dominated by seriously ill patients who require procedures (i.e., surgical, imaging, cardiovascular) and monitored and/or critical care beds.
• Many groups, most notably the Leapfrog Group, have strongly recommended that critical care be delivered by individuals especially trained and board-certified in CCM.
• Major changes are occurring in many specialties, including vascular surgery, cardiac surgery and others.
• While operating room anesthesia has dominated our specialty for many years, in planning for our future, we would be well served to diversify our value to medicine specifically and society overall.
• Encouraging additional training in CCM and also encouraging anesthesiology residents to take critical care fellowships would provide a sound basis for our specialty’s role in the future tertiary care hospital.
• Significant involvement with CCM is crucial for our specialty’s future and the welfare of CCM overall.
• The combined training of anesthesiology and CCM creates the knowledge and skills for the physician leaders of the future tertiary care hospital and potentially with different models of care, the leaders for inpatient care generally.
• The methods to accomplish this goal include incorporating more critical care experience in our residency programs, lengthening our residencies, encouraging incentive-based choices of our fellowships or even redesigning some of our residencies to provide a combined anesthesiology and CCM residency for board certification in both specialties.

Ronald D. Miller, M.D., is Professor and Chair, Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California.