Intensivist

An intensivist, also known as a critical care doctor, is a medical practitioner who specializes in the care of critically ill patients, most often in the intensive care unit (ICU).[1][2] Intensivists can be internists or internal medicine sub-specialists (most often pulmonologists), anesthesiologists, emergency medicine physicians, pediatricians (including neonatologists), or surgeons who have completed a fellowship in critical care medicine. The intensivist must be competent not only in a broad spectrum of conditions among critically ill patients but also with the technical procedures and equipment used in the intensive care setting such as airway management, rapid sequence induction of anaesthesia, maintenance and weaning of sedation, central venous and arterial catheterisation, renal replacement therapy and management of mechanical ventilators.[3]

Intensivist
Occupation
SynonymsCritical care doctor
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Doctor of Medicine or equivalent.
Fields of
employment
Hospitals, Intensive care unit, CVICU, Surgical ICU

Training in Different Countries

Australia and New Zealand

Training in the medical speciality of intensive care medicine is facilitated and managed by the College of Intensive Care Medicine of Australia and New Zealand. Training takes a minimum of six years to complete after internship and involves a dedicated 12 months of clinical medicine training and 12 months of anaesthesia training in addition to training in the intensive care unit.[4] Trainees also complete a first part exam in the relevant basic sciences and a second part 'Fellowship' exam towards the end of training. Doctors who complete training are awarded Fellowship of the College of Intensive Care Medicine of Australia and New Zealand (FCICM) and are eligible to practice as a consultant Intensivist.

Sweden

In Sweden one speciality entails both anesthesiology and intensive care, i.e. one cannot become and anesthetist without also becoming an intensivist and vice versa. The Swedish Board of Health and Welfare regulates specialization for medical doctors in the country and defines the speciality of anesthesiology and intensive care as being:

“[…] characterized by a cross-professional approach and entailing

A medical doctor can enter training as a resident in anesthesiology and intensive care after obtaining a license to practice medicine, following an 18-24 month internship. The residency program then lasts at least five years, not including the internship. See also Residency (medicine), Sweden.

United States

After medical school there are several different routes to becoming an intensivist. One can do a three year internal medicine residency, and then a three year pulmonology/critical care fellowship, or a two year critical care fellowship. Also, if starting with internal medicine, it is possible to do a different specialty fellowship entirely, such as three years of cardiology or gastroenterology, and then an additional one year fellowship in critical care medicine.[6] It is also possible to complete a residency first in general surgery, anesthesiology, and emergency medicine before applying for a 1-2 year fellowship in critical care.[7]

Role in healthcare

Intensivists most often work in the intensive care unit. These physicians oversee the majority of care of these patients and make decisions about treatment, testing, procedures, consultations, etc. Majority of the patients that are admitted to the ICU are severely ill, and these physicians are experts at managing their complex challenges including multiple organ failure, life-threatening infections, trauma victims, and more. They must work with a large number of other professionals including physician assistants/nurse practitioner, registered nurses, pharmacists, respiratory therapists, and more.[8]

Intensivists often man interhospital transfers of critically ill patients, both on short range helicopter[9][10] or ground based missions,[11] as well as longer range national transports[12] to specialized centra or international missions to retrieve citizens injured abroad.[13][14] Ambulance services employ units staffed by intensivists that can be called out to provide advanced airway management, blood transfusion, thoracotomy, ECMO, and ultrasound capabilities outside the hospital.[15] Intensivists often (along with general surgeons and orthopedic surgeons) make up part of military medical teams to provide anesthesia and intensive care to trauma victims during armed conflicts.[16]

References
  1. "Definition of "intensivist"". Merriam Webster: Medical Dictionary. Retrieved 2023-03-26.
  2. Cunha, John. "What Does a Critical Care Medicine Doctor Do?". eMedicineHealth.
  3. "Subspecialty Careers: Critical Care Medicine".
  4. https://www.cicm.org.au/Trainees-and-IMGs/Training-Program/General#TrainingTime. {{cite web}}: Missing or empty |title= (help)
  5. Socialstyrelsen (2015). Läkarnas specialiseringstjänstgöring, Målbeskrivningar 2015 (PDF). Falun, Sweden: Edita Bobergs AB. p. 521. ISBN 978-91-7555-304-7.
  6. "Critical Care Medicine | ACP Online". www.acponline.org.
  7. "Surgical Critical Care Match". NRMP.
  8. "FREIDA Critical Care Medicine (IM) Residency and Fellowship Listing". freida.ama-assn.org.
  9. "Kompetent personal som räddar liv" [Competent Staff That Save Lives]. Akademiska sjukhuset (Uppsala University Hospital). Retrieved 2023-03-22.
  10. "Läkarbemannade prehospitala enheter i Sverige" [Physician Manned Prehospital Units in Sweden]. SFAI. Retrieved 2023-03-22.
  11. "Intensivvårdsambulans" [Intensive Care Ambulance]. AISAB. Retrieved 2023-03-22.
  12. "Medicinska avdelningen vid SLA" [Medical Department at SLA]. Svensk luftambulans (Swedish Air Ambulance). Retrieved 2023-03-22.
  13. Hamadé, Kassem (2009-11-12). "I natt lyfte svensk hjälp – med plants för intensivvård" [Last Night Swedish Help Took Off—With Intensive Care Capabilities]. Expressen (in Swedish). Stockholm. Retrieved 2023-03-22.
  14. "Skadade officeren till Sverige" [The Injured Officer to Sweden]. Försvarsmakten (Swedish Armed Forces). Retrieved 2023-03-22.
  15. Gellerfors, Mikael; Gryth, Dan; Lossius, Hans Morten; Linde, Joacim (2016-03-23). "Snabb utveckling inom prehospital läkarbemannad intensivvård" [Rapid Devlopment in Prehospital Physician Manned Intensive Care]. Läkartidningen (in Swedish). 113. Retrieved 2023-03-22.
  16. "Läkare" [Medical Doctor]. Försvarsmakten (Swedish Armed Forces). Retrieved 2023-03-22.


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