Dolly Dholakia

Because of their comprehensive training in clinical physiology/pharmacology and resuscitation, anesthesiologists are ideally trained to direct the treatment of patients in the intensive care unit. Some anesthesiologists seek specialized fellowship training in critical care medicine as a subspecialty. They oversee the full medical treatment of the sickest patients in the intensive care unit. In this setting, the anesthesiologist's responsibilities include medical evaluation and diagnosis, respiratory and cardiovascular support, and infection control. Anesthesiologists in ICU also have the medical and professional skills to handle a variety of emergency and trauma conditions. Airway management, cardiac and pulmonary resuscitation, advanced life support, and pain relief are among the services they offer. They assist in stabilizing and preparing the patient for emergency surgery as consultants.

Most anesthesia practices avoid considering ICU coverage due to two common factors. The first is sales opportunity, and the second is cardiac care politics. In an age where Ambulatory Surgery Centers (ASCs) and endoscopy centers have proven to be such rational places to search for additional revenue potential, most intensive care facilities are not seen as good prospects for expansion because they are fundamentally unprofitable. Why would you mine the unprofitable when the productive is so close? ICU staffing requirements can present an opportunity for anesthesia practices as well. Given the level of operation and service rendered, rotating members of the community around the unit could be more cost-effective for anesthesia. This will also allow for more flexibility in terms of hiring and coverage.

Anesthesia-based critical care medicine (CCM) is at a fork in the road at the turn of the millennium. While anesthesiologists played a key role in the early creation of critical care, the American critical care anesthesiologist is now a threatened species, outnumbered by colleagues in pulmonary medicine and surgery in terms of numbers and political clout. Anesthesia-based CCM is a peripheral subspecialty of anesthesiology practiced by a small minority in the United States, in contrast to Europe, where anesthesiologists play a dominant role in critical care.  As we seek to broadly redefine the role of the anesthesiologist both inside and outside the operating room, it is timely to ask the question, “Is there a future for anesthesiologists in ICU and critical care?”