Intensivist
{{Short description|Physician who treats critically ill patients in the ICU}}
{{use dmy dates|date=May 2024}}
{{Infobox occupation
| name = Intensivist
| synonyms = Critical care doctor
| pronounce =
| image =
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| official_names =
| type = Specialty
| activity_sector = Medicine
| competencies =
| formation = Doctor of Medicine or equivalent.
| employment_field = Hospitals, Intensive care unit, CVICU, Surgical ICU
| related_occupation =
}}
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).{{cite web|url=http://www.merriam-webster.com/medical/intensivist|title=Definition of "intensivist"|website=Merriam Webster: Medical Dictionary|access-date=2023-03-26}}{{cite web |last1=Cunha |first1=John |title=What Does a Critical Care Medicine Doctor Do? |url=https://www.emedicinehealth.com/what_does_a_critical_care_medicine_doctor_do/article_em.htm |website=eMedicineHealth |language=en}} Intensivists can be internists or internal medicine sub-specialists (most often pulmonologists), anaesthesiologists, emergency medicine physicians, paediatricians (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, point of care ultrasound, renal replacement therapy and management of mechanical ventilators.{{cite web|url=https://www.acponline.org/medical_students/career_paths/subspecialist/critical_care_medicine.htm|title=Subspecialty Careers: Critical Care Medicine|date=June 2023 }}
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.{{cite web|url=https://www.cicm.org.au/Trainees-and-IMGs/Training-Program/General#TrainingTime|website=College of Intensive Care Medicine of Australia and New Zealand |title=General Intensive Care Training Program |archive-url=https://web.archive.org/web/20210730211204/https://cicm.org.au/Trainees-and-IMGs/Training-Program/General#TrainingTime |archive-date=2021-07-30}} 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 anaesthesiology and intensive care, i.e., one cannot become an anaesthetist 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 anaesthesiology and intensive care as being:
{{blockquote
|text=“[…] characterized by a cross-professional approach and entailing
- perioperative medicine,
- anaesthesia and pain relief during diagnostic and therapeutic procedures,
- intensive care,
- urgent care of patients with serious diseases and injuries,
- prehospital care including transport and disaster medicine, and
- pain management.”{{cite book |author=Socialstyrelsen |date=2015 |title=Läkarnas specialiseringstjänstgöring, Målbeskrivningar 2015 |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2015-4-5.pdf |location=Falun, Sweden |publisher=Edita Bobergs AB |page=521 |isbn=978-91-7555-304-7}}
|multiline=yes}}
A medical doctor can enter training as a resident in anaesthesiology 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.{{cite web |title=Critical Care Medicine {{!}} ACP Online |url=https://www.acponline.org/about-acp/about-internal-medicine/subspecialties-of-internal-medicine/critical-care-medicine |website=www.acponline.org|date=June 2023 }} It is also possible to complete a residency first in general surgery, anaesthesiology, and emergency medicine before applying for a one- to two-year fellowship in critical care.{{cite web |title=Surgical Critical Care Match |url=https://www.nrmp.org/fellowship-applicants/participating-fellowships/surgical-critical-care-match/ |website=NRMP}}
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.{{cite web |title=FREIDA Critical Care Medicine (IM) Residency and Fellowship Listing |url=https://freida.ama-assn.org/specialty/critical-care-medicine-im |website=freida.ama-assn.org}}
Intensivists often man interhospital transfers of critically ill patients, both on short range helicopter{{cite web | url = https://www.akademiska.se/for-vardgivare/specialistsjukvard/luftburen-intensivvard/vara-team/ | title = Kompetent personal som räddar liv | trans-title = Competent Staff That Save Lives | website = Akademiska sjukhuset (Uppsala University Hospital) | access-date = 2023-03-22}}{{cite web | url = https://sfai.se/delforeningar/sflpa/lakarbemannade-enheter-i-sverige/ | title = Läkarbemannade prehospitala enheter i Sverige | trans-title = Physician Manned Prehospital Units in Sweden | website = SFAI | access-date = 2023-03-22}} or ground based missions,{{cite web | url = https://www.aisab.nu/sv-se/ambulanssjukvard/vara-ambulanser-och-fordon/intensivvardsambulans | title = Intensivvårdsambulans | trans-title = Intensive Care Ambulance | website = AISAB | access-date = 2023-03-22}} as well as longer range national transports{{cite web | url = https://svenskluftambulans.se/verksamhet/med-sla/ | title = Medicinska avdelningen vid SLA | trans-title = Medical Department at SLA | website = Svensk luftambulans (Swedish Air Ambulance) | access-date = 2023-03-22 | archive-date = 22 March 2023 | archive-url = https://web.archive.org/web/20230322221131/https://svenskluftambulans.se/verksamhet/med-sla/ | url-status = dead }} to specialized centra or international missions to retrieve citizens injured abroad.{{cite news |last=Hamadé |first=Kassem |date=2009-11-12 |title=I natt lyfte svensk hjälp – med plants för intensivvård |trans-title=Last Night Swedish Help Took Off—With Intensive Care Capabilities |url=https://www.expressen.se/nyheter/i-natt-lyfte-svensk-hjalp-med-plats-for-intensivvard-9/ |language=Swedish |work=Expressen |location=Stockholm |access-date=2023-03-22}}{{cite web | url = https://www.forsvarsmakten.se/sv/aktuellt/2010/11/skadade-officeren-till-sverige/ | title = Skadade officeren till Sverige | trans-title = The Injured Officer to Sweden | website = Försvarsmakten (Swedish Armed Forces) | access-date = 2023-03-22}} 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.{{cite journal |last1=Gellerfors |first1=Mikael |last2=Gryth |first2=Dan |last3=Lossius |first3=Hans Morten |last4=Linde |first4=Joacim |date=2016-03-23 |title=Snabb utveckling inom prehospital läkarbemannad intensivvård |trans-title=Rapid Development in Prehospital Physician Manned Intensive Care |url=https://lakartidningen.se/klinik-och-vetenskap-1/artiklar-1/klinisk-oversikt/2016/03/snabb-utveckling-pagar-inom-lakarbemannad-prehospital-vard/ |language=Swedish |journal=Läkartidningen |volume=113 |access-date=2023-03-22}} Intensivists often (along with general surgeons and orthopaedic surgeons) make up part of military medical teams to provide anaesthesia and intensive care to trauma victims during armed conflicts.{{cite web | url = https://jobb.forsvarsmakten.se/sv/utbildning/befattningsguiden/4-civil/lakare2/ | title = Läkare | trans-title = Medical Doctor | website = Försvarsmakten (Swedish Armed Forces) | access-date = 2023-03-22}}
References
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