Can't buy me love? Financial incentives and sub-specialization in anesthesiology.

摘要

In this issue of the Journal of Clinical Anesthesia, Rose and colleagues [3] pose a question of major importance to both public health and to the specialty of anesthesiology: how can academic anesthesiology departments encourage greater numbers of trainees to pursue careers within critical care medicine? From the standpoint of public health, such a question could not be more timely. At present, 1% of the U.S. gross domestic product is accounted for by intensive care unit (ICU) services [4], a figure likely to increase due to rapid growth of the population of adults aged 65 years and over in the coming decades [5]. While past research demonstrates improved outcomes among critically ill patients treated by physicians with specialized training in intensive care [6], only one third of all ICU patients now receive care from such physicians [7]. This observation, paired with a current shortage of critical care physicians that is projected to persist for at least the next decade [8], has led observers within the subspecialty of intensive care medicine to deem the present state of affairs "the critical care crisis in the United States" [9].