Tackling Practice Challenges

Frank O’Connell, MD

The Intensivists In Practice Committee is actually a subcommittee of the Internal Medicine Section of the Society of Critical Care Medicine (SCCM). Chaired by Leo Rotello, MD, FCCM, and Paul Yodice, MD, FCCP, FCCM, the committee was formed roughly four years ago in response to the Internal Medicine Section’s concern that the needs of members practicing in the nonuniversity setting were not being adequately addressed. The committee consists mainly of clinicians working in a non-university hospital setting (although our university based colleagues are certainly welcome), who deal with a wide range of practical issues as they attempt to practice quality critical care medicine in this setting. Some of the challenges highlighted by our committee members include navigating the politics of clinicians impacted by a change in the status quo, negotiating with hospital administrators regarding the value associated with having a dedicated intensivist program, and developing a financial package acceptable to both the hospital administration and the physicians. Our committee has also developed sessions that highlight the development of appropriate schedules conducive to attracting and retaining quality clinicians.​

Our committee is instrumental in supporting clinicians who are making a transition from an academic environment to private practice and who may be struggling with one or more of these challenges. With 70% to 80% of the healthcare in the United States delivered in a nonuniversity setting, the work of this committee has special significance and can provide an important venue for those working in or transitioning to the non-university setting to have their voices heard. This is particularly true for those who are just completing their fellowship training and who often have the most difficult time transitioning to the life of an attending physician, whether in a community- or university-based practice. Additionally, one of the committee’s major strengths is the broad-based involvement by a variety of highly qualified and vastly experienced critical care practitioners. This has led to our developing and presenting many high-quality educational sessions at the annual SCCM Congress, such as:

1. Starting an ​Intensivist Program at Your Hospital: The Nuts and Bolts
2. Cost Savings and Quality Outcome Data to Support an Intensivist Program at a Large Non- University Hospital
3. Practical Considerations for a Medical Intensivist​ Caring for Patients in a Surgical ICU
4. Integrating Palliative Care Specialists into an Intensive Care Unit

Our most recent efforts have been aimed at helping community-based intensive care units (ICUs) develop and implement strategies to make them more centered on patients and families. We have discussed such issues as implementing 24-hour visitation and family presence on rounds and during invasive procedures and resuscitation following cardiac arrest. At SCCM’s 2017 Congress in Honolulu, we presented the results of a survey developed by the committee to gauge the level of patient-centeredness that presently exists across a broad sampling of community-based ICUs. The responses were as varied as the units and provided us with a framework for continued work in this important aspect of patient care.

In this era of changing healthcare, we will all face challenges in our practices in the foreseeable future. Physicians working in the non-university setting comprise the majority of Intensivists across the country. Developing a network of these clinically practicing critical care physicians, such as exists in the Intensivists in Practice Committee, can facilitate interaction across a broad range of geographic areas and enable informed discussion of pertinent and clinically relevant topics. Through these discussions, our committee has the potential to develop and advance solutions to challenges that may be broadly applied across the country.​

One of our members, Mehrnaz Hadian, MD, MS, JD, FCCM, felt so strongly about the mission of critical care specialists in private practice that she founded her own nonprofit advocacy organization to raise awareness nationally of the role of intensivists in non-university and rural hospital settings. Dr. Hadian travelled the country interviewing nurses and physicians (mostly intensivists, some of whom are extremely well known) regarding differences in care between dedicated critical care professionals and those simply covering the unit who may also have other concurrent patient care responsibilities. The question posed to all these clinicians was the same: Does having a dedicated intensivist make a difference in terms of patient outcome? The response, as seen in a video on her website, was overwhelmingly in favor of dedicated critical care professionals.

​Although the Intensivists in Practice Committee is based in the Internal Medicine Section, it is not limited to internal medicine-based intensivists. We welcome​ intensivists from all disciplines (anesthesiology, surgery, emergency medicine, neurosciences, pediatrics, etc.) who face challenges and issues in their clinical practices and who would like to participate in an open venue that stimulates discussion and the use of different approaches among similarly practicing colleagues. We generally have conference calls four times a year and a formal meeting at each SCCM Congress.

In conclusion, the Intensivists in Practice Committee is an efficient and effective way to expand your professional circle. Committee members face and surmount the same types of challenges that you face in your everyday professional practice. Please consider joining our group.