The provision of intensive care to patients in the throes of life-threatening acute illness is one of the most important and most expensive parts of US health care. Today, adults in the United States are increasingly likely to receive intensive care unit (ICU) care compared with previous generations, with the greatest ICU resource use occurring among older patients and those at the end of life.1 Several million individuals are admitted to ICUs in the United States each year at a cost approaching 1% of the nation's gross domestic product.2,3 A large body of evidence suggests that the likelihood a patient will survive an episode of critical illness is exquisitely dependent on how the ICU is staffed.4 In particular, care led by physicians trained and certified in critical care medicine (CCM) is strongly associated with improved odds of survival. In the rest of the developed world, ICUs are staffed exclusively by physicians trained in CCM. However, in the United States, only a third of patients in the ICU are managed by critical care physicians.5 There is no coordinated effort to train an expanded workforce of CCM physicians.
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