Aftermath of Leapfrog

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Given the results of the Leapfrog initiative, it looks like the demand for intensivists is about to skyrocket as hospitals nationwide conform to a "closed" ICU model. I'm interested in critical care, but I can't find much information (on the internet anyways) about the job market for intensivists these days. The advertised jobs offer minimal description of call duties, work hours, compensation, etc.

I have a bunch of questions about the field that I hope some of the critical care attendings and fellows on this forum will answer. I've talked to the academic intensivists at my institution, and I'm fairly well acquainted with their daily schedules since I worked under them as a resident. However, I'm not sure if their work routines and viewpoints are accurate reflections of life as an ICU physician in a community hospital (or other regions of the country for that matter).

It seems like I have a very skewed perspective on medical practice, since I've been at a tertiary academic center for all of my training. I literally have no idea what it's like to practice at a community hospital. So I figured I would post some questions on this forum to get some answers from physicians in various practice settings.

My concerns/questions...

The future of the specialty: Is the projected surge in demand for intensivists a reasonable prediction or is it mostly hyperbole?

Current job market for fellows: How is the job market for intensivists now? Do graduating fellows have plenty of job options or are jobs difficult to find?

Lifestyle concerns: I'm not averse to working long hours but I will be starting a family soon. Thus, I'm looking for a career that strikes a decent balance between work and family. What's a typical work week for ICU physicians in the community? What time do you get to work? What time do you typically leave? How is coverage of the ICU overnight and on weekends handled?

Income: I'm sitting on roughly $260,000 of educational debt. Obviously I need to be able to pay it off and support a family. What is the typical income of an intensivist? How is pay structured? Is it typically a salaried position? Are you part of a group? If so, is there a partnership track? What do partners typically earn?

Job security: Do you feel like your job is secure as an intensivist? In anesthesia, the threat of midlevel encroachment is always present and getting worse every year. Is midlevel encroachment a problem in critical care?

Job satisfaction: Are you happy with your career as an intensivist?

Thanks in advance for any input! :)
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you have the link/reference of where LEAPFROG says closed units are better?

IMHO, they are, but I just want to read the LEAPFROG statement. I googled and couldn't find it

thanks!
 
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europeman said:
you have the link/reference of where LEAPFROG says closed units are better?

IMHO, they are, but I just want to read the LEAPFROG statement. I googled and couldn't find it

thanks!
Click to expand...

Not exactly a position paper, but a quick fact sheet indicating their preference for closed ICUs -- http://www.leapfroggroup.org/media/file/FactSheet_IPS.pdf.

If you haven't, you should read Peter Pronovost's new book -- Safe Patients, Smart Hospitals. He's the guy at Hopkins who pioneered a lot of the changes to staffing models, and his book is awesome. He talks about how they reorganized both the ICUs and the floors at Hopkins.

While I'm admittedly a medical neophyte, it's amazing to me that the closed ICU model wasn't adopted earlier. It was just implemented at one of our local hospitals (private, non-academic), and there were actually significant objections by some of the staff, in spite of the truly remarkable data about the effectiveness of such programs. It seems like a no-brainer that someone with a CCM fellowship should be the primary person managing a patient in the ICU, irrespective of who was managing that person as an outpatient or who was operating on them.
 
sanityonleave said:
While I'm admittedly a medical neophyte, it's amazing to me that the closed ICU model wasn't adopted earlier. It was just implemented at one of our local hospitals (private, non-academic), and there were actually significant objections by some of the staff, in spite of the truly remarkable data about the effectiveness of such programs. It seems like a no-brainer that someone with a CCM fellowship should be the primary person managing a patient in the ICU, irrespective of who was managing that person as an outpatient or who was operating on them.
Click to expand...

Don't go telling that to the FP residents in the FP forum...
 
Hernandez said:
Don't go telling that to the FP residents in the FP forum...
Click to expand...

In fairness, that's only one guy who seems to be espousing that idea -- the other FP folks seem to believe that the amount of ICU time in FP residency should be expanded and maybe CCM fellowships should be offered but they do not equate themselves to not having a need for CCM. That said, even that one is still scary as hell, because if there's one person saying it, there are 100 others who believe it but don't say anything.

I posted in that thread, but in my mind worthy of saying twice: I know virtually nothing about the practice of medicine as a medical student, but even I know that in medicine, arrogance kills people. The fact that some people fail to realize that is pretty scary.
 
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