J Hosp Med. 2010 Jan;5(1):1-3. doi: 10.1002/jhm.580.
A report by the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS), published in 2000, predicted that beginning in 2007 a gap between the demand and availability of intensivists in the United States would become apparent and steadily increase to 22% by 2020 and to 35% by 2030. Subsequent reports have reiterated those projections including a report to congress in 2006 by the U.S. Department of Health and Human Services/Health Resources and Services Administration. This "gap" has been called a health system "crisis" by multiple authors. Two important documents have published specific recommendations for how to resolve this crisis: the Framing Options for Critical Care in the United States (FOCCUS) Task Force Report in 2004 and the Prioritizing the Organization and Management of Intensive Care Services in the Unites States (PrOMIS) Conference Report in 2007. Since the initial COMPACCS report and since these 2 additional reports were published, a new opportunity to take a major step in resolving this crisis has emerged: the growing number of hospitalists providing critical care services at secondary and tertiary care facilities. According to the 2005/2006 Society of Hospital Medicine (SHM) National Survey, that number has increased to 75%. Since the number of intensivists is unlikely to change significantly over the next 25 years, the question is no longer "if" hospitalists should be in the intensive care unit (ICU); rather the question is how to assure quality and improved clinical outcomes through enhanced collaboration between hospital medicine and critical care medicine.
一份由美国胸科学会（American Thoracic Society）和危重病医学会（Critical Care Medicine Society）下属的人力委员会（Manpower Committee）于 2000 年发表的报告预测，从 2007 年开始，美国重症医学医师的需求与供给之间的差距将会显现，并在 2020 年稳步扩大至 22%，在 2030 年扩大至 35%。随后的报告也重复了这些预测，包括美国卫生与公众服务部（U.S. Department of Health and Human Services）下属的卫生资源与服务管理局（Health Resources and Services Administration）在 2006 年向国会提交的报告。多位作者将这一“差距”称为医疗体系的“危机”。两份重要的文件提出了具体的建议来解决这一危机：2004 年危重病美国框架选择（Framing Options for Critical Care in the United States）特别工作组报告和 2007 年美国重症监护服务组织和管理优先化（Prioritizing the Organization and Management of Intensive Care Services in the Unites States）会议报告。自最初的 COMPACCS 报告以及这两份补充报告发布以来，解决这一危机的一个新的重要契机已经出现：越来越多的医院医师在二级和三级保健机构提供重症监护服务。根据 2005/2006 年美国医院医学学会（Society of Hospital Medicine）的全国调查，这一数字已增加到 75%。在未来 25 年内，重症医学医师的数量不太可能有显著增加，因此问题不再是“医院医师是否应该进入重症监护病房（ICU）”，而是如何通过医院医学和重症医学之间的增强协作来保证质量和改善临床结果。
