TY - JOUR
T1 - Critical care and perioperative medicine
T2 - How goes the flow?
AU - Coursin, Douglas B.
AU - Maccioli, Gerald A.
AU - Murray, Michael J.
N1 - Funding Information:
The approach to research must be redefined to ensure that anesthesiologist–perioperative physicians engage in clinical or translational research efforts that benefit patient care. The chance of having anesthesiologist–perioperative physicians funded by the National Institutes of Health (NIH) is increasingly remote unless changes in training proactively are made. A motivated physician-in-training must be identified and aligned with a mentor, who does not use him or her as a workhorse to finish projects but serves as a guide to ensure that the trainee matures into an independent investigator. Identifying a mentor with current NIH support, preferably one with clinical projects in a general clinical research center or with translational bench research complemented by an understanding of clinical priorities and practices, facilitates such efforts.
PY - 2000
Y1 - 2000
N2 - The specialty of anesthesiology is at a crossroad. Do anesthesiologists stay in the illusionary safe harbor of the operating room and allow critical care anesthesiologists to float alone? How c1an in-fighting with other medical and nonmedical providers be avoided, while maintaining or expanding the historic and hopefully future roles of anesthesiologists as hospital-based physicians? A different tact is required to redefine the scope of the practice with broadened training to provide increased expertise in the evolving medical marketplace. This approach would include solid training in business, informatics, data management, and critical thinking on outcomes. This paradigm shift may be challenging, and requires redirection, reallocation of assets, re-education, and a new mindset. If successfully applied, however, it presents a means to strengthen the respected position of the specialty and to promote the medical care and practice of perioperative specialists in the rapidly changing landscape of modern medicine. Regarding the question of turf and ownership of the ICU, the authors suggest pursuing the higher ground of an excellent scope of practice, which facilitates the care and activities of surgical and primary care colleagues. These colleagues, administrators, and governmental agencies will have to be re-educated to support training and provide equitable remuneration. Appropriately trained anesthesiologist-intensivists can complement many other care providers, while providing a wide range of services with an economy of care, whether in a semiclosed or closed ICU setting.
AB - The specialty of anesthesiology is at a crossroad. Do anesthesiologists stay in the illusionary safe harbor of the operating room and allow critical care anesthesiologists to float alone? How c1an in-fighting with other medical and nonmedical providers be avoided, while maintaining or expanding the historic and hopefully future roles of anesthesiologists as hospital-based physicians? A different tact is required to redefine the scope of the practice with broadened training to provide increased expertise in the evolving medical marketplace. This approach would include solid training in business, informatics, data management, and critical thinking on outcomes. This paradigm shift may be challenging, and requires redirection, reallocation of assets, re-education, and a new mindset. If successfully applied, however, it presents a means to strengthen the respected position of the specialty and to promote the medical care and practice of perioperative specialists in the rapidly changing landscape of modern medicine. Regarding the question of turf and ownership of the ICU, the authors suggest pursuing the higher ground of an excellent scope of practice, which facilitates the care and activities of surgical and primary care colleagues. These colleagues, administrators, and governmental agencies will have to be re-educated to support training and provide equitable remuneration. Appropriately trained anesthesiologist-intensivists can complement many other care providers, while providing a wide range of services with an economy of care, whether in a semiclosed or closed ICU setting.
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U2 - 10.1016/S0889-8537(05)70178-4
DO - 10.1016/S0889-8537(05)70178-4
M3 - Article
C2 - 10989707
AN - SCOPUS:0033838149
SN - 0889-8537
VL - 18
SP - 527
EP - 538
JO - Anesthesiology Clinics of North America
JF - Anesthesiology Clinics of North America
IS - 3
ER -