JAMA study shows aging 'baby boomers' to cause treatment demand pinch in critical care units

December 04, 2000

In the first study of its kind to include aging "baby boomers" in its results, researchers today predicted demand for medical services provided by critical care and pulmonary medicine specialists will outpace the future supply of these doctors by 2007. The article appears in the December 6, 2000, Journal of the American Medical Association.

According to the study, critical care specialists today provide care to about 37 percent of all intensive care unit (ICU) patients. Since Medicare enrollment is predicted to grow by more than 50 percent over the next 30 years, this study estimates a shortfall of critical care specialists equal to 22 percent of patient demand by 2020 and 35 percent by 2030. A shortage of pulmonary specialist time will also rise to 35 percent by 2020 and 46 percent by 2030.

Care of the critically ill and management of pulmonary disease are two of the largest specialities in medicine. The increase in the elderly population will profoundly influence these specialist practices, notes the paper.

"The shortfall we predict is troubling because the current provision of care by intensivists is arguably already low and because the aging population will likely create similar shortfalls in other areas of medicine," said Mark A. Kelley, M.D., Chief Medical Officer and Executive Vice President, Henry Ford Health System, Detroit, Michigan. Dr. Kelley, with four colleagues, authored the paper on behalf of the Committee on Manpower for Pulmonary and Critical Care Societies, sponsored by the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine.

The study was designed to project how changes in demography, especially an increase in the aging population, will influence the demand for pulmonary and critical care specialists.

For their analysis, the authors estimated the current provision of critical care and pulmonary services in the U.S. by examining existing population, patient, and hospital data sets. They conducted nationally representative surveys of ICUs, as well as of critical care and pulmonary specialists. The data were then analyzed to determine the influence of patient, physician, regional, hospital, and payee characteristics on practice patterns of critical care intensivists and pulmonologists. These analyses were incorporated into models to forecast the future supply of, and demand for, specialist care in these fields through year 2030.

The research results showed that almost 56 percent of current ICU days were used by patients 65 and older, with the number of days needed per 1,000 population rising from 37 for adults younger than 65, to 178 days for those 65 to 74, and then to 245 days for those 75 to 84. Also, the data showed that two-thirds of all in-patient pulmonary days were incurred by patients 65 and older, with demand in the number of days also rising steadily from 262 days per 1000 population at age 65 to 634 per 1,000 over age 85.

With regard to the number of U.S. intensivists trained, there were 354 graduates during 1996 from pulmonary and pulmonary/critical care medicine programs, 110 graduates from internal medicine critical care programs, 67 graduates from surgical critical care programs, and 63 graduates from anesthesiology critical care programs.

The study points out that, after 2007, with no special circumstances considered other than the growing number of aging "baby boomers," demand rises rapidly while supply remains near constant.

"Our results are a wake-up call to those in public policy who think about workforce issues to start looking at the future the way we did," said Dr. Kelley. "We are not saying our forecasting is perfect. But the data certainly stops you dead in your tracks if you think that specialists will be in over-supply."

He noted that specialists do not suddenly appear when the need for their services is realized or when legislation is passed. It takes a minium of a six-year lead time to produce a specialist.

Since critical care specialists currently provide slightly over one-third of all ICU care, the authors believe it is key to determine the optimal ratio of intensivist care in ICUs.

Further adding a sense of urgency is a call by major companies for more ICU staffing by intensivists. On November 15, the Leapfrog Group, formed by a consortium of large corporations, announced a need for an intensivist in every non-rural hospital ICU. The Group's sponsor is the Business Roundtable, an association of Fortune 500 corporate chief executives. In demanding several new cost-effective approaches they believe hospitals should take to provide better treatment for patients, they said they wanted to educate millions of employees at major corporations that not all hospital care is equal. They want to create incentives for hospitals to reduce medical errors substantially by encouraging their employees to use only hospitals that implement their suggested changes. One of the three medical reforms they propose is for hospitals to staff ICUs with doctors who have credentials in critical care medicine.

Bruce Bradley is the Leapfrog Group's Director, or Bullfrog. He is also the Director of General Motors Managed Care Plans. General Motors provides health care services for 1.2 million GM workers, retirees, and their families. Bradley stresses the urgency of implementing the Group's three initiatives, with particular emphasis on making intensivist care available in ICUs.

"We estimate that almost 54,000 lives in the U.S. could be saved if hospitals staffed non- rural ICUs with intensive care specialists," said Bradley. "We know the tremendous value of these specialist's skills to patient care based on the medical literature and our discussions with experts. We need to start training more intensivists soon in order to rectify this serious national treatment gap. We intend to help that happen nationally through Leapfrog Group's educational efforts with our employees."

Dr. Kelley commented: "As we discovered in our study, right now about one-third of the care in ICUs is provided by intensivists. If the total amount of care went up to 50 percent within the next several years, the need for more intensivists would rise considerably. We believe it is time to look at the future training needs for these professionals very soberly."
After the embargo date/time, reporters can find a copy of the article's abstract at http://jama.ama-assn.org/. Reporters may request a copy of the entire article faxed to them by calling Lori Quigley at 212-315-6442.
Dr. Kelley can be reached for comment on the study at 313-876-8701. Mr. Bradley can be phoned for comment about the need for intensivists at 313-665-4604. For a comment from the three sponsoring societies, call: for the American College of Chest Physicians (ACCP), Susan K. Pingleton, M.D., FCCP, Immediate Past President of the ACCP at 913-588-6045; William J. Martin, II, M.D., President of the American Thoracic Society, through his secretary Julia Valente at. 317-630-8451; and for the Society of Critical Care Medicine (SCCM), Thomas Rainey, M.D., Chair of the Coalition for Critical Care Excellence and former SCCM President at 301-365-4153.

American Thoracic Society

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