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Analysis

How to Address Intensivist Shortfall During Coronavirus Pandemic

By Christopher Cheney  
   April 06, 2020

A healthcare consultancy anticipates a shortage of 7,900 critical care physicians nationwide when the coronavirus pandemic peaks.

The country is facing a "massive shortage" of critical care physicians, according to coronavirus pandemic modeling conducted by Array Advisors.

The United States leads the world in reported coronavirus disease 2019 (COVID-19) cases, with the total as of April 6 at more then 336,000, according to worldometer. A significant percentage of COVID-19 patients require mechanical ventilation in the ICU setting, which is expected to strain critical care resources including staff as coronavirus patients surge in the coming weeks.

ICU staffing shortages are an urgent concern, Neil Carpenter, strategic planning vice president at Conshohocken, Pennsylvania-based Array Advisors said in a prepared statement.

"While the public attention has been on beds and ventilators, we must not lose sight of the staff needed to serve the coming influx of patients. We need a national conversation about how to support and leverage our existing expertise, as well as how to contend with the coming surge of COVID-19 positive [healthcare] providers. In this fight, we need every provider to be well enough to work," he said.

Addressing intensivist shortages

Given the projected nationwide shortfall of critical care physicians, it likely will be impossible to shift intensivists from state to state to meet expected staffing demand, according to Array Advisors. The healthcare consultancy says there are six options for healthcare organizations and public health officials to cope with the shortage:

1. Retain intensivists who test positive for COVID-19 to treat ICU patients via telemedicine or, if personal protective equipment is available, treat ICU patients directly

2. Allow intensivists who have only completed one year of critical care fellowships to practice independently

3. Waive licensing regulations to increase existing international tele-ICU services and allow more international tele-ICU services

4. Enlist retired intensivists to provide direct patient care in ICUs

5. Combine artificial intelligence with advanced practice practitioners to expand the critical care workforce

6. Limit the allocation of critical care resources to patients with "extremely poor prognoses"

The Society of Critical Care Medicine has recommended that hospitals adopt a tiered staffing model in newly created ICUs to stretch the supply of critical care workers during the COVID-19 pandemic.

Critical care physician shortfall

Array Advisors' primary model for the anticipated critical care physician shortage pegs the shortfall at 7,900 doctors nationwide. The model is based on several assumptions, including a ratio of one intensivist for every 14 ICU patients during the day and the loss of 10% of critical care healthcare workers to coronavirus infection during the surge of COVID-19 patients.

The model projects there will be shortages of critical care physicians in every state except Maryland. New York leads the list of the Top 10 states that are expected to have intensivist shortages:

1. New York 1,711

2. Florida 603

3. Texas 579

4. Michigan 485

5. North Carolina 329

6. Georgia 307

7. California 305

8. Louisiana 300

9. Tennessee 291

10. Illinois 289

Christopher Cheney is the senior clinical careโ€‹ editor at HealthLeaders.


KEY TAKEAWAYS

As the coronavirus pandemic accelerates in the United States, more attention needs to be focused on the supply of critical care physicians.

Modeling predicts New York faces the largest shortfall at more than 1,700 intensivists.

Extraordinary measures may be required to address the shortage, including enlistment of retired critical care physicians to provide direct care to ICU patients.


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