Hospitals are struggling to staff their intensive care units with intensivist physicians, and many have turned to their hospitalists to fill the gaps, according to an article in the November issue of Today’s Hospitalist. A survey of Michigan hospitals participating in the Keystone Project found that only 20% of respondents staffed their ICUs exclusively with board-certified intensivists. The rest relied on open staffing models that include using hospitalists to treat ICU patients. Confirming the trend, a survey conducted by the Society of Hospital Medicine (SHM) found that 75% of hospitalists work in the ICU. Although hospitalists share many of the same philosophies and skills of intensivist, they are not specifically trained in the treatment of critically ill patients. Therefore hospital leaders cannot expect hospitalists to deliver a level of care or outcomes that are consistent with intensivists. In fact, the Leapfrog Group said staffing ICUs with critical care-trained intensivists reduces the risk of patients dying in the ICU by 40%. The tough reality is that many ICUs have no choice but to use hospitalists. There are simply not enough intensivists to meet the need, and with the aging population, demand for critical care services is expected to increase. The Society of Critical Care Medicine (SCCM) and SHM recognized this situation and proposed a one-year fellowship program that would train hospitalists in critical care and lead to board eligibility. Currently, hospitalists can enroll in a two-year program to become board certified, but the timeframe prevents hospitalists from entering the program. Many hospitalists simply cannot absorb the financial hit. Critics of the one-year program feel it is not long enough for a hospitalist to become fully-versed in critical care. Supporters of the shorter program argue that a significant portion of the two-year program involves research training, which is not relevant to hospitalists who want to work in the ICU. Even if the SCCM/SHM proposal never becomes reality, it has prompted critical care associations to establish core competencies for critical care professionals. Establishing such standards would allow physicians to be credentialed based on competencies and knowledge, not a time-based program.