Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease - Can we meet the requirements of an aging population?

Context Two important areas of medicine, care of the critically ill and man agement of pulmonary disease, are likely to be influenced by the aging of t he US population. Objective To estimate current and future requirements for adult critical ca re and pulmonary medicine physicians in the United States. Design, Setting, and Participants Analysis of existing population, patient, and hospital data sets and prospective, nationally representative surveys of intensive care unit (ICU) directors (n=393) and critical care specialist s (intensivists) and pulmonary specialists (pulmonologists) (n=421), conduc ted from 1996 to 1999. Main Outcome Measures Influence of patient, physician, regional, hospital, and payer characteristics on current practice patterns; forecasted future s upply of and demand for specialist care through 2030. Separate models for c ritical care and pulmonary disease. Base-case projections with sensitivity analyses to estimate the impact of future changes in training and retiremen t, disease prevalence and management, and health care reform initiatives. Results In 1997, intensivists provided care to 36.8% of all ICU patients, C are in the ICU was provided more commonly by intensivists in regions with h igh managed care penetration, The current ratio of supply to demand is fore cast to remain in rough equilibrium until 2007, Subsequently, demand will g row rapidly while supply will remain near constant, yielding a shortfall of specialist hours equal to 22% of demand by 2020 and 35% by 2030, primarily because of the aging of the US population. Sensitivity analyses suggest th at the spread of current health care reform initiatives will either have no effect or worsen this shortfall. A shortfall of pulmonologist time will al so occur before 2007 and increase to 35% by 2020 and 46% by 2030, Conclusions We forecast that the proportion of care provided by intensivist s and pulmonologists in the United States will decrease below current stand ards in less than 10 years. While current health care reform initiatives an d modification of existing practice patterns may temporarily forestall this problem, most anticipated effects are minor in comparison with the growing disease burden created by the aging US population.