Critical Care Medicine

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Abstract
Ritical care medicine (CCM) as a viable subspe- cialty of anesthesiology is approaching a cru- cial period in its existence that will determine whether it can survive as an important component of our specialty or be relegated to our medical, surgical, and pediatric colleagues. With the many changes in health care delivery, the future survival of anesthesi- ology as a specialty may well depend on the accep- tance that perioperative involvement, rather than sole intraoperative anesthesia practice, is the purview of the anesthesiologist. No longer are economic incen- tives and desirable time management positive factors to induce young physicians to consider anesthesia. Workloads are increasing, economic return is decreas- ing, and jobs are less plentiful. Yet, the opportunity to care for increasingly complex patients with more so- phisticated monitoring and therapeutic modalities, applying scientific physiologic and pharmacologic principles that are the basic tenants of medical prac- tice, still makes anesthesiology an exciting and desir- able profession. A crucial part of our role as perioperative physi- cians is our involvement in postoperative care of the critically ill surgical patient. To allow this role to dis- appear would not only diminish our contribution to patient care but also our value and ability to attract high-quality medical students. CCM became a recog- nized subspecialty of anesthesiology in 1986, with the first issuance of certificates of special qualifications by the American Board of Anesthesiology (ABA). The number of anesthesia critical care medicine (ACCM) physicians remains exceedingly small. To date, there are 622 certified ACCM specialists compared to 4737 in medicine and 1334 in surgery. It is anticipated that approximately 140 anesthesiologists will attempt the biannual CCM examination in 1995. This compares to 4500 candidates for ABA primary certification for the past two years. Stoltzfus et al. in the current issue of Anesthesia & Analgesia have reported the results of a survey of accredited ACCM programs investigating the num- bers of faculty and trainees as well as their practice patterns for the 1992-1993 academic year (1). They received completed questionnaires from 36 of the 42