Good morning, everyone. I'm Sean Thompson. I'm a critical care anesthesiologist at the University of Nebraska Med Center in Omaha, also the fellowship director. And so this is a topic that's pretty close to home, so I don't have any relevant disclosures for today's talk at all. And so the objectives of my talk is to kind of review the workforce update that we wrote over the summer that got published in Critical Care Connections this past fall, discuss the shortage concerns that we all know are prevalent and present right now in the current workforce state, discuss fellowship programs and how that growth is hopefully going to help relieve those things from the physician standpoint, and then also review efforts that are being undertaken in the realms of the nursing, APP pharmacy, and also the respiratory therapy workforce. Because again, multidisciplinary teams have been shown to be ideal for patient care, and so we want to make certain that we have all realms accounted for going forward to maintain this nice, strong workforce to care for our patients. And so when it comes to shortage issues, it's really difficult to know because of how things are kind of delineated, but we know that there are shortages across the country, and in particular probably more in underserved and rural areas, because Pastores and his group reviewed the American Hospital Association data sets and found that there were about 48 percent of acute care hospitals that did not have intensivist coverage, and with hospitals that did have major, large ICUs, that was about 78 percent of those hospitals had intensivist coverage with, again, predominant amount of places that did not have intensivist coverage were in more rural areas as well. And so we've obviously, the other thing that's probably leading to some of the shortage, or a big part of the shortage, is burnout and effects from the pandemic that I think all of us really took on for those couple years as well. And there's a continued increase for critical care as the population continues to age, and so all of these things are kind of snowballing, and that's going to lead us to need more and more providers going forward in the future. And so, happy to report that fellowship programs continue to increase year after year. This is looking at the past four years, and this is across all different varieties of training, whether it be from PEDS, surgical critical care, pulmonary care, and what's nice, too, is that that second to bottom one is a standalone critical care medicine residency, basically, and so they don't have to do the traditional route of training where you do, you know, internal medicine, anesthesia, surgery, what have you. They do a critical care three-year training program and then enter the workforce as trained intensivists from that standpoint, so that's been a nice addition and training avenue for folks to travel down as well and should help to improve and increase the amount of providers available. The applications remain steady, and so we still have about a one-to-one ratio. Palm Creek Care has a little bit above one, they're about one, one and a half applicant per position, and so despite having the growth in these programs, we still have a fair amount of applicants that are still applying, still showing that there is quite a really good interest in critical care medicine from trainees going forward. So that's really a good sign, and this next slide, and kind of the bottom two ones are more of the signal that we have more physicians entering the workforce as well. According to the American Association of Medical Colleges, we were at about just over 13,000 board-certified intensivists in the United States, and now that number's over 14,000. It's about 14,200 total, so even during the pandemic, that number continued to grow, and the forecast is that it's going to continue in the future as well, which again, from the workforce standpoint, should be beneficial. So nursing obviously took a very large hit during the pandemic, had over 100,000 nurses leave the workforce during the course of the pandemic and afterwards, and in an effort to try to pull and get new grads into the ICU, more academic centers are standing up nurse residency programs to get these new graduates into the ICU, get the training and resources that they require to help take care of these really complex and difficult patients, and then it also provides areas for leadership and advancement within their roles in the ICU as well. And these programs have been shown to actually not only increase nursing into the realm of critical care, but it actually helps with retention as well, because it gives them a path forward, so they're just not in a stagnant position, they have room to advance and move forward as well. And then obviously the other retention things is healthy work environment, good, safe patient to nurse ratios, and then obviously competitive pay. For APPs, it's really uncertain what the exact number is just because of how the demographics are laid out, but there's currently about 30,000 nurse practitioners that are listed as critical care nurse practitioners, and just over 2,000 physicians assistants that are listed as critical care. But again, there's probably more so on the physician's assistant side of things because some of them just kind of list what department they work for, not necessarily critical care. And so similar to nursing, there are specialized programs for PAs and nurse practitioners to get more specialized training in particular with critical care, and that will hopefully improve and get more folks into the realm of critical care from the APP standpoint as well, and should helpfully help to increase the amount of folks in the workforce. Pharmacy again, big important cog in the wheel for a big multidisciplinary team, and this is continuing to grow as well. And so we had 143 training programs in 2019, and now we had 223 as of last year, and the number of board certified critical care pharmacists is actually expected to double almost up to over 5,000 by the year 2025. So still probably not enough, but we're heading in the right direction when we look at the pharmacy workforce. Respiratory therapy also took a big hit, and they are still seeing declining numbers, and the American Association of Respiratory Care is working really hard to try to recruit folks in and work on retention strategies as well, really focusing on the workplace environment, having the tools that the respiratory therapists need at the bedside to care for their patients on a day-to-day basis as well. And so obviously, the pandemic and burnout was a major factor for folks leaving the realm, and critical care was the one area that took a big brunt of the hit on this as well. So 27% of nurses worldwide left the profession during the pandemic or shortly thereafter with burnout listed as one of the major mitigating factors as well. And so things that we need to do is, you know, rebuild, regroup, retool, and do what we do and do best, and that's take care of really, really sick folks. The Society of Critical Care Medicine actually has a lot of really great resources on the website that can deal with moral injury, well-being, and those types of things, and looking at things in the workplace that you potentially could be missing, that could be leading to burnout. And, you know, things like drug shortages and those types of things can all lead to burnout as well. And so the society has these really great resources for you to utilize online if that's something that you're dealing with at your home base. And so we keep seeing continued growth, which is great. We suspect that we're going to have a supply in the forecast of increased physicians in the workplace of about 57% by 2025. Nurse practitioners about by 73% by 2025. And this Health Resources Service Administration paper back in 2016 was only forecasting about a 16% increase for providers. So forecast-wise, it seems that we're going to have enough folks going forward to fill those gaps and fill those needs going forward as well. And so very strong job prospects for new grads and for most folks that are in the realm and want to practice in the area of critical care, need to continue aggressive recruitment, getting to trainees as soon as possible. I have med students that I'm at home that I mentor, and they have already told me that they, like, want to do critical care, so I'm trying to foster those things and keep them involved and excited about it. And I think that kind of, it goes across all realms of the multidisciplinary team as well. And really having that strong work environment where, you know, we work together, we take care of the sickest of the sick, and we get folks better, I think is going to really help with hopefully mitigating burnout and avoiding those things. So thanks for your time.

critical care workforce

multidisciplinary teams

intensivists

burnout

Society of Critical Care Medicine