Critical care medicine and the perioperative physician

Summary This report has presented a broad historical picture of the development of modern critical care. The central role of anesthesiology in that process is apparent. In the United States, that role has clearly declined in the last few decades. The reasons for this decline have been suggested by information regarding attitudes of physicians currently training in anesthesiology. That data also suggest ways in which CCM can be made more appealing to those who represent the future of the specialty. Fortunately, CCM fellowship programs have increasing capacity to train anesthesiologists and the potential to increase our representation in active CCM practice is real. Whether such potential is realized will depend, not on academic medical centers, but on innovative private groups willing to add CCM to their scope of practice. Some suggestions regarding goals of such a practice have been proposed and can be summarized as (1) provide high-quality patient care, (2) accept the necessary level of commitment, and (3) learn to “share the load” with grace and sensitivity to the needs of all parties involved. This is not a contest of wills. It is a cooperative effort to make the best use of limited resources, both human and material. Data exist that clearly demonstrate the improvements possible with dedicated multidisci-plinary critical care services. The value from those improvements will be apparent to your patients, your colleagues, and the health care system of which you are a part.