Most hospitalists know when they need a pulmonologist (“intensivist”) and it’s much better for the patient to have too many docs than too few.

I agree that there is not enough intensivist to cover the needs of every major hospital ICU. At times it would be nice to have one individual we could consult that could help with multiple aspect of intensive care medicine, without having to consult multiple subspecialties to manage some of the most critically ill patients.

I think hospitalist are the ideal choice for managing ICU patients with subspecialty consultation or an intensivist when indicated.

As long as there is a market niche, yeah, there will be someone to fill it and IM hospitalists are the rational and capable people to provide that service. At any hospital that can support a closed unit (which depends more on volume than availability), there will be more and more pressure to move to a closed model. As the Leapfrog measures percolate through CMS and TJC, the incentive for hospitals to recruit critical care hospitalists will increase.

We’ve got them — it rocks.

The “turf wars” are rare outside of academia and very large hospitals where doctors actually talk to one another and can work together.

There’s enough work for everyone and I know very few pulmonologists who want to manage DKA and GI bleeds in the middle of the night. A hospitalist who can’t manage an ICU patient shouldn’t be taking care of “floor pts” either – he won’t recognize when they are decompensating.

Happy is right – in an ICU more than any place else, some one needs to coordinate care and keep everyone on the same page. ICU care costs more, but hospitalists can help decrease the costs as well.