There is a shortage of intensivists in the US, particular in the field of surgical critical care. The are many possible reasons, from “graying” of the workforce and increased workloads to decreased reimbursement and increased legal risks. As usual, money is at the root of most problems in some form or another. So is being an intensivist actually “worth” it, and how do we figure something like that out?

A group at Chapel Hill attacked this question from a financial business/financial standpoint. They looked at the lifetime return on investment of choosing a critical care career compared to non-critical care practitioners in the same fields (surgery, medicine, pediatrics). They included income data, debt burden, opportunity costs and taxes in their analysis.

Using standard financial analysis techniques, the authors found that:

• The financial value of the career choice of medical and pediatric intensivists was nearly identical to their non-critical care peers
• The financial value of choosing a surgical critical care career was significantly less than that of a general surgeon
• The lower value of a surgical critical care career was largely due to the opportunity costs of two years of lower salary during the fellowship
• The relative value of an academic critical care career was always lower, and was most pronounced among internists

Bottom line: There are many factors that go into the choice of a career in critical care. They include job satisfaction, quality of life, and many other intangibles. But money frequently intrudes into the decision making process. It appears that choosing surgical critical care incurs some degree of financial penalty, and this may  be a factor that will exacerbate the shortage of these specialists.

Reference: The economic impact of intensivist fellowship training. Poster presentation at the EAST annual scientific session, January 2013.