Nonphysician clinicians in the ICU

Until very recently the medical care of the patient in the intensive care unit (ICU) was provided primarily by physicians. Many of these physicians were specifically trained as intensivists to manage the critically ill and provide minute to minute titration of care to improve the outcomes of these patients. However there has been a change in the delivery of critical care in many centers with the addition of NPCs (nonphysician clinicians) to the team. A 1998 article in JAMA listed 10 nonphysician disciplines that will affect the demand for physicians in the future; this article focuses on only two of these disciplines: physician assistants (PAs) and acute care nurse practitioners (ACNPs). A driving force for the addition of these NPCs to the ICU team is the downsizing of resident programs. This article explores the utilization of NPCs in the ICU, including the perceived advantages and potential controversies associated with these practitioners.