Critical Care Medicine Advanced Practice Provider Model at a Comprehensive Cancer Center: Successes and Challenges

The growing demand for critical care services combined with a shortage of board-certified critical care physicians and increasing limitations on resident training hours have culminated in the need for nonphysician advanced practice providers (APPs), such as nurse practitioners (NPs) and physician assistants (PAs) in US intensive care units (ICUs).^1–6  Recent survey data suggest that NPs and PAs provide care in >50% and ~25%, respectively, of adult ICUs in academic medical centers in the United States.⁷ 

APPs are typically utilized in 2 distinct paradigms in the ICU setting. In the first, APPs are recruited in small numbers to supplement existing residents or to assist the ICU attendings. In the second, APPs are hired in large numbers to function as semi-autonomous workforces in conjunction with ICU attendings. In 2007, Memorial Sloan-Kettering Cancer Center (MSKCC), a 470-bed, tertiary care cancer center in New York City, initiated a critical care...