Monedero, P. (Pablo)

Universidad de Navarra

Presence of anaesthetists in intensive care medicine in Spain

Dadun, University of Navarra

Presence of anaesthetists in intensive care medicine in Spain  Pablo Monedero  Sir: I read with interest the new paper of the CoBatriCE collaboration [1]. The situation of Intensive Care Medicine (ICM) in Spain has not changed since our first publication of the CoBatriCE collaboration in 2004 [2], so it is difficult to understand the different information provided in the new article.  The paper does not reflect the simple, so-called “complexity of the Spanish situation”. The Spanish reality is shown in a 2008 survey of 105 teaching hospitals in Spain (unpublished data from the Ministry of Health):  • Primary intensivists have 2,043 ICU beds in 99 hospitals. Only eight teaching hospitals have exclusively primary ICU beds, with no anaesthesia ICU beds. • Anaesthesia intensivists have 1,455 ICU beds in 97 hospitals (we do not consider 1,572 additional PACU beds). Six teaching hospitals have exclusively anaesthesia ICU beds that provide both medical and surgical intensive care, with no primary ICU beds. • Nineteen teaching hospitals have 5 or fewer anaesthesia ICU beds, but 78 hospitals have 6 or more anaesthesia ICU beds, and 30 hospitals have equal or more anaesthesia- than primary ICU beds.  So Anaesthesia has 41.6% of ICU beds in Spain, although we do not take into account ICU beds governed by cardiologists, surgeons, etc. Table 1 of the paper does not give a real view of the situation of Spain: the speciality status of ICM in Spain is also a “Single-sub Speciality”with “Certification Specialist Training: Alone, Joint”. And Table 2 needs to include Spain as a “Multiple modes of access: Spain (modes 3, 4). 5 countries”. Spanish primary-intensivist trainees spend 2 years of rotations in Medicine (outside of the ICU) and 3 years in the ICU with 1 month of Anaesthesia rotation (a maximum of 32 months in the ICU) [3], and they are legally allowed to work only in ICM in Spain. Spanish anaesthesia trainees spend 1 year of rotation in Medicine, and between 3 and 12 months in the ICU during their training (in the 3rd or 4th year) [4], and they are legally allowed to work both in the operating room and in the ICU as they do. Information about ICM in Spain can not ignore the presence and work of anaesthesia intensivists.   P. Monedero Spanish Board of Anaesthesia, Ministry of Health, Critical Care Section of the Spanish Society of Anaesthesia, ICU Clinica Universidad de Navarra, PIO XII, 36, Pamplona 31008, Spain e-mail: pmonedero@unav.es Tel.: +34-948-255400 Fax: +34-948-296500 REFERENCES 1. The CoBaTrICE Collaboration (2009) The educational environment for training in intensive care medicine: structures, processes, outcomes and challenges in the European region. Intensive Care Med. doi:10.1007/s00134-009-1514-4. 2. Barrett H, Bion JF (2005) An international survey of training in adult intensive care medicine. Intensive Care Med 31:553–561. 3. Official programme of trainees in primary intensive care medicine in Spain (in Spanish): http://www.msc.es/profesionales/formacion/docs/ Medicina_Intensiva.pdf. Accessed 4 Jul 2009. 4. Official programme of trainees in Anaesthesia in Spain (in Spanish): http://www.msc.es/profesionales/formacion/docs/Anestesiologia_y_Reanimacion.pdf.  Accessed 4 Jul 2009.     

Presence of anaesthetists in intensive care medicine in Spain

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Universidad de Navarra

Dadun, University of Navarra