OpEd: The Medical Trainees and Other Professionals Supporting the Intensive Care Units in the Fight Against COVID-19

Nitin K Puri, MD

Nitin K Puri, MD

I am not sure if I ever will get used to reading about the capacity of Intensive Care Units on the front page of national newspapers.  Part of the travesty of this year is when my specialty made headlines and continues to make the news. Intensivists (someone who cares for the critically ill), are supposed to be invisible, caring for post-operative surgical patients, and those too ill for regular medical floors.

Occasionally, loved ones remember us as we offer solace at the end of life. In general, though, we are not the members of the medical community who make headlines. In this year of grief, it has been regularly noted that only half the acute care hospitals in America have Intensivists. My hospital has one of the oldest and most prestigious critical care training programs in the world, but everyone is not us.

In the midst of this surge in critical care patients, someone needed to fill the gap. Across the United States, it has been advanced practice providers, attending physicians from a wide range of disciplines, and physicians in training who met the call. I am grateful to all, but I believe physicians in training (interns, residents, and house staff) deserve special recognition because they are still honing their skills.

After medical school, these physicians in training enter a specialty of their choosing and then spend grueling years honing their trade. In 2003, rules were established to allow house staff to work only 80 hours a week. These trainees often work night shifts, weekends, holidays, and are routinely the first responders when a crisis occurs in the hospital. This apprenticeship occurs after graduate school, but what makes it worthwhile is that it is in the field they choose.

In the spring of 2020, this journey for physicians in training changed. As the pandemic overwhelmed much of the United States, physicians in training from diverse backgrounds were drafted into service to keep the American medical system afloat.

The rate of physicians who were being infected was unclear, and it required tremendous personal fortitude to just do our jobs. As an attending physician, it was my job and responsibility to care for the COVID patients, but this was not the case for these trainees. Without hesitation, however, they joined the fight at great personal risk and have suffered significant consequences, including experiencing symptoms of acute stress, depression, and anxiety. The emotional toll has been tremendous, and the disruption in their education is still unknown. Yet, when asked to help, they did it with aplomb.

In the Intensive Care Unit, we all learned new lessons as different specialties interacted with each other in the development of treatment plans demonstrating the value of  multi-disciplinary care. These intense interactions thawed the tribalism that sometimes occurs between specialties, improving communication and working relationships. This will ultimately benefit patients over the long run.

Medical advancements often occur during tragic events. Perhaps this greater appreciation of our house staff physicians and more interdisciplinary care will be a positive side effect of this disaster.

Most importantly, as we go through our second surge, it is important remember how got through the first wave of the COVID-19 virus. I am grateful to the house staff physicians for not only stepping up, but reminding many of us of the beauty and duty of being a physician. Now, I hope more of them become intensivists.


Nitin K. Puri, MD, is the Division Head of Critical Care Medicine and the Co-Medical Director of the Center for Critical Care Medicine at Cooper University Health Care.

2 Comments

  1. Avatar Barbara Mathern

    Dr Puri,
    Well said!
    Although this year has been one of the most challenging years to work in the ICU, aside from feeling exhausted, I am honored to work under your direction.
    Just the simple fact that you take time out of you day to check on your Respiratory Therapists…asking us how we are holding up/doing…asking if we need anything… it means a lot and for that I thank you!
    Bobbi Mathern

  2. Avatar Kathleen Coyle RN

    Dr Puri
    No one says it better than you, as one of the staff nurses in the ICU, I think I speak for all of us when I say how proud I am of the team at our institution. Every med student, intern, resident, fellow and attending has gone above and beyond. When there is nothing left to give, they give more. Having worked with you for many years, I can honestly say that you inspire greatness. Your leadership is unparalleled and I thank God everyday for each and every one of you. If I am ever in need, I would consider it a privilege to be taken care of by any one of you.

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