The Critical Care Specialty Board System in Korea

Koh, Younsuck

Abstract

When considering the establishment of the Korean Society of Critical Care Medicine (KSCCM) in 1980, the beginning of intensive care in Korea was not behind the time. However, the level of our intensive care quality lags behind that of advanced countries. The unreasonable reimbursement system in Korea for required critical care costs staggers critical care development, along with the full time intensivist shortage problem in intensive care units (ICUs). Currently, the reimbursement rates are estimated to support around 30~50% of the cost. Due to our odd critical care reimbursement system, the more financial losses for intensive care occur, the better critical care is conducted by enhancing critical care delivery system, such as the nurse-to-bed ratio. This inappropriate critical care delivery system results in poor outcomes for our critically ill patients. Critically ill patients present many diagnostic and therapeutic problems. The need to cope with those complicated patients' problems has evolved over the last four decades into a critical care subspecialty in Western countries. The KSCCM has been the only organization in Korea that represents all professional components for critical care. After the 6 year long discussion with other related medical societies, the KSCCM launched the critical care subspecialty board under the auspice of the Korean Academy of Medical Societies on April 15th, 2008. After reviewing the applicants' carriers in critical care and their research achievements, 1,040 critical care subspecialties were born this February. Their primary specialties include Anesthesiology, Emergency Medicine, Internal Medicine, Neurology, Neurosurgery, Pediatrics, Surgery, and Thoracic Surgery. 91.7% of them are university hospital faculty members and they should renew their critical care subspecialty in every 5 years. The required items for the renewal are not easily fulfilled without working as a critical care physician. The structured critical care training program began in designated training hospitals on March 1st, 2009. Over the past few decades, the activities of intensive care units have considerably changed. Recent advances in critical care technology facilitate early detection of patients' problems. Much clinical information derived through research has been evolved as bundles of clinical managements for the indicated patients. The evidences of clinical researches show that the right application of the recommended management bundles at the right time improves patient outcomes. Therefore, the meaning of the critical care subspecialty is to perform the right care at the right time for critically ill patients. We think that the implementation of the critical care specialty and of core critical care education and training system can significantly enhance quality of critical care and patient outcomes. In order to achieve these goals, the critical care delivery system should be urgently enhanced. The enhancement includes the right compensation of critical care cost and the correction of the absurd medical law, ruling on our ICU care. The KSCCM will continuously offer a variety of activities that promote excellence in patient care, education, critical care delivery system, research, and collaboration with other countries' critical care societies. It is our hope that all critically ill patients should receive professional and humane care in Korean ICUs and the inappropriately designed health care system should not jeopardize patients' health.