Only where human lives don't count.
A good intensivist will run circles around a good midlevel for anything that gets to the level of intubation or shock (and many others). Critical care is one the specialties where basic science knowledge is a fundamental requirement for good care. Exactly that basic science knowledge that's so minimized in nursing education of all levels. I am not buying and reading books about patho(physio)logy for nothing.
Half of what I do that's game-changing for the patients is usually counter-intuitive, even to some physicians. If one practices critical care by a book, any one book or source, even UpToDate, one will kill some patients, period. Every patient in the ICU is different.
Now I can see why hospitals love bad intensivists, regardless of their education level. A bad intensivist will order a ton of unneeded tests, and that's how the hospitals make their money, a lot of it. Somebody like me who thinks twice about that, who uses free bedside ultrasound before/instead of the CT scan, will not be highly popular, regardless of lives saved. That's the sad state of American medicine: what's right for the patient is quite the opposite of what's right for the hospital systems.
