I am a strong believer that, among all specialties, anesthesiologists are the best equipped to become outstanding intensivists, in all types of ICUs. Beyond our specialty training, all we need are good diagnostic skills and experience. That doesn't mean that all anesthesiologists or anesthesiologist-intensivists are good at critical care. Au contraire; most of them are not. But our extensive knowledge of physiology, pharmacology, cardiopulmonary resuscitation, airway, ventilation, pain management etc. gives us a fantastic advantage.
I think that the secret of great outcomes in medicine is a HEALTHY balance of intervention and expectant observation. In every specialty, that balance is different, and clearly anesthesiology and critical care are different. Critical care has 2 big components: acute resuscitation and subacute/chronic care. Anesthesiologists tend to excel at the former and suck at the latter. And while the former may save lives short term, it's the latter that actually changes long-term outcomes. It's also the latter which depends so much on good day-to-day medicine, including that expectant observation. As one of my fellowship oldies but goldies told me: "Don't just do something, stand there!". Good critical care requires a significant amount of minimalism, of vigilant doing-nothing. Let nature take its course, help it when needed, but do NOT think it's YOU who's healing the patient. And this is where most surgeons (and knee-jerk anesthesiologists and "associate providers") have a problem. In both anesthesiology and surgery, expectant observation and thinking are frowned upon (and this is why these two specialties are so nicely ripe for midlevel takeover; anybody can follow protocols and knee-jerk algorithms).
I teach my residents that one of the main causes of ICU admission and pathology are physicians. Always look for the iatrogenic. There is no limit to human stupidity, even when one has M.D. after one's name. While this may sound pompous and arrogant, it's the truth. Many of my patients get better by simply removing harmful treatments and allowing nature to take its course. Many ICU protocols are made for dumb people who don't have the skills to adapt to each patient; protocols are better than nothing, the same way that index investing is better than active investing for the large majority. Still, for people like Warren Buffett, the active, contrarian approach can do miracles. The same way, in the hands of the knowledgeable, the non-knee-jerk people, ICU patients do much better.
The secret of being good at critical care is being able to understand what's going on with the patient, and being able to do the RIGHT thing about it. That means both having great diagnostic skills (including physical exam and ultrasound), and a good amount of experience (and PATIENCE). Again, this is where the greats shine. I remember reading online an anecdote about a patient who was in septic shock, on fluids (there was an "empty" ventricle, A-line variability and even some dynamic IVC collapse) and pressors, getting worse and worse, with borderline MAP and urinary output, rising lactates, you name it, despite all the protocolized care and everything but the kitchen sink being thrown at him. Until a smart intensivist came and took a look at his hepatic and renal vessels and noticed a ton of venous congestion, so he stopped the fluids and started diuresing him (because most of his problems were due to fluid overload). While on pressors! (and possibly on CRRT, I don't remember exactly). Within a couple of days, most of the bad stuff was reversed and the patient was extubated, because of a contrarian who took the time to diagnose, think, and apply his extensive knowledge. I see this kind of "miracle", again and again and again, with good intensivists, after taking over similar patients from less knowledgeable providers. Not everybody is made for critical care, the same way not everybody is made for anesthesia.
However, even suggesting that somebody could practice critical care without even a year of fellowship is LUDICROUS. It shows tremendous ignorance of what modern and good critical care entails.I would argue that even that year is just a small part of the ocean of knowledge a good intensivist will need to accumulate; it makes one safer at keeping most patients alive, but there is a long way to go before one is truly good, much longer than in anesthesia. Modern critical care requires a lot of time investment, a lot of reading, hence most of the greats are not the doers. And since anesthesiologists (and surgeons) are mostly doers, who focus on short-term outcomes,... let's not fool ourselves.
