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To the Editor: The Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS)¹ reported that the United States faces a major shortage of physicians in these specialties as the population ages. If the United States continues to provide care in substantially the same way it now does, the committee is probably correct. Two contrasting observations, however, may be in order.

First, medical care in the future care might not be provided in the same way as it is now. Aggressive care management and advance care planning might greatly reduce patient demand for critical care services in particular and for physician services in general. Especially among the very old, services might focus on comfort and care at home, which would rely predominantly on nurses with advanced training. If advance care planning and aggressive early intervention succeeded in eliminating even half of the 22% of days that patients with chronic obstructive . . . [Full Text of this Article]

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Planning Medical Services for the End of Life
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