Sustaining critical care delivery in today’s healthcare environment requires more than resilience—it also calls for collective solutions to systemic challenges.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Past President Jose L. Pascual, MD, PhD, FRCS(C), FACS, FCCM, elaborates on the session presented during the 2026 Critical Care Congress, Critical Care Under Pressure: Sustaining the Workforce and Infrastructure Amid Rising Demands.

Joined by host Marilyn Bulloch, PharmD, BCPS, FCCM, Dr. Pascual examines the complex forces reshaping critical care, from shrinking ICU capacity and hospital closures to persistent workforce shortages and shifting training pipelines. He highlights concerning trends such as reduced entry into certain critical care pathways, particularly anesthesiology. At the same time, he points to encouraging growth in other pathways, with increasing participation from clinicians in emergency medicine, neurology, and surgery.

The conversation underscores disparities in access to care, particularly for rural and community hospitals. Dr. Pascual explores the tension between the regionalization of specialized care and the need to maintain equitable access across health systems, emphasizing the importance of thoughtful resource distribution and collaboration across institutions. Beyond workforce numbers, the evolution of leadership in critical care is also impactful, including the migration of experienced clinicians into administrative roles and the potential need for cyclical leadership models that maintain clinical engagement.

Meeting these challenges requires innovation and cooperation. Dr. Pascual highlights advancements in education, particularly the expansion of simulation-based training, as critical tools for maintaining competency and improving team performance.

Resources referenced in this episode: