OBJECTIVE: The recent Health Resources and Services Administration report on critical care manpower details the impending crisis in the critical care workforce in the United States. DESIGN: A review of the Health Resources and Services Administration statistics indicate the present structure for training critical care physicians through combined pulmonary/critical care fellowships is, and will remain, woefully inadequate to meet demand. INTERVENTION: Training for intensive care unit physicians will require new paradigms for training, including consideration of free-standing critical care residencies and multidisciplinary critical care fellowships. CONCLUSION: Unless the training structure changes, the worsening shortage of intensivists will precipitate a crisis, resulting in the disintegration of critical care delivery in the United States.