Due to the shortages of the traditional ICU workforce, it is evident that APPs and hospitalists are providing care in the ICU. The question then becomes not if but how to successfully integrate them into the ICU. Adding hospitalists, NPs, and PAs into the ICU team as “intensivist extenders” effectively increases the availability of adult critical care services.1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23 However, successfully establishing these alternative providers into an ICU team is not as easy as advertising, hiring a few, and scheduling shifts. Integration of these alternative staffing providers needs effective planning with thoughtful consideration and discussion of many factors, including institutional expectations, financial considerations and rationalization, administrative support, current staff acceptance, governance, recruitment, and retention (Table 78–2).