While past literature has stressed the importance of optimal nurse staffing for improved patient outcomes, this study surveyed intensive care unit (ICU) directors to evaluate physician staffing practices. Investigators discovered overnight in-house physician coverage in only 60% of ICUs, work shifts that exceeded 20 hours more than 80% of the time, and a largely inexperienced group of overnight providers. All of these findings raise concern about workload, fatigue, and patient safety, particularly as they reflect a lack of compliance with guidelines from the Society of Critical Care Medicine in 2003. The survey results are not linked to patient outcomes, and this would represent an important and next step for future study.