Originally posted on my LinkedIn blog at https://www.linkedin.com/pulse/were-coming-you-mike-hess
Every now and then, someone fires up a conversation about education in respiratory therapy. The latest discussion started because of a kind-of-insane rumor that the National Board of Respiratory Care was mandating all RTs get a bachelor's degree in the next couple of years and throwing "all those with associates degrees under the bus." Despite there being no real truth to this belief (for starters, it is not within the NBRC's purview to make or enforce a decision like this), many people immediately panicked, thinking their livelihoods in jeopardy. Although this shows a fairly disturbing ignorance about the roles and priorities of our various professional bodies, the conversation has honestly been revelatory. For example, many people asked, "Why should we bother to get a bachelor's? It doesn't pay more/there's no additional respect/it doesn't help you be a better clinician/various other excuses." For a long time, perhaps, there wasn't a clear answer to this question. But there is now.
It's because of me.
More accurately, it's because of therapists LIKE me. You see, for the past five months, I've been building an outpatient program explicitly designed to help people live better with COPD. As part of a primary care clinic, I make sure patients are on the right medications and that they know how to use their inhaler devices. I make referrals to pulmonary rehabilitation. I help make sure patients get oxygen when they need it. I educate on nutrition and exercise and countless other things. In short, the core of job is explicitly to keep people OUT of the hospital.
I'm not alone. Health systems from UC-Davis to Carolinas HealthCare and everywhere in between are actively working to identify respiratory patients at risk for re-admission. Predictive analytics are even starting to make it possible to identify patients at risk BEFORE they start hitting the ER. Disease management strategies, from the latest GOLD recommendations to the upcoming COPD National Action Plan, increasingly favor outpatient management to inpatient treatment. Reimbursement strategies, like the Hospital Readmissions Reduction Program, are likewise encouraging better longitudinal maintenance over episodic care. The future of chronic lung disease is clear, and it involves spending as little time in the hospital as possible.
That means that changes in employment are inevitable. As more care starts to happen outside the hospital walls, demand for non-ICU inpatient respiratory services is going to drop. It's unlikely to drop to zero (we won't keep EVERYONE out of the hospital), but it's going to be significantly lower than it is today. The days of the "neb jockey" are numbered, and the most logical place for the reallocation of those jobs is in care coordination and case management roles. These often require more than an associate's degree, and that will likely remain the case no matter what happens with alternative reimbursement models or value-based payments. At the same time, we have a distinct need for the respiratory perspective to be represented at the administrative level. But it's obviously not a lateral move from the ward to the C-suite, so we're going to need to up our qualifications there, too. Basically, whichever direction you look, we need more education. The associate's degree isn't going to cut it for much longer.
One of the loudest, most consistent arguments that people use against increasing our educational standards is that a degree won't make you a better therapist. It may be true that a simple sheet of paper won't do that alone (although that's another debate), but there is now a foreseeable time where without it, you won't be a therapist at all. Not because the NBRC or the AARC or even CoARC says you can't be, but because employers will be looking for more. Where are you going to be when that time comes?