Blogs

The AARC and the Profession

By Timothy Myers posted 03-26-2014 09:43

  

Recent news reports about the layoffs of respiratory therapists in Kentucky and the concomitant fervor that’s followed on some social media sites prompts me to address some of the most vocal of claims. The beauty of social media is that those types of forums allow individuals to express their "opinions," but in a rational world, we all must have the foresight and knowledge to understand that opinions are not facts.

 

Here’s what we know --

MythKentuckyOne is eliminating all RTs from their health system.

That is not true. "We have spoken with the media, with RTs involved, the Kentucky Society for Respiratory Care and the Kentucky Board for Respiratory Care to get all the details. The health system has removed RTs from three stand-alone ED's (one of which is completely closing altogether). KentuckyOne still employs RTs in their hospitals and ICUs to perform ventilator management and other care for patients with respiratory diseases. While I disagree with removing RTs from the stand-alone EDs, that is a far claim from wiping them off the map.

MythNurses do not perform physical therapy like they perform respiratory therapy.

Really? I witnessed them doing that everyday in the ICUs and floors for 25 years. Read the RN license in Any State, USA and you will find it in the nursing scope of practice.

Myth. Lack of attention to detail and leadership led to others getting access to "respiratory care scope of practice."

One must remember that legislation and politics are very strange creations. Each RT practice act is slightly different, as state societies needed to work within their own political environment to accomplish getting a practice act passed in the state legislature. Many of these lobbying endeavors were financially supported by the AARC and its members’ dues. It is also a fact that legislators will never pass legislation that tends to restrict another group’s current scope of practice. That will never change today or in the future. Nursing was first in line with practice acts and they wrote it to cover everything from A-to-Z.

Myth. AARC has stood by silently and watched the times pass us by.

Probably not worth the keyboard keystrokes, but I will leave it at the following. Pull the three papers in Respiratory Care on 2015, an endeavor that started around 2005-06 to determine the future of healthcare and the role of RTs. It is very enlightening and the first manuscript published around 2009 points out exactly the processes and changes taking place today. Every AARC National Congress has addressed these items since that time. The proverbial saying is that you can "lead a horse to water, but you can't make it drink".

Myth. AARC is responsible for job loss, under recognition, lack of respect, (and world peace and hunger, some would say).

The AARC is not a 1920's labor union, never was intended to be. Truth is that AARC is "us." It is made up of your peers and colleagues (at least 33% of them) and has advanced the profession in a short time (6 decades) compared to our colleagues (RNs and MDs) that have been around hundreds of years. Is it perfect? Of course not, as nothing is perfect. It is each RT’s responsibility to promote the profession starting at the bedside and moving outward to the public. That is where recognition and respect are earned and jobs are secured.

Fact: Each and every respiratory therapist, each and every day, has ownership in this profession's future. You do it by making a difference in your patient’s life with positive outcomes and high quality care and education that is delivered in the safest method. Documenting, demonstrating and providing those goals will keep the profession around for a long time in critical and new arenas. Failure to do so is doom for any profession in healthcare reform as we move forward.

Fact: Healthcare reform is moving forward; it has to or healthcare will implode in the U.S. otherwise. We have the highest healthcare cost in the world, but fall way down the list in outcomes compared to many others that spend half or less than we do. Healthcare is shifting from reactive and responsive in the expensive acute care setting to one of prevention and wellness. We must quickly change with the times as 75% of today's RTs are in the acute care setting. We must shift into the post-acute care and ambulatory environments to be accessible to our patients across that continuum of care. If that’s not a reason to write in support of HR 2619, nothing is.

 

It was once stated to me that the Best Quarterback ever in the history of the game was the Monday Morning one. So we’re all entitled to our opinions, and much excellent and thoughtful discussion has taken place on these issues. But temper those opinions with facts and realities if a meaningful discourse is to continue. 

10 comments
342 views

Permalink

Comments

06-28-2014 09:51

Thank you for the reply.
I just get frustrated year after year when it looks like the only thing that gets done year after year is to kick the can down the road.
But again, thank you for the reply.
W. Brent Holland, BSRT, RRT-NPS

06-11-2014 11:51

Part 2 (if anyone is still reading--lol)
It is important to understand the fallacies of the statement “25% BSRT by 2020” statement as written. Currently, almost 60% of the profession holds a “minimum” of a Baccalaureate Degree, and many are Master’s or Doctorate educated. An “additional” 25% would push that percentage into the 80th percentile.
Access and financial affordability of advanced degrees are very personal and individual-based decisions that I am unable to speak to outside of my own. Two comments that are global.
• If I was a single, working mom of two with a strong disposition toward science, talents to care for the critically and chronically ill, and an interest in the profession, what is the realistic entry point into respiratory care for me?
• As listed in the 2012 CoARC Report, 85% of the CoARC accredited schools were at the AS Degree level. Twenty-four states did not have any schools above the AS Degree level. As an example, CA licenses approximately 20,000 RTs, yet has only 1 education program current at the BS level
o Will a mandated to move to the BSRT tomorrow supply a workforce in 3-5 years?
o Will we see additional states efforts to deregulate the profession in sunset laws to eliminate scope of practice if a workforce cannot be supplied
o Do we see “respiratory care assistants” move into the arena to provide “lower level tasks” at a cheaper wage (and possibly a higher risk to the patients)
There are many logistics around these efforts that makes the water murky on many of these issues. If it were an easy endeavor, our nursing colleagues would have moved this initiative forward decades ago, yet they also struggle with these same questions despite 200+ years of a head start on us as a profession.
You state that nothing has changed with the role out of 2015 Initiatives, a personal opinion that I will not debate in a public forum. But there are some true changes during that time.
1. Change in the NBRC exam process to potential eliminate 1 exam for the profession (although pass rates will need to greatly improve)
2. One state (and others drafting language) to make the RRT credential the minimum entry for licensure in those states after 2015.
3. Growth of more advance degree programs for the profession
4. Development of articulation agreements and bridge programs to transition AS RTs into Baccalaureate completion programs
5. Hospitals in the marketplace setting minimal job requirements at the RRT level (and some, BS degrees as well) for consideration for hire
6. An initiative before Congress (although poorly supported by the profession as a whole) to recognize baccalaureate-prepared, RRTs under Medicare Part B----which opens the marketplace to the profession outside the hospital’s walls
I am sure there are others that I have missed or overlooked as well. Change is never easy, but it is a necessary evil to adapt and survive in today’s healthcare setting. But a logistic, well thought out approach and strategy is very prudent in the rapidly changing healthcare marketplace.
While personal biases, beliefs and vested interests (and I have them as well), lead us to believe we know what is best for the future of the profession. There are no easy decisions or pathways to get there without some potential negative ramifications. I do not envy the elected AARC leadership and their task at hand in an unpredictable environment, but stand at the ready to support their wishes and to work with them in moving the profession forward.
This is not an “AARC, NBRC or their leadership” initiative. This is one for the profession of 130,000 respiratory therapists. We must work together to meet the challenges and advance the profession in a logistical, strategic manner. Do put personal agendas, beliefs or biases first, will surely create issues and unwanted consequences elsewhere where the “model” does fit or apply.
As the famous quote imparts….United We Stand, Divided We Fall

06-11-2014 11:49

Two-Part Response to meet Word limit...
An update of the 2015 and Beyond Initiatives can be found on the AARC website (http://www.aarc.org/resources/2015_conferences/). I can assure you that the AARC Leadership under the direction President Gaebler has continued to have dialogue and committee work assigned based on the findings of the three conferences.
So the question regarding CRT/RRT is a multifaceted one that cannot be answered with a yes or no… truth be told, a little bit of both.
• The NBRC will launch a new exam in January 2015 that allows for 2 cut scores (TBD), a lower one that will result in the CRT credential and a higher one that will allow the candidate to sit for the Clinical Sims.
• Licensure status is a “state-by-state” issue. While the AARC developed a standard template 30 years ago…often times states had to tweak or take different approaches to get their licensure acts approved. Most states have generic language that would allow for whatever is determined to be the “entry level examination” (but not true across all 49 states)
• No difference in roles between CRT and RRT roles is not something that can be determine by national organizations. This is marketplace driven mainly at the employer level. I can tell you that many institutions delineate the roles and the subsequent pay that results based on those credentials. But other hospitals and their leadership may tend to blend them.
• As of January 2015 in the state of Ohio, all new licensure applicants must have the RRT credential to be granted a license (existing will be grandfathered in as CRTs or RRTs). Other states are also looking at making the RRT credential “entry-level” for a state license.
It is important to understand parliamentary procedure. To “table or postpone” means that the elected leadership at that time believed they did not have the information, resources, etc…..to make a decision on the recommendations brought fourth at that time. That does not mean they agreed or disagreed with them or defeated them as presented. They were not “table or postponed until 2020”…..they can be brought back at anytime as the AARC President and BOD determine once they feel informed and prepared to discuss and vote.
The initiative to increase the education of the profession by “25%” (which would take the profession into the 75-80% range of “advanced degrees”) is very similar to the nursing profession’s goals produce out of the Robert Wood Johnson foundation.
Finally, as I am not the AARC President or part of the elected leadership, I cannot speak for the AARC BOD as to their thoughts about the requirement of a “BSRT” degree (which technically should be a Baccalaureate Degree as some programs governance are in other areas. It is important to understand that as humans, we all have beliefs about future goals and directives. But the role of an elected body is not to promote ones’ own agenda, but to provide benefit for the community at large….sometimes those stars align, other times they do not.

05-03-2014 22:12

PART 2. (See part one below)
In reviewing all of the updates since the 2005 start of the project, I think most prudent practitioners at that time would not think that on the dawn of 2015, we would still be at the same place with CRT/RRT or AAS/BSRT with no difference in what the two can do.
So while it is true that you can lead a horse to water but you can't make it drink... I think at some point the membership looks to the AARC BOD to take a strong stand (and vote) to actually IMPLEMENT the initiatives as opposed to just continue to kick the can down the road.
I would respectfully submit that when the AARC BOD has led the members to water, they will find that there are MANY OF US who are thirsty.
I think that you will also find that so long as the AARC BOD continues to view the water as tainted or flawed (and thus continues to vote to postpone or table it year after year and now decade after decade) then naturally the general membership is going to assume that the water must be tainted and is not drinkable.
In essence, the profession as a whole is not going to take the 2015 and beyond initiative seriously until our LEADERSHIP takes it serious enough to vote FOR IT as opposed to voting to change the name of it to the "25% BSRT by 2020 and Beyond Initiative."
I would also ask that if the main response of your post is to rely on the 2015 and beyond initiative, why did the "AARC Membership Updates" section of the aarc.org page devoted to the initiative end with the December 2012 Membership update that I have referenced? (Does the AARC have no membership update to give in all of 2013 and now half of 2014?)
I can only speak for myself, but in looking at the history of all the studies and published information on the initiative, it looks to me like the AARC opinion on this was 100% support several years ago and is now all but abandoned and now left to "let the free market decide" (I think that is the term that is used in the most recent FAQ section on the AARC site devoted to the initiative.)
(If the free market has not taught us anything, it has taught us that corporations will usually go with the "cheapest but legal" way of doing things. (In essence, if a new grad AAS degreed CRT credentialed therapist is allowed to operate in an ICU and run a vent just like a 4 year BSRT, ACCS credentialed RRT can (but the CRT can be hired legally for a lower hourly wage)... then I think the "free market" will take that option. (At least they have taken that option for the last 10 years and thus will probably continue to do so.)
So long as the AARC BOD (in it's agreements with the NBRC) continue to say "let's keep the CRT credential".. then states will also continue to allow them to practice on the same level as a BSRT RRT therapist.
So long as the AARC BOD (in it's agreements with the NBRC) continue to advocate for "registry eligibility" after AAS degree instead of BSRT degree, then students will continue to take RRT after the bare minimum and thus have no real incentive to go another $25,000 in debt to obtain the BSRT degree. (If I knew what I know now, I can't say that I would have.)
So long as the AARC BOD continues to waiver in the implementation of the 2015 and beyond initiative, then schools, students, and hospitals will continue to keep "everything the same" because they are legally allowed to do so and would be grandfathered in if changes ever do come.
In essence, I think everyone knows that the states are going to (mostly) go with the "minimum requirements" for licensure that the AARC and NBRC say should be the "minimum requirements" and until the AARC and NBRC make the changes, they are never going to be adopted by the "free market" because the leadership in OUR OWN PROFESSION have not even accepted that the changes need to be made.
Respectfully,
W. Brent Holland, BSRT, RRT-NPS

05-03-2014 22:10

Mr. Myers, I must put this in two parts due to AARC size limits of replys….
I for one do appreciate the AARC. I have been a paying member since the day I started the AAS program. I notice that you make reference to the 2015 and beyond initiative in your post.
I must say that I feel as though we have been "baited and switched" by the AARC with the "promotion" of the 2015 and beyond initiative over the last several years.
As you pointed out, the effort started around 2005. However, where are we now? Are we not at the exact same place with our licensure requirements and dual level of practitioner with no "real" difference between the CRT/RRT job roles?
Also, as I recall, the most recent action from the AARC BOD was given to us in the December 2012 update. In essence, the AARC BOD voted to "table" or "postpone" virtually every single goal of the 2015 and beyond initiative until at least 2020 from the way the press release reads. (And even then, the new goal is not even for a full transition to a BSRT requirement by 2020 but only a "25% increase" in the number of BSRT therapists by 2020.) I would respectfully ask at what year does the AARC BOD think we should be a "BSRT REQUIRED" (at least for new entry into the field?)

A lot of us went on to obtain a $25,000 BSRT degree because we were under the impression that the AARC was serious about implementing the 2015 and beyond initiative. (I for one did not think it would be "rebranded" as a "25% BSRT by 2020" and beyond initiative. Nor did I think that the AARC BOD would give us an update every year that basically says... "we again voted to postpone everything"
(see part two)

04-11-2014 16:28

Justin.....We appreciate the inquiry. Those monies are allocated to lobbying efforts in Washington DC as a national organization for the advocacy of the profession. They go to efforts to support AARC lobby efforts like Pulmonary Rehab reimbursement, HR2619, etc...they are not allocated to a state level (that would be the role of state affiliates).
Now that being said, we know that states do not have that much money to lobby as "they are us". Those funds as you point out pale in comparison to the AMA or nursing groups so they are used judiciously and approved by an oversight committee of the AARC Board of Directors.
However; the AARC does not turn its back on state affiliates in need of lobbying support and efforts to protect scope of practice or advocacy needs. Much financial support was provided in one state to protect the RT scope of practice a few years ago. The AARC also has recently provided a loan/grant assistance to Hawaii for licensure and to Michigan in their recent fight to prevent deregulation of their existing licensure. Again, these items go through the due process outline either by Bylaws, Policy and Procedure and decisions by your elected Board of Directors.

03-29-2014 13:53

While I appreciate your response to the excitement surrounding KentuckyOne, I do have to say that I sometimes wonder where the money I donate to AARCPAC really goes. While I realize that we're much smaller, as a profession, than nursing is, it certainly doesn't seem like the PAC is really out there advocating for either increased scope of practice or allowing therapists to practice at the top of their present scope.
While the AARC isn't a 1920's labor union, they do take therapists money for lobbying so that they can protect and advance the profession, and those efforts seem anemic at the best.

03-28-2014 12:25

Tim,
Thanks for the commentary. I have a quick story to share...
Early in my career, I managed a fairly large department in a nationally recognized health system. The president and CEO of our hospital at the time had just brought in a young, hot shot executive who started his career as an EMT. At the time, there was a shortage of nursing jobs throughout the system. The new executive identified this as an opportunity for EMTs. He developed a training course and robust curriculum for local EMTs with the intent of hiring them in the Emergency Department to replace respiratory therapists and offload the responsibilities of the nurses. The long term goal was to place them in the ICUs as well. While the EMT scope of practice in the state did not allow them to work in an "inpatient" setting, there was nothing that prevented them from working in the ED.
Long story short, many of my colleagues and I went to our medical director for support in fending off the EMT invasion. His feedback was not what we wanted to hear, but put things clearly in perspective that I think are relevant to not only the KentuckyOne situation, but across the nation. His response went something like this..."Put yourself at the desk of the CEO. You oversee a budget of several hundred million dollars and have ultimate responsibility of where every dollar is spent. It is your belief that you can place a lesser expensive caregiver in the ED to assume the duties of a more expensive caregiver (RT) and you're legally able to do it. Why would you not? The answer to that question is what will ultimately keep RTs in the ED."
What he was trying to say is that it is your job to show value to your organization every day. What are we doing to improve outcomes? What are those outcomes? Are we utilizing protocols to minimize costs and reduce length of stay or are we blindly giving aerosol after aerosol because that's what the doctor ordered? Are we responsibly managing department productivity? Are we aligning department goals with those of the hospital? What are our patients saying about the care they receive from our department? Are we making a difference?
The paradigm in healthcare has already shifted, and for departments who fail to embrace it? They will fall victim to what happened at KentuckyOne, or perhaps worse...lose RTs jobs across the continuum.
The bottom line? If we don't do these things every day, it doesn't matter what the AARC or the state affiliate does. We'll be forced into extinction. These efforts need to take place everywhere...everyday. Together, WE ARE AARC!
An oh, by the way...because we were able to successfully validate our worth to the hospital, not one single job was lost to an EMT.

03-28-2014 11:28

Tim-
I continue to marvel at comments that express- 'How could they manage without us?', or 'who could take our place?' Fact is, many countries do so, and even provide better healthcare, as you note.
Glad to see your and the AARC's insight regarding the need for RCPs to adapt to a changing market. So many are still rooted in a fee-for-service, "the more the better", "just give me my list" mindset. We have so much more to offer!
My perspective comes from watching an industry fail to adjust to a changing market (Big Steel), and seeing more people in one city (Pittsburgh) lose their jobs than there are RCPs in the world! Failure to adapt is dangerous, maybe lethal to a profession.

03-27-2014 17:20

Tim, thanks for the rational, with the right touch of emontion, comments. Sometimes, we all need to take a deep breath and observe the landscape as a whole.
George Rice