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January 1, 2013 Volume 77, Number 1
Committee News: 2015 and Beyond: What’s the Next Step for Respiratory Therapy? Allen N. Gustin, Jr., M.D., F.C.C.P. Committee on Respiratory Therapy


More than 60 years ago, oxygen technicians (as they were termed at that time) were primarily responsible for administering oxygen to patients via nasal cannula or oxygen tents.1 The oxygen therapist subsequently evolved into what we now call the respiratory therapist (RT). RTs now provide care to tens of millions of patients with pulmonary issues throughout the world and are now present in many areas of the health care system.2 Respiratory therapy has grown from on-the-job training to a fully credentialed profession. The Commission on Accreditation for Respiratory Care oversees approximately 386 accredited respiratory therapy programs in the United States where the majority of training programs offer an associate’s degree in respiratory therapy to graduates (few offer baccalaureate degrees and fewer offer a master’s degree).3 When an RT student completes an accredited program, the graduate must pass a competency exam for entry into the profession. Two exams exist: the Certified Respiratory Therapy Exam (CRT) and the Registered Respiratory Therapy Exam (RRT). As accreditation of each program is tied to the success rate for graduates passing these exams, graduates are expected to pass the CRT exam (required for licensure in most states). The RRT exam is considered advanced practice and is not routinely required for employment or licensure. Accordingly, the RRT is not universally taken by graduates. The National Board for Respiratory Care is responsible for the CRT/RRT exams as well as other specialty exams: Adult Critical Care Specialty Examination (introduced in 2012), the Neonatal/Pediatric Respiratory Care Specialist, and the Sleep Disorders Testing and Therapeutic Intervention Respiratory Care Specialist.4

No one disagrees that health care is evolving. All health care professionals face the challenges of meeting the demands of our aging population. Health care professionals are tasked with improving quality and decreasing the costs of health care. Given these changes, the board of directors of the American Association for Respiratory Care (AARC) planned a series of conferences to determine a future path for respiratory therapy. This goal was termed “2015 and Beyond” and was supported with the input of champions and stakeholders in respiratory therapy.2

In April 2008, the initial conference met with the mission of creating a vision for respiratory care.1 Conference attendees identified the competencies, knowledge and skills needed for future respiratory therapists. As the Baby Boomer generation ages, more care needs will follow (home care, hospital care, critical care and emergency care). Believing that increased emphasis would be placed on managing chronic care, wellness and prevention, respiratory therapy should adapt to these trends of health care. Being able to maintain a sufficient number of highly skilled RTs may become an increasing challenge, as clinical demands may increase faster than the workforce. Respiratory therapists should recognize the need to stay current with health care advances, including enhanced monitoring techniques, new mechanical ventilators, more aerosolized devices for drug delivery and gene replacement therapy via aerosolized methods. The development of care teams appears to be another trend meant to assist with shortages of health care providers. In some settings, RTs are already leading care teams (rapid response teams). Finally, avoidance of (re)admission to health care facilities will become another focus, which may expand the role of the RT in home care, discharge planning and palliative care. Thus, RTs should be prepared to meet the demands of future health care needs and adapt to new roles within care teams.

In April 2009, the second conference met with the mission of identifying the competencies needed by the current RT workforce and any new graduate.5 The conference attendees recognized that RTs are currently being utilized as participants on rapid response teams, participants on ICU teams, and as teachers of other disciplines and patients. RTs should consider development of skills related to prioritization, anticipation, troubleshooting, communication, negotiation, decision-making and reflection.2 The conference attendees believed that each RT should be competent with all modes of ventilation, understand various monitoring techniques (CT scans, etc.) used in health care, evaluate hemodynamics and be knowledgeable in sedation pharmacology. Given the expanding role of the RT, the attendees recognized that each RT should focus on educational opportunities allowing for lifelong learning, leadership training, patient and staff education techniques, continued maintenance of competencies, and participation in and implementation of respiratory care protocols.

The final conference was held in July 2010 and proposed a path for future respiratory therapy practice.6 Conference attendees suggested the following transitions: RT training programs should transition from associate degrees to baccalaureate degrees, the CRT exam should transition to the advanced RRT exam for entry into the profession, states should transition to the RRT exam as a requirement for licensure, and the RT workforce should focus on continuing education to enhance current skills. Attendees recognized that the effort involved in these transitions would be enormous.

ASA has been a strong supporter of the continued development of the respiratory therapy profession. Many ASA members with strong interests in respiratory therapy are members of the ASA Committee on Respiratory Care. This committee coordinates 11 liaisons within national respiratory therapy organizations, including the following: Board of Medical Advisors of the AARC (Clifford Boehm, M.D., William Bernhard, M.D., Lori Conklin, M.D. and Thomas Fuhrman, M.D.), Commission on Accreditation for Respiratory Care (Charles Cowles, M.D. and Allen Gustin, M.D.), and the National Board for Respiratory Care (Robin Elwood, M.D., Omid Moayed, M.D., Theodora Nicholau, M.D., Stephen Stayer, M.D., and Donald Prough, M.D.). As anesthesiologists, we should encourage our RTs to take the RRT exam, further their education and actively participate in our health care teams. In the future, we may find that the RT will be an asset to our health care teams of the future (in ways that we have not seen thus far).



Allen N. Gustin, Jr., M.D., F.C.C.P. is Assistant Professor of Anesthesiology, University of Chicago Pritzker School of Medicine.

References:
1. Kacmarek RM, Durbin CG, Barnes TA, Kageler WV, Walton JR, O’Neil EH. Creating a vision for respiratory care in 2015 and beyond. Respir Care. 2009; 54(3):375-386.
2. Giordano SP. Building a bridge to the future: some points to ponder. Respir Care. 2011;56(5):720-721.
3. CoARC: Commission on Accreditation for Respiratory Care website. www.coarc.com. Accessed October 15, 2012.
4. NBRC examinations. NBRC: The National Board for Respiratory Care website. www.nbrc.org/pages/examinations.aspx. Accessed October 17, 2012.
5. Barnes TA, Gale DD, Kacmarek RM, Kageler WV. Competencies needed by graduate respiratory therapists in 2015 and beyond. Respir Care. 2010;5(5):601-616.
6. Barnes TA, Kacmarek RM, Kageler WV, Morris MJ, Durbin CG. Transitioning the respiratory therapy workforce for 2015 and beyond. Respir Care. 2011;56(5):681-690.