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"Title" volume = practitioners + credentials.

While respiratory care practitioners from Maine to Mexico are busy treating disease and saving lives, our professional organizations operate behind the scenes to determine future directions for our profession. Over the next year, Focus will run a series of articles about current issues being wrestled by our profession's leaders and shakers. We've chosen a few items of keen interest to the RC community--topics which make up the banter at local conferences and the chatter on AARC Specialty Section list serves.

Knowing how difficult it is for RCPs on the front lines to keep up with the global issues, we're collectively calling these articles Hot Topics for the Rank and File.

By their very nature, "hot" topics tend to be controversial. This is of curse, how they derive their heat and what, in the end, makes them so discussion and print-worthy. We're not attempting to solve professional problems here. Our only objective is to provide the Focus readership with an overall summary of some "big" issues and challenge them to form opinions of their own.

A nurse once asked me "How come some "respiratory" people have RRT on their name badge and some have CRTT or CRT What's the difference?" This wasn't the first time I'd been put in the position of having to try to explain this. As an RC education program director for many years, I'd fielded this question dozens of times. Not only did I dread explaining this to students, far worse was trying to explain the strange dichotomy to college academic deans. Believe me, clarifying it never did get any easier.

How many people does it take to administer respiratory care to patients? Apparently quite a few, as evidenced by our surplus of job titles. Think about it, we have practitioners who identify themselves as Registered Respiratory Therapists (RRT); "registry-eligible" therapists (those who plan to sit for and pass the advanced level exams ... someday); Certified Respiratory Therapy Technicians (CRTT); Certified Respiratory Therapists (CRT) (those who passed the National Board for Respiratory Care (NBRC) entry-level exam post July 1998 or those CRTTs who chose to officially change their credentialing title. Many did not); Licensed Respiratory Care Practitioners (those grandfathered OJTs who took and passed their state licensing exams.) Although there are relatively few LRCPs still working in respiratory care, the number of persons holding this title may increase dramatically in 2007 if practitioners credentialed after July 2002 fail to meet the NBRC continuing education mandate. Those persons will lose their credential and no longer have the privilege of calling themselves "certified" or "registered". And of course, the mix includes Graduate Respiratory Therapists (GRT) (new grads waiting to earn their credential.)


What's more, none of this correlates to the educational level of respiratory care practitioners. The title volume includes RRTs who are graduates of associate degree programs and CRTs who are graduates of bachelor degree programs.

Is it any wonder that those outside the profession look at us with a jaundiced eye when we try to clarify our job titles or educational requirements? Just yesterday, I received a sales advertisement in the mail for professional liability insurance from the Healthcare Providers Service Organization (HSPO). Question #2 on the application was a check-off of title. It contained the following four options: respiratory therapist, respiratory care practitioner, respiratory care provider and respiratory therapy technician. I was left scratching my head. It's understandable that the outsiders don't get it, but many people within the profession don't want to sort it out either. In the end, it's becomes easier to lump us altogether and refer to us collectively as "respiratory"

Nowhere has the question of credentials, the exams which give entree to those credentials, or what those credentials mean, been more vexing than within the RC profession. The fact that there are two levels of credentialing has been far more divisive than helpful. Letters to the Editor in the Advance for Respiratory Care Practitioners newsmagazine provides a forum for RCPs to air their thoughts and opinions. The letter-writers just can't seem to put the CRT vs RRT issue to rest. Perhaps though, this may not be a bad thing. It seems that those in the profession's "inner circle" are sitting up and taking notice. Clearly, the topic of a "single-entry level" has become grist for the mill.

Managers and educators alike are debating the whys and wherefores of our credentialing dilemma and its possible long-term ramifications for the profession. More and more respiratory VIPs are asking why we as a profession continue to promulgate the dual level credentialing system. Although well-intended and useful at the time of its inception, many believe the classification of an entry-level practitioner has outlived its usefulness.

There are what seems like a thousand reasons why we both should or shouldn't move to a single entry system. The question, however, really isn't whether we should or shouldn't, but whether we can or we can't. (No one has asked my opinion on this, but yes, I think we should; the problem is, I don't think we can).

It's thorny and complicated. Even if the profession could easily move to a single-entry level, the issue doesn't exist in a vacuum. Inextricable to any discussion of a single entry level are questions related to a number of important factors. First up, what would that single level be? The profession would need to shed itself of the notion of entry-level versus advanced practice and decide just what it is the health care industry needs and wants from respiratory therapists. Then what about the nomenclature? Educational levels? Manpower needs? Job descriptions? And the biggest predicament of all is the fact that current legislation links licensure to passing the "entry level" exam.

It's obvious that any monumental change in our credentialing system can only come about following extensive dialogue. I can't imagine that our profession at large could ever reach consensus on this. But the AARC, the NBRC and the educational accrediting agency, CoARC, have the joint responsibility of ensuring that "respiratory practitioners are fully qualified to meet the demands of patient care, regardless of the letters which come after their name.

Watching how this all plays out in the years ahead will be interesting, is an understatement. But then, it may actually turn out to be a moot point. One that in time may actually take care of itself. For it's a fact that fewer and fewer practitioners are earning the RRT credential and unless this curious situation changes, the single credential may become its own self-fulfilling prophecy.

by Sandra McCleaster RRT
COPYRIGHT 2004 Focus Publications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004 Gale, Cengage Learning. All rights reserved.

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Title Annotation:HOT TOPICS
Author:McCleaster, Sandra
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Geographic Code:1USA
Date:Mar 22, 2004
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