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A bachelor's degree for RCPs--a good idea?

There have always been proponents of a baccalaureate education for RCPs. In fact, there now exist approximately 60 RC educational programs which offer a bachelor's degree. But these graduates are exceptions to the rule. After decades of debate regarding the appropriateness of educational requirements for RT practitioners, the millennium brought with it the implementation of an associate degree as the minimum education level for entry into practice. Now just five years later, the profession has matured to the point where discussion about the need for all RTs to have advanced levels of education has emerged.

The American Assoc. for Respiratory Care (AARC), the National Board for Respiratory Care (NBRC) and the Committee on Accreditation of RC Programs (CoARC) are now advancing the cause for a higher educational level. Recently they issued, in the form of a white paper, a tripartite announcement promoting baccalaureate and graduate level education for respiratory therapists. This announcement propelled the subject into the realm of the "hot topics." And it's a topic that's tangled in the web of discussion regarding our professional credentials and what those credentials should mean. The dialogue is fast and furious and, I think, profoundly interesting. So for this Focus article, I'll toss out some points and counterpoints for your consideration.

Is the BS degree an appropriate entry level for RT? Certainly a bachelor's degree entry level would elevate the status of respiratory care as a profession. One point noted in the corporate white paper, having less than a bachelor's degree, RTs are often not recognized as professionals. Government, private third-party payers, and the military use the achievement of a four-year degree as one of the defining criteria for a "professional."

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Let's take a look at our colleagues in Physical Therapy (PT), Occupational Therapy (OT) and Pharmacy. These are professions that RTs often seem to think have it better than us. PT and Pharmacy are moving to doctoral entry-level; OT is moving to a master's. True, like Respiratory Care, Nursing does have entry at both the AS and BS level, but nursing also utilizes a clinical ladder based on education.

Respiratory Care really took a hit during the 90s in the wake of the managed care movement. That sad experience showed us that the practical aspects of our job could easily be given away to other better-established disciplines. Let's face it. If we want to stand shoulder to shoulder with better-educated professionals, if we want a seat at the decision-making table, we may well have to think seriously about higher education. Why? Because those with associate degrees are viewed as "worker bees", whereas those with a BS or master's degree are perceived as professional health care managers. Yes, in the policy-making arena, advanced degrees do matter.

But on the front lines of respiratory care, the question being asked is: Would there be any meaningful difference between an AS and a BS degree respiratory therapy graduate? The answer is maybe or maybe not. There's a general consensus, (probably correct), that having an advanced degree offers little or nothing in the way of improved psychomotor skills. And there doesn't seem to be evidence, at least that I'm aware of, that four-year grads perform any better on NBRC credentialing exams. For these and other reasons, it seems that most rank and file RTs see absolutely no need for a four year degree.

Nor do their employers, who understandably, see no need to hold out for a BS when an AS person can hold the same credential. It's competency, not educational degree, that determines who does what. Day-to-day respiratory care is constantly in a state of controlled crisis with the role of the front line, AS prepared respiratory therapist being defined by the routine demands of patient care. So, burdened department managers, concerned with surviving, rather than thriving, see maintaining the status quo as a daily accomplishment.

Plus, there's no clear role delineation for RRTs vs CRTs, let alone AS vs BS degrees. There's no salary differential either. In fact, throughout most industries, those with bachelor's degrees earn more $$, but it doesn't hold true in the RC profession. An RT's salary will not go up because he or she has earned a bachelor's degree.

The backers of higher education standards feel that people with advanced degrees "walk, talk and carry themselves" differently (read better). Somewhat of an elitist attitude, I'd say. But it does beg the question: "Does the profession make the practitioner or does the practitioner make the profession? Those with bachelor degrees will surely come with better oral and written communication skills, qualities which are well recognized in terms of professionalism. Those with the ability to write well, speak clearly and think globally will be the ones who will be equipped to advance the profession and make contributions on behalf of Respiratory Care to the overall health care system. It's not unreasonable to think that putting a better face on Respiratory Care will gain us more respect as a profession over the long haul.

That said, it's not as if there aren't RTs who have advanced degrees. The AARC Manpower Study tells us that approx 30% of respiratory therapists have a four-year degree or better. But I would venture a guess that the majority of these persons won't be found at a patient's bedside. Bachelor' degree prepared RTs tend to leave the front lines. Which leads me to ask: "Do we really want to take our better educated therapists away from direct patient care?"

Whether a BS entry level would make a difference in student recruitment is another point which sparks real debate on both sides of the fence. Opponents of the baccalaureate degree are sure it would constitute professional suicide in light of the current manpower shortage. On the other hand, ask most high school students and their parents what a college education means and they'll say "a bachelor's degree." Academically strong students want a BS degree even when they're looking for a career in health care. Recruiters have long known that parents of high achieving students want their kids to enter educational programs which culminate in a four-year degree. So having a presence in a four year institution might just give the RC profession the credibility it needs to attract the best and the brightest. There are those, however, who believe that a four year investment in the education and training of an allied health profession is too long. Playing the devil's advocate though, a four-year graduate could be construed as a two-year graduate who has completed 60 additional college credits in general education studies. The facts of the matter are that many AS degree RT programs require from 70 to 75 credits for graduation. It's not at all unusual for students to take up to three years to complete. At that point, what's another year and a half?

So you can see that the overall views on the necessity of a BS degree for RTs have been mixed. And as it distills, the current consensus seems to be that we won't be seeing a BS degree as an entry-level requirement in the foreseeable future.

But does it have to be all or nothing? Admittedly, a bachelor's degree requirement for entry may be a giant leap, but certainly, no one would argue with the concept of RTs pursuing an advanced degree once they're working in the field. And in fact, in its broadest interpretation, the AARC's white paper is simply promoting the concept of life-long learning for RTs.

The question then becomes: Will rank and file RTs see the value in continuing their education to the point of completing a bachelor's degree? I have to wonder. If registry-eligible therapists aren't pursuing the RRT credential, why on earth would they pursue a bachelor's degree? Especially in light of the lack of any reward from within the profession for earning that degree. But assuming that some would and certainly some have, does not the absence of both clear role delineation and widened scope of practice for BS holders cause them to move away from the profession? If a BS degree offered some real "usable" value to the therapist's career, perhaps we wouldn't lose our best and brightest to other careers or "defect to nursing". We see strong RTs pursuing BS degrees in other fields simply because institutions offering a BS degree in RT are very few and far between. Which brings me to my own personal thoughts on this whole issue.

There may be a logical answer. One that would go a long way towards reducing the "title volume" confusing our profession. One that might also put an end to the weary RRT vs CRT debates. One that could eventually eliminate the problem of CRTs not earning the RRT credential. One that wouldn't conflict with RC state licensure laws.

Why not develop upper level BS programs which would require earning the RRT credential as a criteria for graduation? Key to this idea would be limiting the RRT eligibility to those and only those who hold the bachelors degree. These four-year graduates would be the "advanced practitioners" and would provide leadership in areas of supervision, management, teaching, and research. Or by virtue of their degree and credential, they would become the specialty practitioners. We could then reserve the AS degree and the CRT credential for those who by their own admission and/or inertia, don't aspire to having more.

This would require a large endeavor on the part of our professional organizations and the education community to be sure. But to my way of thinking, in a world where degrees and credentials have some real meaning, at least this would make sense.

by Sandra McCleaster RRT
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Title Annotation:respiratory care educational programs
Author:McCleaster, Sandra
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Geographic Code:1USA
Date:Sep 22, 2004
Words:1613
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