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The bachelor's degree for RTS: has its time finally arrived?

As I write, it's September 2009. The specter of health care reform has the entire country poised for groundbreaking change. President Obama's plan, regardless of what form it takes, will pose unprecedented challenges for the health care industry and everyone in it. The issues that define 21 st century healthcare are finances and patient safety. It's unlikely that the health care industry can ever find a way to balance the need for cost control with the concerns of safe care and best practice. How the country will reconcile the need for access and quality care for all Americans is, at this juncture, anybody's guess. What we do know is that we are living and working in an environment of reimbursement cutbacks and costly regulations. And thanks to the economic downturn, we're looking at the most depressed health care labor market ever.

Respiratory therapists are standing at the brink, hoping to find a place that will take the profession into the future, wherever that future may be. The American Association for Respiratory Care (AARC) has been proactive. By way of its "2015 and Beyond" project, it's attempted to identify the "knowledge, skills and attributes" of the next generation of RTs. Although not yet completed, some things have already become quite apparent. Health insurers, seeking out the least costly settings for their patients, are making acute care hospitals the care site of last resort. Gone will be the days of lock-step non-protocolized floor therapy. Respiratory care will expand from its traditional role at the bedside while disease management, rather than treatment, becomes the order of the day. Unlike some other allied health disciplines, the emphasis on health promotion and disease prevention favors the services of a respiratory therapist. For this, we come well equipped and should be grateful.

In order for the RTs of the future to survive, let alone thrive, in the new health care environment, they will need to develop skills and qualities quite apart from those required in the past. The next generation of practitioners will need to be broad based. Indications are that, in addition to having the knowledge and technical competency already expected of them, therapists will also need to be versed in areas of management, research and education. These global concerns will no longer just be "the boss's problems." Our ability to live on will depend on how well we can influence quality care management and utilize evidence-based care. Those with the ability to write well, speak clearly and think globally will be the ones who will lead us into the future.


It's going to take a lot more than an associate's degree to prepare tomorrow's respiratory therapists for a world of disease management and evidence-based protocols. Two year programs are already bursting at their seams and could never, within the limitations of an associate's degree, provide the curriculum necessary for the development of leadership in those key areas of management, teaching and research.

There's a recipe for hope being written. The AARC wants to facilitate higher education for its members. To that end, it's planning the establishment of a Training Institute in Professional Development. This initiative is predicated on the creation of a true collaboration between the professional organization and four-year academic institutions. The plan envisions a core curriculum consisting of general education courses that would apply across the board; studies would then be divided into the three key tracks: management, education, and research. It's a work in progress, but the hope is that the Institute's curriculum be accepted by four year- institutions and ultimately culminate in a baccalaureate degree.

Several years ago the AARC, the National Board for Respiratory Care (NBRC) and the Committee on Accreditation of RC programs (CoARC) together took a bold step. Collectively, in the form of a white paper, the three organizations put forth an announcement promoting a baccalaureate degree for respiratory therapists. Was it purposely prophetic? Given what we're now seeing in the crystal ball, it surely seems that its time has finally come.

The BS degree could benefit our profession in more ways than the obvious. One often discussed idea is for upper level BS programs to require earning the RRT credential as criteria for graduation. That would put an end to the tiring CRT vs RRT debate that's plagued our profession for years. It would provide a logical place for the long outdated two levels of credentialing that the NBRC just won't let go. Specialty credentials could become the province of the bachelors-prepared RRTs only. We could then reserve the AS degree and the CRT credential for that small cadre of practitioners the profession will still need to deliver a reduced volume of hospital-based respiratory care. From a purely practical point of view, in a world where degrees and credentials have meaning, this scenario would make some very good sense. All in all, a bachelor's degree would go a long way in elevating the profession, better positioning RTs for success now and well into the future.

Ten years ago, a bachelor's degree for respiratory therapists was viewed as a possibility. Now, driven by necessity, the idea will very likely become a reality. We're seeing the signs already. Government, private third party payers, and the military all use the achievement of a four year degree as one of the defining criteria for being a "professional." The AARC's Medicare Respiratory Therapy Initiative, now pending in Congress, would effectively allow respiratory therapists to provide respiratory care services under Medicare Part B. Reimbursement would be forthcoming for therapists, acting as physician extenders, to see patients on their own. But the federal government has put forth the condition that Part B will only include therapists who hold a bachelor's degree.

Much of this has been said and proposed before. There have long been proponents who have advanced the cause of a bachelor's degree for respiratory therapists. But now, after decades of debate, the market forces have pushed the stars into alignment. Advanced study doesn't seem to be a choice any more. It's becoming a must. Read that white paper and you'll realize that it's probably what the profession wanted all along. But the time had to be right.

by Sandra McCleaster RRT

Sandra McCleaster, MA, RRT is a veteran therapist, lecturer, educator and adjunct faculty member at Bergen Community College in Paramus, NJ.
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Author:McCleaster, Sandra
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Geographic Code:1USA
Date:Nov 1, 2009
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