Are Therapists Headed for Extinction?

Vol. 16 •Issue 14 • Page 66
Parting Thoughts

Are Therapists Headed for Extinction?

I am proud to be a therapist. I started as an on-the-job trainee in 1975 and have progressed to the post of Director of Clinical Services at Calvert Memorial Hospital, Prince Frederick, Md. Along the way, I have made many friends and gained much knowledge and wisdom. I have been a member of the AARC since 1979.

Over the past five years, I have been fortunate enough to attract and retain a highly trained and experienced group of therapists at my hospital, but I am growing increasing concerned about the future of our profession. The role of the therapist has significantly changed over the years from a physician-ordered, task-oriented professional to that of a highly educated, highly skilled professional who functions as a physician extender through the use of protocols.

The U.S. Department of Labor’s Bureau of Labor Statistics projects there will be an increased demand for therapists far greater than average for all other occupations through the year 2005. The substantial growth in the number of people who are middle-aged and elderly will heighten the incidence of cardiopulmonary disease, driving this growth.

Consider the statistics. In 1987, only 12.2 percent of the population was 65 or older. By 2010, the baby boom generation will start moving into this age group, and by 2030, almost 25 percent of the U.S. population will be over 65. As the numbers of elderly increase, the need for respiratory therapists will also increase. We all need to start asking: Where will we get therapists we need?

Everyone knows about the nursing crisis from TV, radio and newspaper stories. Unfortunately, there is a significant crisis in our own profession as well.

In 1998, there were 6,027 graduates from respiratory care programs. By 2000, the number dropped to 5,516 and dipped to 4,437 in 2001. That is a 31 percent decrease in the available candidate pool in four years. During this same time frame, there was a decrease in the available RN candidate pool too, but it was only 17 percent.

Sixty percent of the respiratory training programs have seen decreases in their class sizes, and it is currently estimated 8.6 percent of the respiratory programs will close within the next year or two. Meanwhile, the nursing profession expects to see increased enrollment over those same two years.

Entry-level educational requirements for therapists and nurses are fairly equal at an associate degree level. Both groups have bachelor’s degree options. After that point, things change quickly. Nursing offers master’s degree and doctorate options.

Clinical responsibilities for both groups are equivalent, and each has a well-defined scope of practice. Therapists, however, work with neonatal, pediatric, adult and geriatric populations in multiple clinical arenas like general floor, emergency and trauma care and are well versed in cardiology, sleep, rehab and neurology. Most hospitals would be hard pressed to find nurses who routinely work in that many arenas.

Therapists add significant value to the organization. Throughout their shifts, therapists assess, evaluate, treat and reassess their patients. They develop appropriate, cost-effective treatment plans that help facilities save money.

For their efforts, therapists are consistently paid $6,000 to $12,000 per year less RNs. In short, therapists bring far more to the table, yet are paid significantly less.

There are some simple solutions perhaps. While the AARC has done a tremendous job over the years, the organization must face some 21st century realities. The change to the CRT credential and continued use of dual credentials (now CRT and RRT) was a mistake. It is limiting us as a profession. I started as an OJT and then became a CRTT and then an RRT. I realized that staying at the lower level was not in my best interest or in the best interest of the profession.

When RRT-eligible candidates graduate, they must first take the CRT exam. If they pass this, then they can get a license and at some later date take the RRT exams. Many don’t even bother to write the upper level test anymore.

In 1998, some 63 percent of advanced-level graduates sat for the RRT exams, according to Bill Dubbs, speaking at the AARC Summer Forum in 2001. That number fell to 52 percent in 1999 and to only 20 percent in 2000. The latter is a pitiful number and an excellent reason to eliminate the CRT exam for advanced-level graduates.

I recently interviewed a recent respiratory care graduate from a BS program. She asked, “Do you expect me to take the RRT exam?”

“Yes,” I said. I told her I do not hire CRTs. Basically the interview was over at that point as she was not interested in getting her RRT. Harsh? Probably. But we need to take a stand somewhere or our profession will slowly go the way of the dinosaurs.

John Ennis is a Maryland practitioner.