Vol. 20 •Issue 20 • Page 13
Do You Know the Difference Between Licenses and Credentials?
Veterans of respiratory care state licensure wars well know the value of their hard-fought battles. After all, it was not so long ago that an individual could be a bus driver one day and a respiratory therapist the next.
It was not so long ago that a good salary for a respiratory care practitioner (RCP) was 25 cents above the minimum wage.
Often there is confusion among therapists as to the basic differences between professional credentials and licenses. This is an understandable error from someone just starting in the field. In reality, we have both; but our respiratory credential is quite separate from a state license.
Therapists hold national credentials issued by the National Board for Respiratory Care (NBRC). Created in 1960, the NBRC has as its mission the development and delivery of credentialing examinations for respiratory care and pulmonary function technology practitioners.
The NBRC has established the minimal standards practitioners must meet for certification. The NBRC issues certificates and maintains a directory of credentialed individuals. That organization also promotes ethical and educational standards for the profession and works to advance the education and stature of the field on a national level.
To date, the NBRC has issued more than 304,000 professional credentials to more than 186,000 practitioners. The board tests nearly 18,000 candidates annually.
States Govern Practice
Licensure laws, however, are a far different matter. Licenses are issued on a state-by-state basis. Many states use the credentials issued by the NBRC as a determination for initial competency/certification of the practitioner as an RCP. And once a license has been issued, the practitioner is in charge of keeping that license up to date. But the state license is good only in the state issued.
Not all practitioners hold credentials. Some states have recognized the value of on-the-job training and have made provisions for practitioners who lack formal training to gain a license. In some states, this provision has a statute of limitation.
In most cases there was a cut-off period for OJT qualification. Those not qualifying by the end of that period were not permitted to continue working in the profession. And if practitioners get into trouble in one state, they cannot escape by simply crossing a state line.
Working with the state licensure agencies and the American Association for Respiratory Care (AARC), the NBRC has automated a national database, which tracks the disciplinary status of practitioners.
Known as the National Respiratory Care Disciplinary Database, this resource provides a repository for disciplinary actions taken against respiratory care practitioners by state. Pending actions or appeals are not maintained in the database.
Still More Confusion
Questions have been raised about the purpose of the Committee on Accreditation for Respiratory Care (CoARC). This agency provides accreditation services for institutions that provide respiratory therapy education. They do not directly credential practitioners nor do they issue licenses.
Although licensure laws have been enacted in nearly all states, there are variances in provisions and the scope of care they permit. Many states continually review and update their laws. In some cases, existing statutes are being openly challenged by emerging and existing health care professions.
For example, polysomnographers want to provide oxygen therapy and other services; nurses are asking to provide respiratory medications and manage ventilators; and pharmacists are asking for an expanded role in asthma case management and care.
All of these situations impact therapists. Other health care professionals are being proactive in response to the changing health care environment. As budgets tighten and billing becomes more restrictive, the profession that can provide the most services will garner higher reimbursement and be the most likely retained when or if cutbacks occur. If a small rural home health agency can send one practitioner who can provide all patient services rather than two or three practitioners, it will send the one.
If a hospital can transfer a long-term, ventilator-dependent patient to a step down unit or the floor where he can be managed by nurses, there is no need to maintain a large, full-service respiratory care staff.
People Who Give Care
Some practitioners scoff at the notion other professions can comprehend and effectively manage highly complex modern modes of ventilation and machines. Non-therapists don’t necessarily have to. Hospitals can maintain highly trained therapists to staff their ICUs and train personnel from other departments to operate simple basic home ventilators and medication-delivery systems. Such a move would result in a significant cut in the number of therapists a facility would need to have on duty at any given time.
On paper, the plan to have a core staff of ICU therapists may look good. In reality, the plan may not work. If disaster does strike, the ICU staff is already at full capacity caring for patients and may not be able to respond to other areas.
As health care providers, our first responsibility is to our patients. We are entrusted to deliver safe, effective care and facilitate their healing. This requires competency and diligence on our part to ensure that legislation is enacted on a state level to guard our patients’ best interests.
Margaret Clark is a Georgia practitioner.