Respiratory Therapy: Healthcare’s Diamond in the Rough

diamond in the rough

By D. Robert Handy, RRT, BSRT, MBA

The call and need for specialized care for pulmonary ailments can be traced back further than many recognize. A document from Ancient Egypt, called the Ebers Papyrus, alluded to inhalation treatments for patients with asthma. Beginning in the late 1700s and continuing through the late 1800s, discoveries and advancements such as oxygen use and its transportation in the body, the invention of the stethoscope, and bronchoscopy would lead to an increased understanding of the pulmonary system. Just after the turn of the 20th Century, pulmonary medicine advanced rapidly to combat issues like the flu epidemic of 1918, and innovations like the iron lung began to pave the way for Respiratory Therapy to be conceived as a specialty.

The 1940s and ’50s saw the inception of on-the-job trained respiratory technicians, the creation of the professional organization that would become the AARC (American Association of Respiratory Care), and the creation of formal respiratory therapy schools. Over the ensuing decades, Respiratory Therapy has evolved into the career that we know and love today.

Yet, as a profession, I believe that we are underutilized, underappreciated, and underrepresented. We are the epitome of the phrase “Diamond in the Rough”. Thanks to the efforts of a famous mouse, the phrase “Diamond in the Rough” has found its way into pop culture, generally describing something that has great potential and value while simultaneously being unrecognized by those near it. Even those of us in the profession haven’t likely realized our full potential. Although many of us recognize that we can contribute so much more than the healthcare community at large can even fathom.

I recently saw a post on a social media site where a respiratory therapist posed a question regarding the reason behind there being so many accolades surrounding the nursing community, and why similar accolades did not exist for respiratory therapy. Many commented that awards such as the AARC Apex Recognition Award exist, while others stated they had no idea this existed and demanded that the AARC should do more to promote our community. I noted that it is difficult for the profession to move forward when the vast majority of those practicing it have seemingly little or no interest in promoting it. Consider this, how many times have you had to explain what your profession is and what your day-to-day job entails after telling someone that you are a respiratory therapist?

Over the last decade, how many pieces of legislation have been initiated by the AARC? At least a dozen. And of those, how many passed all the way through and became Law? Zero. Why? In my mind, the most prominent reason is the lack of support. Support from who you ask? The respiratory therapy community at large. In the United States, there are an estimated 181,689 practicing respiratory therapists, either at the CRT or RRT level. My question to you is, how many of those RTs do you think are registered members of the AARC? 43,553. That’s just over 23%. How do we expect the Federal Government to support a profession whose professionals can’t even shell out less than half a shift’s pay for membership into its single professional organization?

But let’s consider this from another aspect. Respiratory therapy has become all but regulated to acute care in hospitals. How much could we accomplish if we were allowed to do real therapy with patients? While there is some call for RTs outside the hospital setting, such as in pulmonary rehabilitation programs, some home health, and (hopefully soon) in telehealth, there are so many unexplored areas that RTs could bring a new level of expertise and experience.

Some home health programs have respiratory therapists, but due to limited reimbursement from insurance and Medicare, they are largely used in a consultation capacity, leaving much needed respiratory care in the hands of nurses. While nurses are fully capable of performing these tasks, they oftentimes lack the necessary expertise to truly give patients the attention they need.

How about long-term care? What kind of patient outcomes could we achieve if respiratory therapists had direct contact and supervision of patients who had chronic respiratory illnesses? What if we had direct involvement in the planning and execution of their care? What kind of impact could we have?

Consider if respiratory therapists worked in clinics and provider offices, actively participating in patient care? Imagine being involved in the care of a COPD patient from diagnosis. The impact an RT could have on a person’s life if they were there from diagnosis, helping with education, the development of a care plan, being their advocate from day one of diagnosis, not just day one of hospital admission. How different would that patient’s life be if we started working with them in the beginning, instead of from the time we are called to the emergency department to assist with intubation?

You may note that in some states, like Utah, there exist individual companies who employ respiratory therapists in these types of roles, such as home health, telehealth, and in clinics and offices. These respiratory therapists are instrumental in the care of these patients from diagnosis to death and make a major impact on these patients’ lives. The companies that employ them see their value and recognize the need for our specialty in the lives of patients. However, the current reimbursement system used by government payers doesn’t recognize these respiratory therapists or the value they bring to patient care in these areas.

Conjecture and dreaming might be able to help us get a glimpse through the crystal ball of time to see what our future might hold, but these things aren’t just going to happen because we want them to happen. What can we do, -no- what MUST we do, to ensure that the profession reaches its full potential?

One place to start would be convincing the respiratory therapy community at large to become active members in the AARC. This single action would propel us into the limelight of healthcare, allowing us to show the world that we are a needed profession, that we have so much more to contribute to healthcare, ever so much more than “Albuterol Q4”. Once we can make a show of strength, to show Congress and others that the profession is backed by every RT and ready to take on more than we’ve been given, then maybe some of these other dreams can begin to take shape.

There are other ways to engage in the promotion of the profession. Join a committee or council at work. Volunteer to be a preceptor for students or take part in working with a respiratory therapy program near you. Share your expertise by mentoring a new RT. Create or work with a community program, like the Breathe-zy after school program that was created and developed by RTs in Utah. Or find your own way to engage in promoting the profession.

I don’t have all the answers. I don’t know what it will take to get your coworkers, colleagues, and fellow respiratory therapists to take the leap of faith needed to propel us forward. However, I do know that if you’re reading this, somewhere inside you, there is the voice of a little RT who wants to make the world a better place.

If you’ve ignored that little RT in the past, if you’ve looked at that little RT and said, “But what can I do?, I’m just me…”. If you’ve ever wanted someone to say, “Wow! You’re a Respiratory Therapist?! They’re awesome!”, then now is the time to make a move. To find the courage to speak up and engage with others. Let’s show the world what a “Diamond in the Rough” is truly worth and what Respiratory Therapy can do.

D. Robert Handy, RRT, BSRT, MBA is a staff therapist and an adjunct respiratory instructor at Stevens-Henager College in Salt Lake City, UT. Connect with Robert on LinkedIn.

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