Physician Extension in the Field of Respiratory Care: A Natural Fit

Transcription

1 Physician Extension in the Field of Respiratory Care: A Natural Fit Shane Keene, DHSc, MBA, RRT-NPS, CPFT, RPSGT, RST Chair, Department of Analytical and Diagnostic Sciences Associate Professor, Director Respiratory Therapy Program University of Cincinnati, College of Allied Health Sciences

2 American Medical Association(AMA) 1847 American Nursing Association (ANA)1896 American Occupational Therapy Association (AOTA) 1917 American Society of Radiologic Technologists (ASRT) 1920 American Physical Therapy Association (APTA) 1921 American Association for Respiratory Care (AARC)1947 American Academy of Physician Assistants (AAPA) 1968 Timeline Used with permission Dr. David Shelledy Dean, Rush University

3 Entry Level Education in Allied Health Physical Therapy Doctoral degree - DPT Occupational Therapy Master s degree a number of OTD programs already up and running Speech therapy Master s degree Physician Assistant Master s degree Clinical Nutrition Master s degree Respiratory Therapy Associate s degree RT is falling farther behind the other allied health professions in terms of education and training

4 1. Physician Assistants (Masters) $89, Physical Therapists (Doctorate) $79, Radiation Therapists (BS) $79, Occupational Therapists (Masters) $74, Speech Therapists (Masters) $72, Audiologists (Doctorate) $71, Nuclear Medicine Technologists (BS) $69, Registered nurses (hospitals) (AD/BS) $69, Diagnostic Medical Sonographers (AD) $65, Medical Technologists (BS) $58, Radiologic Technologists & Technicians (AD) $56, Respiratory Therapists (AD) $56, Respiratory Technicians (AD/cert) $47, Medical Records and HIM (AD) $35,920 Pay BLS 2012 Used with permission Dr. David Shelledy Dean, Rush University

5 974 pages in length Physician assistant referred to 42 times Allied health referred to 33 times Occupational therapy referred to 4 times Physical therapy referred to 3 times Respiratory therapy (or RC or RT) referred to 0 times Affordable Care Act

6 What is a physician extender? A specialty trained and licensed health provider that works under the direct supervision of a physician. Referred to as mid-level practitioners Master s degree typical; examples: Nurse practitioners (NP) Physician Assistants (PA) Radiology Assistants (RA) These providers easily transition into the role of physician extender. Introduction

7 Integral part of the multidisciplinary team Intimately involved in routine patient care Delivers services in life and death situations Positive impact on the patient populations they serve Role of the Respiratory Therapist

8 Despite the important contributions of this profession to the health care community and the availability of graduate level education, a clearly defined pathway to naturally progress into the physician extender role has proven to be elusive thus far. Why not RT as a PE?

9 On the job training; inhalation therapists Technical schools; diplomas/certificates 1970 s recognized as Respiratory Therapy Associate degree Baccalaureate degree Master s degree (3 programs) Advanced practice respiratory therapists (APRTs) standards introduced by COARC Evolution of RC Education

10 Although the minimum standard for respiratory care education has increased, the practitioners ability to pursue advanced degrees and the scope of practice/autonomy within the profession has not followed suit. Results in lack of: professional fulfillment, recognition, advanced opportunities Frustration with career choice Evolution of RC Education

11 2003: AARC & COBGRTE identified the need for graduate education in RC in several areas, including clinical specialization 2012: 70% of RC dept. managers feel the entry level degree for the profession should be at the baccalaureate level RTs are considered experts at blending complex technology and clinical skills at the bedside Literature Review

12 The first non-physicians serving in traditionally only physician roles in the U.S. appeared in 1960s Created to provide care to patients that were underserved and to extend the ability of the physician to care for more patients Less training & less pay = more cost effective Development of NPs & PAs

13 A NP is a RN with advanced academic and clinical experience; able to diagnose and manage most common/chronic illnesses The PA works under the direct supervision of a physician after they have completed a graduate program consisting of didactic and clinical experiences and becoming certified/licensed to practice Baccalaureate degree is the preparation for entry into both professions Role of the NP & PA

14 Nearly 100% of all teaching hospitals in the U.S. utilize NPs and PAs in patient care Studies suggest no significant difference in patient outcomes or satisfaction when mid-level providers are used Outcomes may actually be improved when these extenders are added to existing health care teams Need for Physician Extenders

15 What is stress? Non-specific response of the body to any demand for change. In today s respiratory care climate, stressors in the profession are prevalent Increasing workloads, evolving technology, external governance and regulations RTs are still highly functional despite this stressful environment Stress in Allied Health

16 The extent to which the Patient Protection and Affordable Care Act will influence the job responsibilities of the RT is yet to be determined; however, practitioners may be asked to do more with the same or nominal increase in resources. Readmission rates Patient satisfaction Emerging new roles for the RCP Influence of the ACA

17 Grants & scholarships available for midcareer level practitioners Improve recruitment/retention & enhance education within allied health workforce Solidifies use of physician extenders to provide the highest quality outcomes deliverable in the most cost-efficient manner; health care cultural norm RCPs routinely treat heart failure, pneumonia, & COPD which are named in the CMS Readmission Reduction Program Influence of the ACA

18 Nationwide shortage of pulmonary care intensivists; 1500 by the year 2020 Number of expected new entrants into the field is not expected to offset those getting ready to exit it Baby boom generation Dispersion of pulmonologists is geographically skewed, leaving rural hospitals faced with inadequate staffing Looking Ahead

19 Advance the practice of respiratory therapy with graduate education, competency assessment, and credentialing to be physician extenders for pulmonologists and/or critical care physicians Post-professional Master s degree; skills in education, research, management, and/or advanced clinical practice (CoARC draft of accreditation standards of advanced practice programs in Respiratory Care) Feasible Solution

20 Associate level respiratory care programs will need to develop articulation agreements with BS completion respiratory care programs -ongoing COARC would have to accredit graduate level respiratory care programs in which the graduates would be eligible to sit for boards for the new credential for advanced practice-finalized The NBRC would have to develop a new advanced practitioner The AARC would have to lobby to credential-preliminary All state licensure bodies to accept it and adopt a scope of practice for it-????????? All 49 state licensing bodies will have to adopt guidelines for the advanced practitioner-????????? Next Steps

21 Questions?

22 American Association of Respiratory Care. (2003). Development of Baccalaureate and Graduate Degrees in Respiratory Care. Retrieved from Centers for Medicare and Medicaid Services. (2013). Readmission reduction program. Retrieved from Commission on Accreditation for Respiratory Care. (n.d.) Find an accredited program. Retrieved from Currin, J. (2007). Nurse practitioners and physician assistants: Do you know the difference? Medical Surgical Nursing, 16(6), Economist. (2013). Prescription for change: America s hospital industry prepares for upheaval. Retrieved from Gershengorn, H. B., Johnson, M. P, Factor, P. (2012). The use of non-physician providers in adult intensive care units. American Journal of Respiratory Critical Care Med 185 (6) pp Hess, D. (2005). Training and education challenges for the twenty first century: Respiratory care competency and practice. Respiratory Care Clinics (11) Hoffman, L.A., Miller, T.H., Zullo, T.G., Donahoe, M.P. (2006). Comparison of 2 models for managing tracheotomized patients in a subacute medical intensive care unit. Respiratory Care 51: Hooker, R.S. (2006). Physician assistants and nurse practitioners: the United States experience. Medical Journal of Australia, 185 (1), p. 4. Kacmarek, R. M., Barns, T. A., Durbin Jr, C. D. (2012). Survey of directors of respiratory therapy departments regarding the future education and credentialing of respiratory care students and staff. 57 (5), p National Conference of State Legislatures. (2010). Summary of the Health Workforce Provisions in the Patient Protection and Affordable Care Act. H.R Retrieved from References