The AARC Respiratory Therapist Human Resources Study 2000:

The AARC Respiratory Therapist Human Resources Study 2000: Association Releases Results of Landmark Survey of RT Workforce In the last 20 years, the AARC has conducted five human resource surveys on behalf of its members. The most recent was the 1992 survey. 1 The AARC Respiratory Therapist Human Resources Survey 2000 is the most comprehensive study of its kind ever conducted by the AARC. While previous AARC surveys relied exclusively on data provided by employers in acute care hospitals, this study was much broader. It included separate surveys to employers in all common respiratory therapy employment venues acute care, long-term care, home care and respiratory therapy education programs accredited by the Committee on Accreditation for Respiratory Care (CoARC). In addition, respiratory therapists, regardless of where they were employed, were surveyed directly. The primary objectives were to capture and report information about the number of respiratory therapists working today, the venues in which they practice, demographic characteristics of the workforce, and the compensation they receive. The study projects there are 111,706 respiratory by William H. Dubbs, MHA, RRT Editor s Note The source of this article is the executive summary of the 300-page Respiratory Therapist Human Resources Study 2000 report recently conducted for the American Association for Respiratory Care by Applied Measurement Professionals, Inc., (AMP). This study project was directed by a panel of experts working in the various venues of care represented in the study and selected from the AARC s Blue Ribbon Panel on Value and Recognition. The project panel was chaired by Kerry George, BS, RRT, and included Patrick Dunne, MEd, RRT, FAARC; George Burton, MD, FAARC; Dianne Lewis, MS, RRT; RADM Fred G. Paavola, RPh, FAPHA; Harold R. Stevens, MD; and John Walton, MHA, RRT, FAARC. William Dubbs, MHA, RRT, AARC associate executive director, served as the staff liaison to the panel of experts. The study s panel of experts worked closely with AMP and made final decisions on the content of the surveys, approved all survey procedures, and approved the final report. The final report is composed of five survey reports that are organized identically. AMP Program Director for Research and Development Robert C. Shaw, PhD, prepared the final report, which is available from the AARC (information on how to order the complete final report appears at the end of this article). therapists currently in the workforce the highest number ever reported. In the acute care hospitals alone, which three-quarters of all therapists report as their primary place of employment, employers report having 6,510 vacant full-time equivalent positions (FTEs) this year. This represented a slightly higher vacancy 34 AARC Tımes December 2000

Take-Home Notes This study of the profession s current workforce found there are approximately 111,700 respiratory therapists working today. The study includes current wage/ salary information for all positions in the various venues of care nationwide. The percentage of respiratory therapists with associate or higher degrees has increased considerably since the last AARC human resource survey in 1992. More than half of all therapists now have associate degrees, and about one-fourth have baccalaureate degrees. rate than was reported in 1992. To fill these vacancies, as well as vacancies in all other sites of care in which respiratory therapists are employed, the respiratory therapy educational programs graduated an estimated 5,572 new therapists in 1999. Comparison with previous AARC studies Hospital Employer Survey Comparison of results from the AARC Respiratory Therapist Human Resources Study 2000 with previous human resource surveys conducted by the AARC is limited because different methodologies were used in the 2000 study. 2 Previous surveys involved hospital employers only and surveyed only hospitals classified by the American Hospital Association (AHA) as general medical and surgical and having respiratory services. Comparisons between the 2000 hospital employer survey and the 1992 survey are limited because the AHA no longer asks hospitals for information about respiratory services in their annual survey. Consequently, hospitals with respiratory therapists or respiratory services are no longer identified in their database. Therefore, the research panel had to develop criteria that would identify hospitals most likely to employ respiratory therapists and provide organized respiratory care services. The panel recognized that while respiratory therapists may be employed in hospitals with less than 35 beds, larger hospitals were more likely to have an organized respiratory care service and employ therapists. Additionally, rather than surveying only hospitals classified by the AHA as general medical and surgical as was done in the 1992 survey, the 2000 hospital employer survey included all hospitals (regardless of AHA classification) with 35 beds or more. Other important differences limit comparison between the 1992 and 2000 hospital employer surveys. The 2000 hospital employer survey asked only about positions held by respiratory therapists. Previous surveys asked about all employees of the respiratory therapy department and included aides, clerical staff, equipment technicians, and others. Additionally, the 1992 survey asked questions about credentials, education, years of experience, ethnicity, sex, and age. In the 2000 study, those demographic questions were asked in the survey of respiratory therapists rather than in the hospital employer survey. Documenting the workforce Table 1 shows a comparison of projected FTEs from the 2000 hospital employer survey and 1992 survey. Note that the total FTEs of managerial personnel (director through supervisor/ assistant supervisor) decreased by 21.3 percent from 13,167 in Table 1. Hospital Employer Survey: Total Projected FTEs Position Director 4,937 4,066 Assistant/Associate Director 1,538 Manager 1,081 Supervisor 6,748 Supervisor/Assistant Supervisor 6,482 Staff Therapist/Technician 86,702 55,729 Diagnostic Technologist 9,095 Instructor/Educator 933 Disease Manager/Patient Educator 787 Respiratory Therapy Aide 3,928 Clerical Staff 2,723 Equipment Technician 1,318 Other 4,133 Total 109,202 80,998 1992 personnel titles are in italics 2000 personnel titles are boldfaced AARC Tımes December 2000 35

Table 2. Hospital Employer Survey: Projected Number of Vacant FTEs Job Title Position Difference % Change Director 111 35 Assistant/Associate Director 71 Manager 7 Supervisor 299 Supervisor/Assistant Supervisor 208 Staff Therapist/Technician 5,153 2,832 Diagnostic Technologist 508 Instructor/Educator 91 Disease Manager/Patient Educator 348 Respiratory Therapy Aide 62 Clerical Staff 56 Equipment Technician 27 Other 145 Total 6,510 3,442 3,069 189% 1992 personnel titles are in italics 2000 personnel titles are boldfaced 1992 to 11,685 in 2000. In the same period, the number of staff FTEs (respiratory therapist, respiratory therapy technicians, diagnostic technologist, instructor/educator, and disease manager/patient educator) increased by 75 percent from 55,729 to 97,517. This is consistent with the trend in the health care industry to shift from managerial and supervisory to staff positions during the 1990s. If the respiratory therapy aides, clerical staff, equipment technician, and other non-clinical positions are taken out of the total 1992 FTE count of 80,998, the number of managerial and clinical positions would have been 68,896. The 109,202 projected FTEs in 2000 represents an increase of 40,036 FTEs (58.5 percent) in managerial and clinical positions from 1992. Table 2 shows a comparison of projected vacant FTEs from the 2000 hospital employer survey and the 1992 survey. The total vacant FTEs of managerial personnel (director through supervisor/assistant supervisor) increased by 27.7 percent from 321 in 1992 to 410 in 2000. In the same period, the number of staff FTEs (respiratory therapist, respiratory therapy technicians, diagnostic technologist, instructor/educator, and disease manager/patient educator) increased by 215 percent from 2,831 to 6,100. The total vacant 6,510 FTEs in the 2000 hospital employer survey represented a vacancy rate of 5.96 percent of the 109,202 total FTEs. The 3,151 vacant managerial and clinical FTEs in the 1992 survey represented a vacancy rate of 4.57 percent of the 68,896 managerial and clinical FTEs. Hence, the vacancy rate is 1.39 percent greater in 2000 than it was in 1992. Therapists are contracted from non-employee pools and from outside temporary staffing agencies to supplement staffing when vacant positions cannot readily be filled. Table 3 shows a comparison of supplemental FTEs from the 2000 hospital employer survey and the 1992 survey. The total supplemental FTEs of managerial personnel Table 3. Hospital Employer Survey: Projected Supplemental FTEs Position Difference % Change Director 70 9 Assistant/Associate Director 3 Manager 0 Supervisor 91 Supervisor/Assistant Supervisor 17 Staff Therapist/Technician 4,742 3,844 Diagnostic Technologist 474 Instructor/Educator 28 Disease Manager/Patient Educator 35 Respiratory Therapy Aide 132 Clerical Staff 21 Equipment Technician 33 Other 162 Total 5,440 4,221 1,219 129% 1992 personnel titles are in italics 2000 personnel titles are boldfaced 36 AARC Tımes December 2000

Table 4. Hospital Employer Survey: Projected Mean Hourly Salaries Position Director $26.45 $19.20 Assistant/Associate Director $16.97 Manager $18.10 Supervisor $20.99 Supervisor/Assistant Supervisor $15.95 Staff Therapist/Technician $16.66 Respiratory Therapist $14.55 Respiratory Therapy Technician $11.81 Diagnostic Technologist $17.51 Instructor/Educator $20.71 Disease Manager/Patient Educator $19.04 Respiratory Therapy Aide $8.14 Clerical Staff $9.03 Equipment Technician $8.88 Other $12.57 1992 personnel titles are in italics 2000 personnel titles are boldfaced (director through supervisor/ assistant supervisor) increased from 29 in 1992 to 161 in 2000. In the same period, the number of staff FTEs (respiratory therapist, respiratory therapy technicians, diagnostic technologist, instructor/educator, and disease manager/patient educator) increased by 137 percent from 3,844 to 5,279. The total supplemental 5,440 FTEs in 2000 represented 4.98 percent of the 109,202 total FTEs. The 3,873 supplemental managerial and clinical FTEs in the 1992 survey represented 5.62 percent of the 68,896 managerial and clinical FTEs. While the total number of supplemental staff is significantly greater in 2000 than in 1992, the percent of supplemental staff is 0.64 percent lower in 2000 than it was in 1992. The AARC compared the number of projected salaries Percentage of RT Workforce 64 62.3 Female from the 2000 hospital employer survey and the 1992 survey, as shown in Table 4. Because different job titles were used in the 2000 and 1992 hospital employer surveys, it is impossible to quantify changes in mean hourly salaries. Individual Therapist Survey The comparisons made between the 2000 individual therapist survey and the 1992 survey are shown in Figures 1-4. Again, it is important to remember that very different methodologies were employed in these surveys. The most important difference is that respondents to the 2000 individual therapist survey were therapists working in all venues in which respiratory services are provided. The 1992 survey respondents were directors of respiratory therapy services in acute care hospitals only. The percentage of respiratory therapists with associate or higher degrees has increased considerably since the 1992 survey. It is noteworthy that more than half now have associate degrees and nearly one-fourth have baccalaureate degrees. There has also been a substantial (continued on page 40) Figure 1: Gender Comparison 36 37.7 Male AARC Tımes December 2000 37

Putting It in Perspective: What AARC Found Out About the Here are some highlights from the five surveys conducted that comprise the AARC s Respiratory Therapist Human Resources Study 2000. Respiratory Therapist Survey highlights: 6,500 surveyed; 1,856 responses; 28.6 percent return rate Projected 111,706 therapists working; 70,145 projected therapist as their employment title Mean age, 40; mean years of experience, 14; mean years working for current employer, 9 Mean hourly wage (all positions), $19.62 per hour ($40,809 annually); median additional annual compensation, $750 (New England region offers highest median additional compensation) 73.5 percent report having Certified Respiratory Technician/Certified Respiratory Therapist (CRTT/CRT) credential; 68.5 percent report having Registered Respiratory Therapist (RRT) credential 50 percent report having ACLS certification; 26 percent PALS, 32.9 percent NRP 46.8 percent report involvement with bronchoscopy; 62.7 percent, intubation; 27.3 percent, noninvasive cardiology; and 21.3 percent, conscious sedation 74.5 percent report graduating from a therapist program; 20.7 percent, technician program Female, 64 percent; male, 36 percent Caucasian, 86.1 percent; African American, 4.5 percent; Hispanic, 3.9 percent; Asian/Pacific Islander, 2.8 percent 75.5 percent reported acute care hospitals as their primary place of employment; 9.1 percent, home care; 5.9 percent, long-term acute care (LTAC)/rehabilitation 22.7 percent report more than one employer 43.5 percent who work in hospitals typically work a 12-hour shift; 37.9 percent work an eight-hour shift Associate degree, 51.2 percent; Baccalaurate, 24.6 percent; some college, 15.9 percent; master s, 5.2 percent; high school/ged, 2.5 percent 77.3 percent work in one venue only. Hospital Employer Survey highlights: 2,987 with 35 or more beds surveyed; 778 respondents; 26 percent response rate 74.2 percent urban (50,000 population or more); 25.8 percent rural Projected 109,202 FTEs employed by hospitals; 5,440 of those being filled by supplemental staff; 6,510 FTEs reported vacant this year Projected 86,702 staff therapist FTEs budgeted this year with 5,153 of those therapist FTEs vacant Mean salaries: director, $26.45; supervisor, $20.99; staff, $16.66; diagnostic technologist, $17.51; instructor/educator, $20.71; disease manager/patient educator, $19.04 84.5 percent of all hospitals provide more than 16 hours of service each day 44.4 percent of hospitals provide additional clinical responsibilities to therapists who attain additional certifications, and 19.1 percent provide additional pay to those therapists Tuition reimbursement is the top recruitment/retention incentive offered by 64 percent of hospitals Time to recruit therapists increased in 42.8 percent of hospitals, and staff turnover increased in 23.1 percent 93.3 percent report traditional department organization; 4.1 percent, partially decentralized; 2.6 percent, totally decentralized Large hospitals (more than 122 beds) staff a median of 20 FTEs, small hospitals (35 to 122 beds) staff a median of five FTEs Urban hospitals pay more in every category: difference ranges from $2.00 to $5.00 per hour Large hospitals (more than 122 beds) pay more than small hospitals (35 to 122 beds) for all categories (about $2.50 per hour for staff to about $6.00 per hour for directors) 38 AARC Tımes December 2000

urrent Respiratory Therapy Workforce Educator Employer Survey highlights: 376 surveys mailed to sponsors of all CoARC-accredited programs; 163 surveys returned; response rate of 43.4 percent; survey conducted in late spring of 1999 15.8 percent of respondents were from a technical school; 56.3 percent, from a community college; 27.8 percent, from a university Median number of full-time FTEs: technical school, 2.0; community college, 2.0; university, 2.45 Projected full-time FTEs: 1997-98 = 1,072.32, 1998-99 = 1,054.55, 1999-2000 = 1063.64 Projected part-time FTEs: 1997-98 = 335.02, 1998-99 = 327.50, 1999-2000 = 328.25 (does not include physicians) Percent full-time faculty holding 12-month contracts: program director, 64.2 percent; director of clinical education, 59.6 percent; other faculty, 49.3 percent Program faculty holding doctorate degrees: program director, 12.3 percent; director of clinical education, 6.4 percent; other faculty, 12.6 percent Full-time faculty with tenure across program types: technical school, 21.8 percent; community college, 46.3 percent; university, 33.1 percent Mean monthly salary by academic position: program director, $4,570.83; director of clinical education, $3,871.55; other faculty, $3,762.39 Mean monthly salary for all faculty across program types: technical school, $3,592.40; community college, $4,212.32; university, $4,214.06 Note: Durable medical equipment (DME) and long-term care venue surveys had severe sampling limitations; thus, caution must be exercised in interpreting results. DME Employer Survey highlights: 500 surveys mailed to DME employers accredited by the Joint Commission on Accreditation of Healthcare Organizations to provide clinical respiratory services; 55 returned; response rate 11 percent Median budgeted FTEs for staff therapists: last year, 3.0; this year, 2.5; next year, 3.0 Mean hourly wage by position: director $28.98; clinical coordinator, $21.42; staff therapist, $16.88 About one-half of employers give additional responsibilities if therapists have earned additional certifications About one-fourth of employers give additional compensation if therapists have earned additional certifications Few reported decrease in recruiting time; most report turnover rate remaining constant Most frequently used incentives include: tuition reimbursement, performance-based bonuses, and profit sharing Recruitment time compared to last year: majority about the same, 31 percent increased, 5.5 percent decreased Long-Term Care Employer (LTAC/rehabilitation, selected for-profit skilled nursing facilities) Survey highlights: 317 surveys mailed; 56 responses; 17.7 percent return rate Few had budgeted positions for instructor/educator and disease manager/patient educator Mean reported staff therapist FTEs: last year, 11.08; this year, 14.50; next year, 14.60 Mean hourly wage by position: director, $24.71; supervisor, $20.20; staff, $17.39 Less than half receive additional compensation for additional responsibilities Most frequently used incentives include: tuition reimbursement, performance-based bonuses and profit sharing, and finder s fee Recruitment time compared to last year: majority about the same, 22.2 percent increased, 9.3 percent decreased Turnover compared to last year: majority about the same, 18.5 percent increased, 22.2 percent decreased AARC Tımes December 2000 39

Figure 2. Race/Ethnicity Comparison Percentage of RT Workforce 1.2 1.8 2.8 2.1 American Indian/ Alaska Native Asian/Pacific Islander 4.5 decline in the number of respiratory therapists who have not taken any college courses. The percentage and number of respiratory therapists holding both entry-level and advanced credentials has increased substantially since 1992. Additionally, the percentage and number holding specialty credentials has increased considerably. Government labor statistics comparison 8.8 African American There are substantial differences in the projections made by the AARC Respiratory Therapist Human Resources Study 2000 and the U.S. Department of Labor in its publication Occupation Outlook Handbook at http:// www.bls.gov/. The U.S. Department of Labor states that 86,000 jobs are held by respiratory therapists and that 90 percent of the 3.9 4.4 Hispanic 86.1 82.1 Caucasian 1.5 0.8 Other jobs are in hospitals. This 2000 AARC human resources study projects 111,706 respiratory therapists employed in the United States. More than 75 percent (75.5 percent) of the respiratory therapists responding to the AARC s 2000 survey identify acute care as their primary venue of employment, while 9.1 percent report home care and 6.3 percent report long-term acute care hospitals and rehabilitation as their primary employer. The remaining therapists report CoARCsponsored educational programs, skilled nursing facilities, industry, and other (including clinics and physician offices) as their primary site of employment. The Department of Labor reports median annual earnings for respiratory therapists to be $34,830 (as of 1998). The AARC 2000 survey reports $39,333 as the median and $40,809 as the mean annual wage for all respiratory therapists. 1998 Department of Labor comparisons of median annual wages for selected health care professionals are shown in Table 5. Entry-level therapist wages The average hourly wage is $16.15 (SD $3.14) or $33,592 annually, among 63 respondents to the therapist/technician survey who indicated that they had worked for up to one year since graduation. This subgroup was selected to represent therapists at entry level. Although this was a relatively small subgroup of respondents, the distribution of wages around the mean was normal, so we expect this value to reasonably approximate the population mean. The minimum wage Table 5. U.S. Department of Labor 1998 Comparison of Median Annual Earnings Occupation All Care Sites Hospitals Respiratory Therapists $34,830 Not available Registered Nurses $40,690 $39,900 Physical Therapists $56,600 $50,100 Occupational Therapists $48,230 $46,200 Speech Language Pathologists or Audiologists $43,080 $44,800 40 AARC Tımes December 2000

Figure 3. Comparison of Academic Achievement by Therapists 51.2 Highest Academic Degree Achieved 13.1 15.5 28.4 42.0 24.6 14.0 Not Surveyed 0.2 No High School Diploma 2.5 High School/ GED Some College Associate Baccalaureate 5.1 2.0 Masters 0.6 0.3 Doctorate earned by this subgroup is $8.50, and the maximum wage is $24.29. However, a more precise wage range is produced by looking within the first standard deviation bounded by wage values of $13.01 to $19.29 ($27,061 to $40,123 annually). These responses include the effect of shift and other kinds of wage differentials, so entry-level therapists and their employers who wish to compare their salaries to these national results should take note of that fact. What the study means Now that the AARC has completed its largest-ever study of the respiratory therapy workforce, what are some examples of what it could really mean to RTs nationwide, as well as those who employ them? With this study, employers now have the demographic characteristics of the profession at their fingertips, which will help them make better workforce decisions and see trends in the profession, such as skills RTs have gained or could gain in the future. The study provides an estimate of the entire RT workforce including supply and demand for RTs, where they are working, and their scope of practice. It documents variability in salaries, recruitment, and employment incentives, as well as differences in urban and rural RTs. Clinicians will also benefit from the study, as they will be able to compare their skills, education/training, and salaries to other RTs and check job vacancy rates in various parts of the country. For educators, the study is a veritable smorgasbord of information to help them better recruit and prepare people to work as respiratory therapists in all care settings. It also enables them to compare their own salaries among other health care professionals. In addition, respiratory therapy advocates on the federal, state, and local levels now have a new resource that documents the strength of our workforce whenever they seek better recognition among health care decision makers or do public relations in their areas. According to Jill Eicher, AARC s director of government affairs: The results of the AARC s human resources survey provide Congress with key information on the presence of respiratory therapists in the AARC Tımes December 2000 41

Figure 4. Comparison of Therapists Reporting Specific NBRC Credentials 73.5 37.9 Percentage of RT Workforce 37.9 36.9 9.0 9.6 CRTT/CRT RRT Perinatal/ Pediatric 2000 0.3 CPFT 3.7 0.3 RPFT health care system. This information is useful for any respiratory therapist when talking to their own member of Congress on the impact of federal policies on the respiratory therapy profession. For the AARC, this year s human resources study will help Association leaders continue to recognize and confirm important trends in our profession, devise strategies to improve public and government relations, and, in essence, chart a better course for the future. William H. Dubbs is an associate executive director at the AARC Executive Office in Dallas, TX. REFERENCES 1. Bunch, D., & Cathcart, M. (1992). AARC completes 1992 human resource survey. AARC Times, 16(5), 56-63. 2. Dubbs, W.H. (2000). The AARC 2000 respiratory therapist human resources survey soon to be released. AARC Times, 24(9), 42-43. The AARC Respiratory Therapist Human Resources Study 2000 This comprehensive study surveyed 6,500 therapists, 2,987 hospitals, 376 respiratory education programs, 500 DME employers, and 317 long-term care employers. Study includes: number of therapists working, the venues in which they practice, demographic characteristics, and compensation. Published December 2000, paper cover, spiral bound, 314 pages, 306 tables, and 89 figures. AARC Respiratory Therapist Human Resources Study 2000 (Item No. BK9) Only $55 for AARC members (plus $7.25 for shipping and handling) $75 for nonmembers (plus $8.25 for shipping and handling) Purchase Order, MasterCard, or Visa accepted American Association for Respiratory Care, Order Desk, 11030 Ables Ln., Dallas, TX 75229 voice (972) 406-4663; fax (972) 484-2720