The Current State of Respiratory Care: Licensure, Credentialing, Education, and Advanced Practice Shane Keene, DHSC, RRT-NPS, CPFT, RPSGT, RST, FAARC Department Head, Analytical and Diagnostic Sciences University of Cincinnati Disclaimer I serve as a Commissioner for the Commission on Accreditation for Respiratory Care I also serve on some committees affiliated with the NBRC and AARC Any statements or observations within this presentation that are not of an objective nature (numerically driven) are my personal insight and opinion and are not endorsed by any organization 1
AARC Strategic Plan Expedite the continuing development of baccalaureate and graduate degree education in respiratory care with the goal of the baccalaureate degree as entry level. Actively engage and support state affiliates in the movement toward registered respiratory therapist as entry level for licensure. Collaborate with NBRC and CoARC to expedite the development of standards for education, credentialing, and avenues for reimbursement for the Advance Practice Respiratory Therapist. State Licensure Licensure is present in 49 states Alaska is the only hold out because it is not financially feasible Licensure boards are becoming more active and many some have taken steps that affect the entry level to practice while others are considering the step. 2
Changes with Licensure California and Ohio have mandated the RRT credential as the entry level in to practice. CRTs licensed prior to the change are grandfathered The State of Maryland is also considering the RRT credential as the entry-level in to the profession Other states will most likely follow suit as the concept is no longer novel Current Practitioners by the Numbers 230,506 Credentialed Practitioners RRT- 141,875 61.5% CRT- 88,631 38.5% ACCS- 984 0.4% NPS- 12,488 5.4% CPFT- 13,043 5.6% RPFT- 4,365 1.8% SDS- 315 0.1% 3
Credentialing CRT/RRT Exams NBRC New Therapist Multiple Choice Exam for CRT/RRT Two cut scores- CRT is the low cut score and RRT is the new high cut score (6 point difference) Even if you pass the written exam with the higher cut score you still have to pass clinical sims to be awarded RRT credential Clinical Simulations are now 20 short sims as opposed to 10 long ones Information gathering and decision making are now grouped together for a cumulative score. You no longer have to pass both portions of the simulations independently Credentialing CPFT/RPFT NBRC New Therapist Multiple Choice Exam for CRT/RRT Two Cut Scores One test: CPFT is the low cut score and RPFT is the new high cut score Should increase the number of candidates and credential holders for diagnostic exams 4
Future of Credentialing The NBRC will not eliminate the CRT exam because it would open the organization up to law suits. The elimination of the exam would devalue the CRT credential. It will be up to individual state licensing boards and health care organizations to police the entry level into the profession not the NBRC or CoARC Education CoARC CoARC accredits 447 programs 422 base programs 16 satellite programs 9 sleep disorder programs 5
Education: Degrees Breakout Associate degree 85% (374 programs) Baccalaureate degree 14% (61 programs) Master s degree <1% (3 programs) Illustrated Degree Breakout 6
Education Trends Compared to 2013, there was a 1.8% decrease in associate degree programs and a 7% increase in baccalaureate degree programs. The AS degree accounted for the largest (84.7%) of all degree types, a 23.4% decrease since 2011. The BS degree accounted for 13.7% of all degree types offered in 2014, an increase of 22.4% since 2011. Changes in Program Applications Total applications to accredited programs were 20,405 for 2013. Applications reached a peak of 23,430 in 2011, and decreased by 12.9% between 2011 and 2013. The mean number of applications per program was 46 in 2013. Compared to 2012, applications decreased by 12.5% for associate degree programs and by 11.3% for baccalaureate programs. 7
Degrees Earned by Program Directors in CoARC Accredited Programs Program Directors Baccalaureate 52.5 % Master s 34.0 % Doctorate 13.0 % Major shortages of RT educators are anticipated with the last wave of the Baby Boom Generation retirement CoARC Standards Degree advancement standards are now complete. CoARC will now accredit degree completion programs at the baccalaureate level and master s programs that are not entry-level. This accreditation does not effect existing entry-level programs and will be voluntary. It should facilitate the standardization of RT education beyond entry-level. 8
Coarc Standards Thresholds 80% pass rate on CRT credentialing success 3 year average 9% or 39 programs failed to meet threshold this past year 70% Job placement rate 3 year average 9% or 39 programs failed to meet threshold this past year One threshold obviously affected the outcome of the other in some programs as students who cannot pass the CRT exam are not eligible for employment Respiratory Programs by State 9
Advanced Practice Programs CoARC now has standards in place for colleges or universities to apply for advanced practice These graduate programs must minimally be offered at the masters level Students entering advanced practice programs must be bachelors prepared and have the RRT credential Advanced Practice Credentialing The NBRC has been commissioned to develop an advanced exam and credential. The name of the credential will most likely be Advanced Practice Respiratory Therapist (APRT) or (RRT-AP) The exam will take minimally 2 years to develop and would be available only to graduates of advanced practice programs 10
Advanced Practice: What is Happening Now A 12 member ad hoc committee composed of equal representation from CoARC, NBRC, and AARC has been charged with moving the process forward A large number of students completing their bachelors degree in respiratory care are currently doing so in an effort to leave the field by gaining eligibility to graduate schools (predominately PA programs) Hopefully we will have viable graduate programs soon to keep our brightest practitioners in the RT field who want to be physician extenders Advanced Practice: Next Steps Physician buy-in (survey member physicians of the National Association of Medical Direction for Respiratory Care (NAMDRC) Differentiate the skill set of APRT from other physician extenders. Duplication of services will be much more difficult to get reimbursed from third party payers Pick a state to pilot a program and show it works. Will most likely be accepted on a state by state basis much like anesthesia assistant, which is currently viable in 28 states. 11
Takeaways The culture and work force are starting to demand higher achievement in the profession State licensure boards are raising the standards Bachelors programs are growing Even though fewer students are applying and graduating from RT programs, many programs are still having trouble with job placement Could be an indicator of at least segmental market saturation Advanced practice will be a reality When, where, and in what capacity are still yet to be determined References American Association for Respiratory Care http://www.aarc.org/aarc/missionstatement/ California Society for Respiratory Care http://www.csrc.org/ Commission on Accreditation for Respiratory Care (2015). 2014 Report on Accreditation in Respiratory Care Education. Retrieved from http://www.coarc.com/ National Board for Respiratory Care (2015, First Quarter). NBRC Horizons. Vol. 41 N. 1 Ohio Society for Respiratory Care http://www.osrc.org/ 12