So at the present time our profession finds itself amid the fifth period of respiratory therapy, whereby many wonder if cost cutting measures will result in our profession being cut. While we used to be a pay for service department, we are now mainly just a service department. And while our services are essential to ideal patient care, there are those who believe our services have out lived their usefulness.
In many regards they are right. For many years now our profession has sort of milked the system, as many of us find ourselves doing procedures that we know are pointless, but we don't say anything because we are being paid.
Hospital administrators don't say anything either, because they know, even though most of what we do is a waste of time, that many of the things we do are absolutely essential to good patient care. I mean, who gets called first when a patient is in respiratory distress? It's the respiratory therapist. In many cases, the therapist is called even before the doctor.
And even if the therapist isn't called first, the physician insists on the therapist being present. Ever watch one of those old movies when the doctor is doing all the work during a code in the ER and says, "Where the hell is respiratory?" While that's an inaccurate description of accuracy, it sort of portrays how the medical profession views our profession: they think we're a bunch of useless dummies, but in cases of emergency we are the first one called." The point being: our services are needed, but they won't admit it.
The truth of the matter is, no one knows respiratory like the respiratory therapist. I even had a hospitalist come up to me recently and admit this. He said, "You respiratory therapists are our pulmonologists. When we have a respiratory patient we call you and we heed your advice."
The fifth period of respiratory therapy exists in a time where the government is getting more and more involved in healthcare. What this means is that many decisions regarding patient care have been removed from the physician, removed from hospital administrators, and given to government officials who sit in comfy leather chairs hundreds, if not thousands, of miles away from the patients they intend to help.
These government officials consider themselves the experts. They know what's best for every patient in the United States even though the majority have no healthcare experience whatsoever. This is where your protocols and order sets come from. They say they are an attempt to improve patient care. But we know the true reason for them is an attempt to cut reimbursement costs to hospitals.
They say they are not being forced on hospitals. But the truth is, if hospitals don't adapt them reimbursements will be cut. So, in this way, hospitals are forced to adapt them whether they want to or not. In the end, while the government saves money, hospitals have to eat the cost of implementing and enforcing these protocols and order sets that no one wants and that don't work.
In the midst of all this, sits the respiratory therapist in the RT Cave. He grumbles and gripes under his breath when asked to do yet another breathing treatment on a patient who is not short of breath and probably doesn't need it. Yet he keep his mouth shut for fear of alienating the very folks he relies upon.
Yet the time appears to have arisen whereby the word has gotten out, and certain members of Congress have established bills that would deregulate respiratory therapists in order to save costs. In other words, the process has begun whereby the powers that be will be looking at everything we do, and deciding if we are really needed. There has even been talk of educating certain nurses to do what we do. "After all," one nurse said to me, "All you guys do is turn knobs anyway, as most vents just work themselves."
You think that's true? Most therapists know that we are more than just button pushers and neb jockeys: we are an essential part of the patient care team. While most physicians, nurses, and hospital administrators understand this too, their hands might be forced to pull the rug out from under us for no other reason than to cut costs.
Will our profession survive? Surely we will. Yet the scope of our practice might result in us picking up duties we don't want to do, such as wiping butts and cleaning up puke. Yet, if we play our cards right, it might evolve the other way too, where the scope of our practice allows us to remain an integral part of the patient care team.