For those of you who are AARC members (and you all should be) you are probably aware by now that in Kentucky one large health care system is eliminating respiratory therapists from the E.R. Their duties (including ventilation) will be handled by nurses. Obviously this plan was not well thought out by the management of that health care system and I anticipate that it will be very problematic once implemented. Those of you who have been in the RT field for 20 or more years have seen something similar to this tried in hospitals in Texas and it just didn't work out well - nurses are not respiratory therapists, they are not trained to be respiratory therapists, and they don't think like respiratory therapists. The AARC is writing a letter to that healthcare system voicing opposition to their decision.

But given that we now have being implemented throughout the United States what many experts (including physicians) consider to be a disaster of a health care reform law (the Affordable Care Act, aka,  "Obamacare") we are beginning to see the ramifications not only on patients losing their health insurance after they were promised they could keep it, or losing their doctors after being promised they could keep them, but we are seeing it within health care institutions like the one in Kentucky. Hospitals and other providers are having to slash costs to the bare bones in order to survive and many physicians are no longer accepting Medicare or Medicaid patients. Many of the duties once limited to nurses are now being performed by medical assistants who have very minimal training, and you are seeing more nurse practitioners who are doing what was once limited to physicians. In Texas, Medicaid is discontinuing reimbursement for continuous pulse oximetry for children who are  receiving mechanical ventilator assistance in the home. 

In fact, a recent article voicing opposition to the Medicare Respiratory Therapist Access Act HR 2619 which incorrectly drew the assumption that respiratory therapists were going to be able to set up their own practice and eliminate the need for a physician was published in a well-respected medical journal. That article essentially solicited support in opposition to HR 2619. Fortunately the AARC is drafting a rebuttal of that article and clarifying that HR 2619 does not eliminate the need for physician involvement but rather, requires physician involvement. 

For as long as the respiratory care field has been around physicians have been our allies, but since the federal government has been systematically dismantling our healthcare system in the U.S. even physicians are starting to feel threatened and are becoming more protective of "their territory." As respiratory therapists we should be concerned, but this is not the time to panic. In Texas your strongest advocate, the TSRC, is closely monitoring federal and state legislation that could affect you as a licensed respiratory care practitioner. Now is the time for your involvement - it is up to you to add muscle to the TSRC by adding members to its roll. Obviously if you are reading this newsletter you are probably already a TSRC member. But you know someone who isn't. You work with someone who isn't. Or maybe you hired someone who isn't. There are over 15,000 licensed RCP's in Texas but only about 3000 TSRC members. What message does that send to politicians? That less than 50% of RCP's support their professional organization?

If you want to have a voice in matters affecting your career and your future and you want your legislators to hear your voice then membership in the TSRC is the best way to ensure that. Legislators look closely at how many licensed RCP's there are versus how many TSRC members there are - the smaller the percentage the less likely your voice is to be heard by your legislators. So it really is up to you - encourage your coworkers who are not TSRC members to join now. If you are a Respiratory Care Department Director you should make it mandatory for your employees to be TSRC members and you shouldn’t consider hiring any RCP who is not a TSRC member. Many of us on the TSRC Board of Directors only have a few more years until retirement so it really doesn't impact us all that much. But to those of you starting your career or who have several more years before you can retire it will impact you greatly. So join. Get involved. Run for office at the District, Region or State level - nominations are currently being accepted for all positions at all levels, and it is perfectly acceptable to nominate yourself. You determine your future and the future of this profession. By not joining and not getting involved you are essentially saying, "it doesn't matter to me what happens to my profession or to my future."