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In My Opinion

CRT vs. RRT Debate Rages On

Published August 23, 2010 12:52 PM by Jimmy Thacker
The education section of the AARC Connect is having a wonderful discussion (and several sub-conversations) about the two-tiered system used in our profession to designate CRTs from RRTs.

The first highlight is how educators may be failing our graduates in getting them prepared for the RRT exam and how that has adversely affected our profession. Craig Black, program director at Ohio's University of Toledo, said "educators were falling down on the job in preparing our students for the CSE." He further suggests that the CRT was developed "with the idea that we would have a two-tiered profession -- technician and therapist. ... Clearly, it is time to overhaul the credentialing procedure that we use for our profession."

In agreement with Black, Robert Brown, program director at Education Affiliates Inc., of Phoenix, stated, "The credentialing structure now does not match the educational system and the employment structure for respiratory practitioners." He also writes: "It should be noted that passing the NCLEX is necessary to obtain a state license whereas passing the RRT is not a requirement of state licensure for respiratory care program graduates. This may be one of the biggest disincentives to taking the RRT exams."

When discussing how new RRT graduates seem, at times, ill-prepared to join the profession with the tools we believe they should have to make an immediate impact, John Hughes, of Millersville University, Lancaster, Pa., stated we should "consider that perhaps many of our programs are not preparing graduates to think and choose the way an advanced therapist thinks and chooses."

I did strongly disagree with one comment on the message board. "The RRT exam stands as the credential carried by the experienced professional respiratory therapist -- one who has advanced beyond ‘rookie status' and is prepared for and qualified for greater challenge," a therapist wrote.

New RRTs are the experience of the profession? Let's hope not! While many RRTs do possess experience, graduating from an RRT school does not give it to you. Rather, it's the years of work in the field that prepares you with experiences that you can learn from. Is this person suggesting that all of us lowly CRTs with 30+ years of experience are still "rookies"?

Gayle Carr, of Illinois Central College, seems to agree with me. She asked the question: "How can any graduate, no matter how well-prepared or how good the program, be able to pass an advanced exam, when by definition a new graduate is not an advanced practitioner? Isn't a new graduate a beginning practitioner -- not an advanced practitioner?"

In my opinion, this is exactly the type of discussions we need to be having for our profession. Although none of us will agree with everything stated, it's important that we talk about it. Clearly, many state societies are not touching these issues. The AARC, whom I have chided in the past, is at least showing a willingness to take on tough issues and listen to those working in the field with the experience and knowledge needed to contribute and point us in the right direction. The profession will only continue to grow, work out its problems, and be steered down the right paths when members of our ranks speak up.

Check out the full discussion at AARC Connect. You will need to log in with your AARC number and password. If you don't have one, perhaps this is the issue that convinces you to support your profession by joining.

13 comments

To Whom It May Concern:

I hate to see the arguments going on in the fields that I was once very active.   NSCPT and NBRT:  Each organization has its position and needs for the Cardio and Pulmonary organizations.  There should not think that one group is better than the other.  Believe me, there are well trained and slightly less well trained in any of those organizations.  This is an individual type of performance.  It is best to work together to perfect what is already established in any of those organizations.

Sincerely,

Rick Aguilar, NBRT and NSCPT as a pass member bur registered.

Rick Agular, Pulmonary/Surgery - Pulmonary Technologist Registered, Retired November 19, 2013 5:31 PM
Tucson AZ

I have BSRT & RRT-have been considered by AAST's/CRTs or RRTs as "silly." Told I wasted my time & money to get BS, since there's no distinction (or "advantage") to BS. They get they're RRT JUST like me-hold same jobs-make the same money. And the way things are now, & HAVE BEEN, they are right. CRTs hold supervisory positions, over RRTs-no advantage. While other "registered, BS degreed" profs hold supervisory positions, & feel & act superior to us. BS's RRTs NEED to rank higher, or we'll continue to be treated INFERIOR.

m b, BSRT, RRT, RPSGT, RST July 10, 2012 9:17 PM
FL

Being a dedicated member of the AARC, I find myself logging in to AARConnect on a near daily basis. While

July 6, 2012 10:01 AM

 Our scope of practice should require the minimum of a BSRC in order to be eligible to take our licensure exam. There is absolutely no need for both CRT and RRT practitioners as there is no real difference in their practice. In order to enhance our rank, and thus pay, in our healthcare roles we must enhance the educational standards of our field. Occupational Therapists, Physical Therapists, and Speech Therapists now require a Master level degree to attempt licensure. When you consider how much more critical our modalities are in sustaining life, it should shock you that our field requires far less education than those fields that restore finction but not life itself. In order to attain the respect, rank, and pay that we deserve; we will need to be able to compete in regard to our educational standards as well. Our field has incredible potential, and we are some of the most important providers of care. It is my fear that this potential will never be realized until we enhance our educational standards. Elimination of the CRT, and requirement of BSRC is long overdue. I am disappointed that it has taken the NBRC so long to enhance it's standards.

Dave Thompson RRT-NPS/MHA     Cardiopulmonary Manager

Dave Thompson, Respiratory Care - Cardiopulmonary Manager, THP July 3, 2012 7:46 PM
Flower Mound TX

 As it stands, all RCPs registered or not assume the same duties and in many instances the same pay. This type of structuring makes the profession appear non-essential when it comes to credentialing and it also appears that maintaining the two credentials suggest the nbRC and its associates are using this as a way of making money without the true reward for the therapists.  

 Granted, many CRTs have vast knowledge and clinical skills in the field/profession however, those therapists who come along after and must endure two years of education as in receiving an Associate of health Science should also be rewarded for that degree obtainment, unless this also is a ploy to delay the admission of therepists into the field because it appears that too many are graduating too fast with less positions open.

 Many CRTs would rather change into nursing than attempt the RRT exam just because the applying for the exam remains elusive and difficult and, the cost for such a small pay increase (in our minds) does not warrant such activities: applications, fees, transcript, and approval.

 If this is about "titles" and "appearances" then it is working well because many of those with RRT credentials are not as experienced as CRTs however, the educational level and how to search out information is one of the benefits of the degreed therapist. The disconnect between the old guards and the new therapists is obvious in many if not all facilities because the old pre-NBRC therapists tends to look at degreed therapists as simply book smart with no common clinical  skills sense while the two year grads tend to look a old school as lazy and uneducated with little or no sense of educational value with the 'business as usual attitude".

  For the most part both are correct! Competition do arise between the old guard and the new grad and many times it is encouraged by  instructors imposing their personal feelings on the students to make them think that the old therapists have gotten lazy and so goes the continuing fight and great chasm separating the two.

 Even through all of this, we as therapists need to get our act together because the regulating agencies are looking at ways to increase our responsibilitites and presence in health care. "Decreasing cost while improving the health" Barnes etal(2010) of the patients will be a major part of the changes coming. Evidence based care will take precedence and having facts to effect a change will be a part of our responsibility even  though we as respiratory care has been doing this already.

As the article submits,  

  The American Association for Respiratory Care established a  

   task force in late 2007 to identify likely new roles and

   responsibilities of respiratory therapists (RTs) in the year

   2015 and beyond. A series of 3 conferences was held

   between 2008 and 2010 also,  July 12-14, 2010, on Marco

   Island, Florida. The participants, who represented groups

   concerned with RT education, licensure, and practice,

   proposed, discussed, and accepted that to be successful in

   the future a baccalaureate degree must be the minimum

   entry level for respiratory care practice.

   Also accepted was the recommendation that the Certified

   Respiratory Therapist examination be retired, and instead,

   passing of the Registered Respiratory Therapist examination

   will be required for beginning clinical practice. A date of 2020

   for achieving these changes was proposed, debated, and

   accepted. Recommendations were approved requesting

   resources be provided to help RT education programs,

   existing RT workforce, and state societies work through the

   issues raised by these changes.

We as a profession need to get it together before some other entity decides they know whats best for us.

Barnes, T. A., Kacmarek, R. M., Kageler, W. V., Morris, M. J., & G.

     (2011). Transitioning the Respiratory Therapy Workforce for

      2015 and Beyond. Respiratory Care, 56(5), 681-690.

     doi:10.4187/respcare.01169

Samuel , resp. Care - RRT, TRMC July 31, 2011 11:45 AM
Orangeburg SC

Ok enough of the bull crap!  I dont care about other states other than california.  The california society of respiratory care  is throwing a fit because they would like to eliminate the crt credential and use the rrt credential instead to become and RCP.

You just recently I asked the the president of the southern califonia division of the CSRC, how many CRT Vs RRT were on the board?  She said that they were all RRT's.  People you need to attend the meetings and we need to get CRT's on the board.  These idiot RRT's think that all CRT's are not properly educated.  Ever since California started grand fathering Techs into RCP's!  You know we can all get get our underwear in a knot and nothing will get resolved.  People wait until the "Baby Boomers" crisis begins.  There will not be enough CRT or RRt to treat all these patients.  I think that the only solution is to grandfather all crts to rrt as the white papers mention from the CSRC.  You cannot punish our old timers who are still CRT and proud of it!!!!!  If this doesnt work then we need to form our own CRT?RCP Society of Respiratory Care and put a stop to all this non-sense

John , Respiratoy - RCP May 6, 2011 9:12 PM
Los Angeles CA

We shouuld all be working as a team. RRT, CRT doesn't make a lot of difference. Its just a title. What matters is patient care. Its a matter of providing the right procedure for whatever the situation calls for in an effective and efficient manner. There are CRT's that are better than RRT's and RRT's that are worst than fresh graduate CRT's but I do believe that everyone should always be kept abreast with the latest informations and technology occuring in the respiratory world. Taking exams twice to earn a title doesn't make you better than anybody. There should only be one examination for everyone to be able to work as a respiratory therapist. Call it anything you want, what's important is you have the knowledge and the expertise. We RT's don't make a lot so stop making profit from our sweat. It's hard earned.

em, respiratory - rcp, sgmh April 8, 2011 10:20 AM
banning CA

I don't see the CRT being a financial generator for the NBRC. I see it as an adjunct for new therapists being able to earn income as they continue to learn and grow, working towards the advance degree. As a new therapist a lifetime ago, the technical college I attended was CRT only. It was two years later that the program became a degree program.

Nine years ago, I decided that being a CRT wasn't enough. There was too much that I didn't know about my own field. I finished my AS in Respiratory Care, and have been studying ever since. I took my last board exam in December. Unless I chose to take my career in a completely different direction and become a polysomnographer, I have earned every credential in our field at the highest level.

My question to those of you that still carry what was designed to be an entry level credential for so many years, why don't you just go down and take the RRT? I was at a disadvantage. I've worked for the same pulmonary group for nearly my entire career, so there was so much that I didn't see when it came to equipment and procedures. Studying for more than a year for my RRT made me keep my therapist cap on, to keep learning. I still do, not just to be good at what I do today, but to be good at what I will be expected to do tomorrow.

If you're afraid of taking that exam, don't be. Put your therapist cap on and keep learning.

Lisa

Lisa, diagnostics - staff therapist, Georgia Pediatric Pulmonology January 28, 2011 8:05 PM
Atlanta GA

Great thoughts, David! The lack of distinction in duties and pay between CRT and RRT level therapists points to an obvious "glitch" in our standards. As a CRT, I am not convinced that RRTs, especially recent grads, deserve such a distinction, but your point is well made and well taken. The NBRC and AARC have done nothing to separate the two, and there is a cloud over who does what and who gets paid what. Some organizations, such as yours, have taken it on themselves to differentiate by excluding CRTs from their payrolls. As you said, that leaves some needing to pass the CRT and RRT exams just to keep their jobs. The problems are in the hierarchy. In my opinion, there are some institutions that may need to define the roles of the CRT (if any) and the RRT. A community-based rural facility, for instance, may not have the option because of a lack of talent applying for a job, while a large university hospital would. It's a human resource challenge to fill slots with those deemed most talented who are available. At some point, we, as a profession, will have to define what it takes to work as a respiratory therapist. In doing so, we will discriminate against those who built the field, the OJT ( almost gone now ) and the CRT, but may be able to improve our standard of care by using RRTs with more education. Instead of ruling out the CRTs, we should be encouraging them to get their RRT credentials. The new rules that offered the "grandfather" clause a couple of years back was handled poorly. Many CRTs were not aware of the opportunity to gain the RRT until it was too late because the NBRC was not straightforward about it. As it is, we have too many states with too many different rules about licensure. I, too, attended a school that no longer exists, about 30 years ago. When I travel, it becomes a major obstacle producing transcripts from a school that is no longer there. We need some kind of norm, some sort of organization that allows us to grow. We need standards in this profession so that the minute you decide you want to be a therapist, you know the requirements. We don't have that. Our professional organization has failed to lead any kind of fight to get that done, and the NBRC and state-level licensure is seen as a way to make money off of therapists who want to work, rather than a regulating agency. My suggestion is that this year, we should all vote for those AARC members who understand our frustration, and cast our ballot in the AARC's election process for 2011 that way. The old "status quo" of doing things is antiquated. We need fresh people with fresh ideas, who are working therapists and understand the needs and frustrations of working therapists rather than a bunch of academics who sit in offices all day or have their salaries funded by huge governmental grants. We should appoint a special council to figure out how to make RRTs out of CRTs, and if the CRTs are unwilling, how to phase them gracefully. We need people in office who will address the many issues with the NBRC and take steps to correct them. Elections are coming up. In my opinion, now is the time to make a stand. Thank you for your comments. Have a great RT week!

Jim Thacker, RT - BS, CRT, AE-C October 13, 2010 8:39 AM
Lexington MO

I will agree that any pedigree does not make you necessarily any more knowledgable or a competent therapist in and of itself,(CRT vs. RRT).

However, should we not try and have higher standards for us as RT's?  Our department here made a decision to make the RRT designation for our department the standard within one year, and within one year of hire for any new RT's we will hire.  This should not have been such an undertaking since all of our RT's are at least four or more years s/p graduation.   Yes some needed to take the CRT exam over which was disheartening but it is the requirement for those past that three year window.

What is the troubling part is that the NBRC is not consistent relaying to the candidates what is required of them when they apply.  Depending on the day of the week and who you get, it seems you can get 2-3 different answers for the same question.  People need to use snail mail vs. registering online a lot, gather transcripts from the school they attended 14 years ago, and fill out paper applications just to become eligible for those who have been professional CRT's for years already. This drives them and myself crazy!

What this has also done now is delayed and turned off those CRT's from signing up for the RRT test itself. Some of our staff are also now in a position of potentially losing their current job status due to not completing the RRT requirement in a timely manner.  Granted accountability rests on the individual itself, but the process for those who are CRT's to become RRT's has not made it any easier on them or the image of the NBRC itself.

The CRT vs. RRT in the past had more meaning and did come with a higher wage compensation years ago, not really much difference anymore.  We need to make a decision on one credential for our profession and be done with it. Similar to how nursing is with higher education for those who want to pursue further advancement.

David Warren, RRT, Cardiopulmonary Services - Director, Memorial Health Center October 12, 2010 5:23 PM
Medford WI

I agree with Eric regarding the CRT being  merely a money source for the NBRC. we should make the RRT the standard test to obtain a state license

nader alqam, Respiratory - RRT , Kindred Hospital September 26, 2010 4:29 PM
Ontario CA

I agree with you. I don't think  you can say that all RRTs are bad, and I've really grown tired of hearing people say that all CRTs are bad. I have worked with good therapists who held both credentials, as well as bad ones. As a manager, would you really rather hire a brand new RRT grad than a CRT with experience? I'm all for giving new grads an opportunity, but let's face facts, CRTs built this field. We owe them a little loyalty. CRTs were given the opportunity to take the RRT exam and "grandfather" in to being an RRT. Some did, many did not. The reason is that the difference between the two jobs is very slight. Larger hospitals can discriminate because they have the ability to attract more applicants, but in a rural area, as long as you have a license, no one will even ask if you are a CRT or an RRT. They just want to know you are competent. I admire anyone who seeks an advanced practitioner status. I just don't think there is a big enough difference in the current structure we have to warrant it, particularly if you've already been working for 25 plus years. There is no incentive to make the move from CRT to RRT. If the NBRC, AARC, and anyone else wants to solidify their positions and encourage people to obtain the RRT credential, there has to be a reason. Most CRTs are too smart not to notice that hasn't been done yet. CRT jobs are becoming few and far between, because we haven't donated more money to the NBRC, a group who doesn't even recognize the COPD Educator or the Certified Asthma Educator. I think they have to earn a little respect first by acknowledging that some people choose to specialize in something other than advanced money waste. Thanks for your comment.

Jim Thacker, RT - BS, CRT, AE-C, TRAC September 2, 2010 9:57 AM
Lexington MO

I think the "advanced practitioner" description is a misnomer.  It's now possible for graduates of programs to become an RRT within days of graduating, even before having 1 day of experience in the real world.  I've worked with CRTs who have volumes of knowledge and experience who are reliable and hard working, and also with RRTs who are book-smart only, but lack common sense and aren't seen as a resource by others.  In my opinion, the CRT exam should be eliminated, and the RRT should be the entry level exam with the specialities being "advanced" if you will.  The CRT just seems too much of a financial revenue generator for the NBRC, and nothing else.  Why would they ever eliminate the CRT when they can charge you for that and the RRT now?  That is the problem.

Eric, Respiratory - Director August 30, 2010 1:30 PM
Nashua NH

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