Who is a Respiratory Therapist?
Updated: May 19, 2020
Well, I am.
You know that whole "ventilator" talk you've heard lately from Governor Cuomo of New York? The device labeled so crucial to the survival of COVID-19 patients at the beginning of this pandemic by President Trump? The device is also known as a "respirator"? Yes, that one. Ever wondered who manages that device in the hospital? I mean, there are some self-sufficient versions out there, but there's a clinical personal responsible for managing how that device works with the human body. That individual is a Respiratory Therapist.
Respiratory Therapists are vital members of the healthcare team. Often mistaken for Nurses (even among healthcare workers in the hospital), Respiratory Therapists are clinically trained practitioners who have a thorough understanding of the respiratory system- both anatomy and physiology.
The respiratory system begins in the nostrils of the nose and somewhat ends in the lungs' alveoli sacs. I say somewhat because, at a deeper level, the work of the respiratory therapist is fundamental to the cellular level of our existence.
The Science
Here's the science as best as I can describe it. Your body needs "energy" to function. For your body to make that energy, it needs glucose and oxygen (amongst other things). If you were a science student, you might recall the Kreb cycle. The Krebs cycle is how glucose is broken down (glycolysis) to make 36 Adenosine Triphosphate (ATP) molecules. ATP is the chemical term for energy. For ATP to be produced in the Krebs cycle, oxygen must be present. In essence, glycolysis is the breakdown of glucose in the Kreb cycle in the presence of oxygen to make ATP, with a by-product of carbon dioxide. All of that is called cellular respiratory.
How does oxygen get to the cellular level? Further simplified- you inhale, it goes into the alveoli-capillary membrane (crosspoint in the lungs), and crosses over by diffusion into the blood vessel (pulmonary vein) in the lungs. This vessel takes the blood straight to the heart, which pumps it through your arteries to the rest of your body. As the blood passes by cells, cellular respiration (Glycolysis/Kreb cycle) begins. The now deoxygenated blood (venous blood without oxygen, but with carbon dioxide) returns to the lungs via veins to be repopulated with oxygen. And the cycle repeats itself.
What a Respiratory Therapist Does
Where do Respiratory Therapists come in? Still simplified- if you happen to have a lung condition, or conditions affecting your ability to inhale and exhale normally (for instance, asthma, chronic obstructive pulmonary disease, or COVID-19), you'll need a doctor to diagnose your condition, and a clinician to provide Therapy for your lungs. In most cases, your lungs will heal itself. The prescribed medication and Therapy is to help improve symptoms, speed up the healing process cautiously, and bring the lungs back to homeostasis (the tendency toward a relatively stable equilibrium that the body desires- aka your norm). RRT's practice under the guidance and orders of Medical Doctors.
Whenever I have the privilege to educate new nurses in the hospitals about how to think of Respiratory Therapists, I say:
"Respiratory Therapists exist for two foundational purposes, oxygenation and ventilation."
This simple truth is the building block for glycolysis to make ATP. It is the truth that explains lung expansion therapy after a traumatic event that leads to lung collapse, or secretion removal when COPD produces too much secretion. The foundation of oxygenation and ventilation is why Respiratory Therapists care for myasthenia gravis patients when the diaphragm collapses. What we do as Respiratory Therapists is to ensure the Respiratory system is functional as God intended.
How to Become a Respiratory Therapist
In many countries, the work of a Respiratory Therapist is under the purview of Physiotherapists (Physical Therapists in America), Anesthesiologist, Pulmonologists, and nurses in some cases. But in North America, the Middle East, and parts of Asia (the Philippines in particular), Respiratory Therapists are licensed members of the care team. In the USA, the requirement to practice as a Therapist is a state license as a Respiratory Care Practitioner.
In Texas, where The Texas Medical Board licenses me, Respiratory Therapists must have graduated from an accredited program. Programs across the country vary from community college Associate's of Applied Science (AAS) degrees to Masters of Science in Respiratory Care.
More common are the AAS programs; next are the Bachelors of Science programs. The AAS can be likened to earning an ADN (Associates Degree in Nursing), while the BSc could be compared to a BSN (Bachelors of Science in Nursing).
Both degrees allow an individual to sit for the licensing exam by the National Board for Respiratory Care (NBRC).
The NBRC is responsible for the Registered Respiratory Therapist (RRT) credential. Also, they administer the Registered Pulmonary Function Testing (RPFT), the Adult Critical Care Specialist (ACCS), the Neonatal/Pediatric Specialist (NPS), and the Sleep Disorder Specialist (SDS) examination.
Most Respiratory Therapists generally practice under the RRT credential. However, a few underwent further training and sat for the specialist examinations aforementioned.
Money Talk & Growth Potential
I'll shoot directly, new graduate RRT's earn about 10% less than R.N.'s, in my experience. An RRT that grows through the ranks, and becomes a supervisor starts to earn about the same as an R.N. supervisor.
One who becomes a manager/director makes about the same as R.N. leaders (up to 6 figures depending on department size & hospital system), but there's a ceiling with Respiratory that doesn't exist for Nurses.
An RRT wanting more than the role of a Respiratory Department director will have to pursue other paths or seek multidepartmental leadership opportunities. For instance, an RRT Director could later become a Vice President over ancillary departments, hospital operations, or similar roles, having oversight of respiratory, imaging, rehabilitation, facilities services, and the likes.
Others wanting more have parlayed their leadership skills into administrative positions, i.e., becoming Chief Operating Officers, etc.
Still, others wishing to remain clinical have gone on to earn additional clinical degrees, like becoming an Anesthesiologist Assistant (similar to a Certified Nurse Anesthetist), a Physician Assistant, and even going on to Medical School.
I chose the path to administration (for now ☺️). I don't practice as a Respiratory Therapist, daily, but these past couple months as demanded of me more in that arena than in the past six years. It's been a pleasure to serve in that capacity, nonetheless. So, fundamentally, Respiratory Therapists are a part of the healthcare team that cares for patients with Respiratory issues.
Show an RRT some love when next you see one.
Best wishes,
L.B.