Battle Brewing


Vol. 16 •Issue 8 • Page 20
Battle Brewing

They were the very first specialty credentials offered by the National Board for Respiratory Care. But are the CPFT and RPFT credentials still viable as stand-alones? Or are they in danger of being subsumed by the RT credential?

Some CPFTs and RPFTs who do not also possess a CRT or RRT credential are feeling a little like red-haired step-children today: abused and forsaken.

One such individual, who wants to remain anonymous, currently works as a sales rep but formerly performed pulmonary function tests in New Jersey.

That option will no longer be available to him soon.

New Jersey’s State Board of Respiratory Care has ruled that by September 2005 only individuals licensed to practice respiratory care can perform PFTs in the state. Respiratory care boards in California, West Virginia and, possibly, New York are said to be considering similar measures.

TURF GRAB?

The sales rep, an RPFT, said he has taught continuing education seminars on PFTs. Yet New Jersey’s board has informed him in writing and over the phone that he must enter and pass a respiratory care program to perform PFTs in New Jersey beyond 2005. He calls the measure a turf grab.

“They are simply going overboard in trying to protect their profession by including PFTs in their umbrella,” the man told ADVANCE. “All PFTs should be done by PFT-credentialed personnel. There are numerous invasive procedures an RPFT can do that an RT cannot.

“I have seen astounding differences between testing done by RTs and testing done by PFT professionals,” he continued.

“This is shortsightedness on the part of the people who put the bill together. If they are really interested in improving the quality of patient care, they should write into their licensure bill that you should have a minimum credential of CPFT to do PFTs.”

NO INTERVIEWS

New Jersey’s board has ruled that only RTs will be allowed to perform PFTs, with two exceptions:

1. Health care providers licensed by appropriate agencies who are practicing under the accepted standards of the licensee’s profession, or

2. Properly trained individuals not licensed in respiratory care nor another health care field. But they can perform only basic spirometry, limited to peak flow, forced vital capacity, slow vital capacity and maximum voluntary ventilation measurements.

Since he works in sales, not health care, the individual who contacted ADVANCE would fall into the second category, meaning he could no longer perform complex PFTs such as methacholine challenge testing and body plethysmography.

Might the New Jersey board consider the solution of “grandfathering in” individuals who possess the CPFT or RPFT credential? They won’t say. Dorcas O’Neal, executive director of the New Jersey board, has refused all ADVANCE requests for interviews.

NEW YORK NEXT?

Barbara Howard, BS, RPFT, who works in the pulmonary/exercise diagnostics lab at The Lung Center at Children’s Hospital of Buffalo, in New York, also received a letter from the New Jersey Board alerting her about their intention to limit PFTs to RTs.

“They were just alerting people such as myself who don’t have respiratory therapy as a background, but I saw it as them saying, ‘This is happening here, you should be aware of it,'” Howard said. “I would be very interested to hear the rationale for this and would like to know who they would grandfather in.”

She added: “I have 23 years experience in the field. I have a BS in biology and secondary education. I am more than qualified to do this testing. For someone to say to me I need to go back to school to perform these tests is wrong. I am not doing respiratory therapy. I am doing pulmonary diagnostics. They are two very different tracks in respiratory care. It would make no sense for me to get a degree in respiratory care when I do diagnostics.

“There are many people across the country with the PFT credential but not the RC credential, especially in university-affiliated hospitals. There are people who have been doing it for over 15 years.”

If New York were to follow suit, Howard said she would “probably work through the NBRC and the AARC. They are very aware of this issue. It is on their agenda to address.”

DIFFICULT ISSUE

Gary Smith, FAARC, executive director of the Lenexa, Kan.-based NBRC, sounded apprehensive about the whole issue. “I wish the NBRC didn’t have to comment,” he said. “This is a difficult issue.”

Word had just reached Smith that California is considering requiring people who perform pulmonary function testing to either be licensed as an RT or hold a CPFT or RPFT credential.

“I know of no state other then New Jersey that is requiring anything special of pulmonary function technologists who are not respiratory therapists,” Smith said.

“I think the NBRC board, although it has not taken an official position on it yet, supports limited licensure permits for pulmonary function technologists who hold the CPFT and RPFT credentials to perform their duties as diagnosticians, as well as limited licensure permits for polysomnography technologists to perform their duties.”

As a matter of fact, he added, “part of the NBRC’s original resolution for allowing use of the entry-level CRT exam for licensure was that a state not prohibit CPFTs and RPFTs from performing their functions as diagnosticians. The rationale is that the CPFT and RPFT exams are based on separate job analyses from respiratory therapy. The RT exam in therapeutics is not designed specifically to test competency in diagnostics alone. It’s inappropriate to require PFTs to take the CRT exam to perform pulmonary function testing because it’s a specialized area, supported by a separate job analysis.”

MOST DUAL-CREDENTIALED

This issue could get more complex because the number of candidates vying for the CPFT and RPFT credentials has increased significantly over the past couple of years, according to Smith.

However, “it’s safe to say that currently most of the individuals taking the CPFT exam are likely either already credentialed as CRTs or RRTs or have graduated from respiratory care programs,” he said.

Still, the training RTs receive is not on a par with training those who want to specialize in PFTs undergo. “There is some exposure to PFTs in the CRT and RRT exams but clearly not to the extent as on the CPFT and RPFT exams, which are much more specialized and detailed” regarding pulmonary function testing, Smith said.

Asked whether a stand-alone PFT credential still has value, he said: “The value is that one has demonstrated competence over a wide range of diagnostic techniques. A lot of institutions require a CPFT credential to perform in their labs.”

Smith said the NBRC never issues mandates to employers about whom they should and should not have performing health care. So it would never mandate that only CPFTs or RPFTs could perform PFTs.

However, if a state barred CPFTs or RPFTs from performing their specialties, NBRC officials “would do whatever we could to support” them, he said. “Clearly, the NBRC would help any CPFT or RPFT defend themselves to a state and any other entity that indicated they might not be qualified to perform PFT studies. We would offer support and testimony that they are qualified to do PFTs.”

EXEMPTION REMOVED

California’s Respiratory Care Board has established a task force that will develop a proposal similar to New Jersey’s but not as exclusionary, according to Executive Officer Stephanie Nunez.

“Before 1996, our law provided an exemption that allowed people other than RTs to perform PFTs,” she said. “Since then only licensed practitioners are authorized by law to perform PFTs in California. However, the board recognizes that non-RTs are out there performing PFTs, and rather than taking enforcement action against them, it developed a task force to examine the issue.”

Some board members “think only licensed practitions with the RPFT credential should perform PFTs in California when doing anything other than a blowout maneuver,” Nunez said.

Although it is possible to create new certification categories, it is unlikely, given the current fiscal restraints on state government to expand and find the fiscal and personnel resources required.

“The other big factor is we’ve been alerted to a shortage of pulmonary function techs in the state,” she said. “There are not a lot of schools offering it. Techs are retiring. It’s hard to fill the need. So before we start saying you must have this credential, we need to look at whether we can fill the demand.”

The California board is also considering placing polysomnographic technologists under the RT umbrella, enabling RTs to perform those duties as well as credentialed non-RTs. The same type of measure could apply to PFTs. “We are looking at these proposals but have taken no action yet,” Nunez said. “Expect action by the legislative sessions of 2004.”

Smith said the NBRC has no problem with the California licensure board recognizing the CPFT and RPFT credentials and granting limited licenses to individuals who hold these diagnostic credentials.

If the board rules that only NBRC-qualified individuals can test in California, “I have every confidence the board would allow time for people to obtain their credentials,” shesaid. “We don’t want to see anyone excluded.”

You can reach Michael Gibbons at mgibbons@merion.com.

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