Ignorance regarding allied health providers, yet another educational problem?

[chbare]

As some may know, after nearly a decade, I am once again a student. I am working my way through an allied health program (Respiratory Practitioner). However, I continue to run into a recurring theme on the job. Medics and Nurses who I work with continue to question my judgment regarding going through such a program. The most common question I am asked is "how does it feel to take a step backwards."

Anecdotally, it would appear that many people are really not aware of what other provider (allied health in particular) go through in terms of educational preparation. Not only RT, I would also include radiology, sonography, and other allied health providers in this mix. My first class was pharmacology, and on the first day of the first semester, our instructor went into the energy production cycles of our cells; however, the depth was quite impressive. I am talking about explaining the functions of cytochromes and talking about how FAD is reduced. At the end of the class, he stated this discussion was simply a preface and the core concept of what we do pharmacologically relates to the adequate supply of oxygen to this cycle. Additionally, the first semester will be nothing but focused anatomy, physiology, pathophysiology, and patient assessment techniques. Skills taught will be rather minimal, and we do not even learn CPR until the end of the semester after all of the A&P and pathophysiology.

Yet, even after explaining the curriculum to people, they still do not understand. While I am not one to take things personally, I think this is important because much of what we do is inter-related and for the sake of continuity of care, we must be aware of what other providers do to include a basic understanding of their educational curriculum and role in the health care environment. We in EMS take offense when people call us ambulance drivers; however, how knowledgeable are we about other providers?

Take care,

chbare.

[spenac]

Hope you the best with step backwards.

Actually congrats on moving forward with your education. Good idea on educating each other on the other allied fields.

[VentMedic]

You've chosen a relatively new profession with RT as it has only started ot make serious advances with licensure in the 1980s. Few also know what RTs actually do or the opportunities for them. Few monitor their legislation or know where they stand in the whole health care realm. Few know about th e Bachelors and Masters degree for RT and the beneifts both will bring once a couple of Bills are passed. A few believe if they can put albuterol in a nebulizer they are at the same level as an RT.

Physical Therapy (as well as OT and SLP) is one porfession that I like to use as a very well paid and highly educated profession that doesn't need alot of visibility or TV shows to prove their value to anyone. Like many of the allied health professions, they get their satisfaction from their patients and other members of their team. Again, some may think if they walk a patient down the hall they are just the same as a Physical Therapist. Nothing could be further from the truth if you ever read their charting.

Radiology is another allied health profession that few realize the depth of study it requires. The specialities it also involves not only for the different technology but also for the many different age groups is pretty amazing. Interventional and therapeutic Radiology Technicians are highly respected by the doctors who work with them and the patients that need their expertise.

Nuclear Medicine Technician is another growing professional that has gained rapid growth in education and pay. Again, this is a relatively new profession.

Medical Lab Technologists who have up to Doctorate levels are another profession few understand. Many just think they draw blood. So again, some Paramedics believe if they put some blood in a tube while doing an IV they are doing the same "skill" and that makes them just the same.

EMT(P)s often measure the worth of a profession solely based on the "advanced" skills. You can tell a Paramedic that you run an ECMO pump but if you say you don't intubate at that facility, they believe you are "unskilled" and a lower level. Thus, there is a lack of understanding about the depth of medicine. However, if one was to tally up the many skills of the various professions such as nursing, RRTs, SLPs, OTs and PTs, they would by far out number what a Paramedic can do. Most skills of the Paramedic can be listed in a paragraph. Even the skills of the LVN can outnumber those of a Paramedic. Nursing and RT do not always list their skills but rather they only list the exceptions for their scope of practice. The one thing RNs is learning is that their two year entry level of education is no longer adequate in the competitive world of medicine. Thus, many are going straight for the BSN and then MSN.

This has been the argument with Paramedics vs RNs. When the discussion is brought up just skills are mentioned. "I can start an IV". "I can intubate". What some Paramedics don't realize is all the total patient care that goes into being an RN. Or, that RNs can intubate in most states if that is part of their job description such as for transport or L&D.

We could also examine the many things that are happening with physician extenders that are rarely understood by those who have never worked with these professionals. There have been numerous discussions on EMS forums that "they don't belong" here or there but again few know their education or what potential their base educaton will lead to. If you look at their professional associations' websites, you might have an indepth look into the world of medicine and what others are doing in the name of patient care. In fact, if you look at any of the allied health professions associations' websites you will see they are actively lobbying not only for their increased professional issues but also those of the patient.

Edited August 23, 2009 by VentMedic

[JPINFV]

We in EMS take offense when people call us ambulance drivers; however, how knowledgeable are we about other providers?

Take care,

chbare.

I also just recently started school for a new profession (finally, thank god) at Western University in So. Cal. One of the things that the school is starting this year is an Interprofessional Education program bringing together students from the university's osteopathic medical, physician assistant, physical therapy, pharmacy, graduate nursing, veterinary (don't ask, I don't understand this one either), optometry, podiatry, and dental programs to work through problem based learning scenarios.

More information:

http://www.westernu.edu/xp/edu/interprofes...ional-about.xml

http://prospective.westernu.edu/interprofessional

Additionally, the three new programs (dental, podiatry, and optometry) are sharing courses with the osteopathic medical students.

[CBEMT]

Hmm. Interesting that the RNs consider Respiratory a step down.

[chbare]

Hmm. Interesting that the RNs consider Respiratory a step down.

Yes indeed.

Take care,

chbare.

[Kiwiology]

Interesting. At least here in NZ our ambulance officers are respected as another group of healthcare providers by thier peers (although this is not at all reflected through registration, licensure or legislation -- watch this space) be they paid, volunteer, BLS, ALS etc.

I have only ever heard the media (and maybe the lay public) here refer to an AO as an "ambulance driver" or "worker"; I'm not sure that other HCPs "get" all our titles (e.g. if you're ALS you can be a Paramedic, an Advanced Paramedic or an Intensive Care Paramedic depending on where you work) but that's another issue entirely!

[VentMedic]

Hmm. Interesting that the RNs consider Respiratory a step down.

That is changing since RT has made the 2 year degree officially their minimum entry level requirement and the weeding out of those who didn't want to upgrade has removed the slackers out of the critical care areas. This is much like what happened to the LVNs who had worked in the hosptials. They were given several years notice that things were changing and their options were clear. Rid and I have had this discussion many times since when he had worked in the hospital, RTs were only OJTs. That is also how I started over 25 years ago when I didn't want to do another 24 hour shift on a fire truck for extra money.

Now that there is a Bill for RTs with a Bachelors to move into another environment and reimbursement opportunities, that will bring about even more changes in attitude.

Some of the older RNs do remember what they went through when they were "just diploma" nurses and that was their entry level of education. Of course in the 1970s, many of the allied health professions did not exist or were just OJT techs. RNs were still in charge of all. Things change as medicine and technology changes.

RNs are feeling the level of their own education requirements being scrutinized and it is even more evident in the multidisciplinary meetings. For even my own degree at a Masters level on my tag I feel a little under educated at times with the PTs, OTs, and SLPs around me. It has been a good incentive to advance my own education. RNs are finding themselves working for unit managers who are not RNs. RNs who had fought the BSN are now also going back to school.

It is usually the ones who work only in one area of the hospital and see an allied health provider do only one task. RNs that have never worked in the critical care areas, where the majority of RT work is done, will probably not see an RT do much except O2 rounds on the floors which is still a decent revenue producer as usually the RT department carries the cost of that big liquid O2 tank outside the hospital on their budget. If the RNs don't go to the HBO or Cath Lab Center, they again will not see what RTs do. The same for Radiology. If all the RN sees is someone pushing a big machine for an X-Ray and have never been down to IR or involved in therapeutic radiation, they don't know what these professionals do.

However, it is no different than what some in EMS believe for RNs. They may only see an RN start IVs in the ED and ask the doctor what's next and may not know their 2 volumes of protocols and procedures exist. As well, if the EMT(P) has never stepped foot inside a progressive ICU or seen a Rapid Response Team work on a patient, they may think the RNs are pretty worthless and must call for every order. Nothing could be further from the truth. Again, the EMT(P)s measure worth by "skills" so it doesn't matter if an RN can do many "critical care" things, if they don't intubate in the ICU they are considered inferior to an EMT(P) by some in EMS. Some even believe the RN and even the RRT must sit through a Paramedic class to get the intubation skill. What they don't realize is how many healthcare providers do have intubation in their scope of practice by the state if there is a need for it.

In the hospitals, skills are viewed a little differently. Doing "just intubation" is not going to get you that much respect since some RTs have been intubating since back in the 70s as OJT techs. If it is a complex set of "skills" that requires additional education such as specialty transport, ECMO, CVVH, VADs etc, then that is viewed at a different level. Knowing ACLS in itself is also a fundamental requirment for many ICU RNs and treated as an expectation and nothing special. Infact, knowing the many protocols such as Sepsis, ARDS, etc is more along the lines of critical care.

Phlebotomy is a skill. It is viewed as a needed skill but not necessary one that requires much education, except now entry level phlebotomists are now nationally and state certified. If someone is seen doing phlebotomy the "skill" few will recognize that the person might be a MLT with 6 years of colloege.

Edited August 24, 2009 by VentMedic

[tniuqs]

You can tell a Paramedic that you run an ECMO pump but if you say you don't intubate at that facility, they believe you are "unskilled" and a lower level.

Sure is a loud statement about the knowledge level of most Paragods is it not ? I so enjoy a conversation with my REMT-P friends when we talk about transport ventilation, monitoring CT and ABG inturpretation in relationship to Ventilator interactions then to watch them pull out a palm pilot to calculate a profound respiratory acidosis further complicated by a metabolic acidosis .. and that deer in the headlights and the 1000 yard stare. It is funny that the vast majority of Floors RNs call for respiratory and before the resident in many cases, order/ request stat CXRay and ABGs based on "extremus" instead of protocol. In my old ICU's RNs and majority of Intensivists don't dare even touch the Ventilators accept to silence the alarms, that said there are, like any profession GOOD RTs and those that are barely acceptable.

So congratulations chbare for taking the plunge into a specialist area .... the RT Practitioner course is under development here with the "skills" of CT insertion just one area of development in legislation, its a 3 year RT program here in Canada now and about 2 credits short of Bachelors, due to the fact the government refuses to pay 23 cents more an hour difference between diploma and degree ... cheap buggers.

cheers

Edited August 24, 2009 by tniuqs

[EMSPROFESSIONAL]

It is unacceptable that fellow professionals would degrade one another even if in another specialty.