The opportunities for career advancement for RCPs have never been greater.

Although RCPs have made many advances in both scope and type of practice over the past 50 years, the best is yet to come. The impending transition of the respiratory care education system from a 1-year to a 2-year entry level makes this a particularly auspicious time to consider career advancement. Some would define this change as moving from a staff to a supervisory (or from a supervisory to a managerial) position. Others would contend that career advancement means the addition of skills and responsibilities to their current inventory; this, of course, would result in increasing the RCPs’ scope of practice.

Still others see career advancement as moving away from being an RCP and toward becoming a nurse or physician. Although this may be thought of as career abandonment, not advancement, this is not so. As long as the lessons learned as RCPs are not forgotten and are integrated into the practice of the new endeavor, they are advancing their RCP careers and training.

Career advancement depends on a combination of factors, all of which require engaging in change. Any professional growth must come either from within current practice or from outside. Professional growth from within current practice is called job enrichment by some management theorists (whereas adding tasks without adding authority is called job loading). An example of job enrichment is the development and implementation of therapist-driven protocols. On the other hand, job loading—the addition of time-intensive and manpower-intensive tasks that do not add value to the professional practice—could be exemplified by the use of handwritten records for patient-care statistics that could be better captured by a computerized database.

Job enrichment occurs through the application of advanced levels of knowledge and skill. Therapist-driven protocols, for example, require advanced knowledge of pathophysiology, the natural history of the disease process, therapeutic interventions, probable outcomes, and the psychology of patient compliance. In addition, the skills needed to implement therapist-driven protocols successfully include (but are not limited to) obtaining a patient history and physical examination, diagnostic-test interpretation, scheduling and sequencing of therapies and diagnostic procedures, interdisciplinary communication, and patient advocacy.

Organizations that truly encourage their employees to use their current skills and knowledge fully and to seek higher levels of learning will be energetic, quality-oriented, outcome-centered institutions. It is likely that these organizations will have high morale, low turnover, and low rates for both absence and sick leave. Such organizations are currently referred to as empowered or empowerment organizations.

Job loading, however, does not require additions to the practitioner’s skills or knowledge base. Rather, job loading leads to stagnant jobs, discouragement of initiative in the workplace, boredom, and high rates for absence, sick leave, and turnover. Such organizations are referred to as task oriented.

Job enrichment requires the addition of new knowledge, but this is probably not enough to satisfy the desire for career advancement, which is likely to call for additional formal education, training, and experience. These, in turn, may require significant investments of time, effort, and funds to produce the desired ends. Before undertaking career advancement, individuals must take the time necessary to set suitable goals for themselves.

Several avenues leading toward career advancement are open to RCPs. Those within respiratory care include clinical specialty tracks, management, training and educational roles, and sales and marketing positions. Overlaps among these possibilities are common; for example, many medical-equipment manufacturers hire RCPs to provide a clinical-applications viewpoint in new-product development, to train and educate marketing/sales staff and customers, to develop educational and technical materials for regulatory and clinical in-service purposes, and to promote clinical staff development. Outside the common definition of respiratory care, several other possibilities now exist in research settings, hyperbaric medicine, sleep diagnostics, perfusion technology, case management, life-care and discharge planning, environmental medicine, medicolegal consulting, and public health.

A somewhat novel area of expanded, enhanced practice is clinical research. Its positions carry titles such as project manager, study (or clinical-trial) coordinator, or clinical research associate. Jobs of this type are found with pharmaceutical manufacturers and in clinical research facilities that conduct clinical trials under contract to drug or equipment manufacturers. The clinical-trial coordinator is responsible for clinical data collection, subject evaluation and assessment, quality assurance, and trial-site compliance. Generally, these positions require at least a bachelor’s or master’s degree, in addition to strong clinical experience.

In addition, university teaching hospitals or research hospitals may employ research therapists or assistants. Some of these may be part-time positions or may be entwined with other clinical or administrative responsibilities. These positions are seldom advertised, and are generally located through word-of-mouth referrals. Usually, individuals holding these positions began as entry-level research assistants and worked up to more responsible positions. Master’s or doctoral degrees may be required for advancement.

Contacting those responsible for hiring at such sites is difficult. Offering to volunteer and showing interest in the area of investigation (as well as having some experience in that area) may be helpful. The best way to show interest in research is to perform and publish research. Journals in respiratory care are always receptive to relevant research articles and will provide manuscript guidelines, along with a review of submitted papers. It should be stressed that nearly all hospital-based research positions are funded through grants having a set term, so a job may well end when its grant expires.

Hyperbaric Medicine
Hyperbaric therapy (originally applied to treat decompression sickness) is now commonly used as a treatment for wounds that are slow to heal, as well as for individuals poisoned by carbon monoxide or cyanide. In addition, skin and vascular grafts may propagate more quickly under hyperbaric conditions. Hyperbaric practice will require more education and experience than most RCPs receive in their schools and training programs. Hypobaric and hyperbaric physiology, chamber operations and safety, decompression physics, pathophysiological variances due to pressure change, and medical emergency response in pressure vessels must be understood for success in hyperbaric medicine. A scuba-diving certification course exposes learners to hyperbaric conditions and intensive study of the physics and physiology of diving; it may, therefore, be helpful to RCPs who hope to determine whether they wish to pursue a career in the hyperbaric field.

Sleep Diagnostics
Sleep diagnostics has been an area of rapid growth for several years and is closely aligned with respiratory care. The RCP who is interested in sleep studies and other applications of polysomnography already has a good basic knowledge of the problems associated with apnea and the use of sophisticated monitoring and airway-control devices. The amount of study devoted to this material in most respiratory care courses is, however, not enough to make the new RCP a competent or knowledgeable sleep technologist.

Sleep laboratories are not entirely nocturnal operations; many studies and a great deal of screening and scoring are performed during the day, with testing for sleep latency, narcolepsy, insomnia, or restless leg syndrome often being more readily performed then. Many children have sleep difficulties, and the number of adults with disturbed sleep architecture is far greater than previously thought. This suggests that sleep centers will become busier and will require more employees in the future. Several schools and corporations offer sleep training and certification courses.

Perfusion Technology
With additional education and training, RCPs make good perfusion technologists. Operating and monitoring devices such as extracorporeal membrane oxygenators, heart-lung bypass machines, cell scavengers (auto transfusion devices), and cardiac-assist units, perfusionists understand cardiac and pulmonary anatomy and physiology. Their work entails both biological and mechanical proficiency. They generally work in surgical, trauma-center, or intensive-care environments.

Perfusion technology courses are offered at several sites in the United States; some offer master’s degree programs to RCPs who already hold bachelor’s degrees. These programs are intensive, in both classroom and clinical-experience requirements, and they have a limited number of student openings.

Case Management
Case-management courses are offered by several organizations, leading to certification by the Case Management Society of America. Case managers work to maximize return to health while minimizing cost in various patient populations. These professionals are, in reality, resource-control experts who coordinate the care provided by members of other health care professions. Case managers may follow the patient from the acute stage through the rehabilitation process until a stable condition has been reached. They may be employed by insurance companies, private industries, or (via contracting agency) individual patients.

Planning Fields
Life-care planning is a subspecialty within case management. The life-care planner’s activities extend beyond those of the case manager to encompass the remainder of the patient’s life. Life care planners work with law firms, courts, insurance companies, and individual patients to determine the needs and costs associated with long-term injury and illness. These findings are used to structure insurance payments, litigation demands, and payouts.

Another planning field, discharge planning, is usually disease specific and patient focused. As its goal, it has the provision of the most seamless transition possible from the hospital to the next site of care.

Environmental Medicine
Occupational risk assessment and intervention involve such tasks as pulmonary function screening, mask fitting, and building/work-area environmental evaluation. RCPs should become certified by the US Occupational Safety and Health Administration (OSHA) in pulmonary screening and mask fitting. Work-area evaluation is best learned through a combination of training and supervised practice. Interested RCPs should contact the occupational/environmental medicine clinics or departments of local medical schools, as well as the regional offices of OSHA.

Medicolegal Consulting
Medicolegal consulting is a new and expanding field for RCPs. Nurses already have specialty practice organizations in this field. Medicolegal consulting deals with potential medical liability (malpractice or device-failure) cases. RCPs who consult in this area contract with attorneys to review medical records and to provide advice and education regarding respiratory care procedures, knowledge, techniques, and equipment. RCP experts may be called on to give depositions and testify in court. RCPs who perform these services must be qualified as experts in respiratory care; this generally means having long and varied experience and gaining peer recognition through making presentations at regional and national meetings and writing published journal articles and/or texts. It also means being able to defend and support that expertise to other attorneys, juries, and opposing RCPs.

Courses in legal procedures, evidence, and legal research will increase the RCP’s chance of success in this field. Obtaining a secondary degree or a certificate as a paralegal will also be viewed as a positive factor by contracting attorneys. Local community colleges can provide information on paralegal studies. The time needed to establish a career in this field can be long, and success will depend on the RCP’s self-marketing; technical, communication, and presentation skills; along with a presence in (and recommendations from) the legal community.

Public Health
Public health education is a field that seems suitable for RCPs. Given the increasing number of asthma and chronic obstructive pulmonary disease cases, there is an evident need to develop a cadre of knowledgeable practitioner-educators. These must be people who can educate patients, caregivers, public officials, and the general population in prevention, treatment, and health monitoring for these and other diseases. Formal training in health education, adult education, and public health is available through colleges and universities. Both bachelor’s degrees and master’s degrees are offered.

On-the-job training is sometimes available through local or state associations such as the American Lung Association, the American Heart Association, or the Cystic Fibrosis Association. Each has program directors or health educators whose job is to teach professionals and the public concerning the conditions that the organization focuses on. State and local health departments are also possible employers.

This list is not meant to be exhaustive, but to stimulate the reader’s imagination and creativity. Expansion of career options is not a cut-and-dried activity. Each person’s strengths and interests vary, and so does his or her ideal solution to the problem of career advancement.

Paul Mathews, PhD, RRT, is associate professor of respiratory care education at the University of Kansas Medical Center, Kansas City.