Why Get Registered?
Karen Milikowski’s guest editorial (March 2004) eloquently described a crisis facing the respiratory care profession today: the lack of intrinsic motivation for excellence in many RCPs who do not pursue the RRT credential because they perceive few external rewards. I believe that this situation is an unintended consequence of the licensure laws in more than 40 states. RCPs were, understandably, anxious to enact state licensure laws over the past decade. However, an opportunity to establish two levels of practice, already delineated by credential, was missed. It is far more challenging to go back and amend licensure laws. A model for respiratory care practice of the future can be found in each state’s nurse practice acts. (See the National Council of State Boards of Nursing Web site at: www.ncsbn.org.) These laws establish distinct levels of practice from licensed practical (vocational) nurses at entry level; to registered nurses at the next level; and advanced practice registered nurses (APRN): the nurse practitioners, nurse anesthetists, and midwives. Professional RCPs have a vested interest in seeing all eligible practitioners become registered therapists. It is essential for the credibility of the profession. In the states that have licensure, the next mandate for state societies should be to establish two levels of practice, with two different credentials, and two different legal definitions of practice. For those who do not yet have licensure, include levels of practice in your initial licensure act.

—Patricia Carroll
Meriden, Conn

Physician assistants
I just received my latest copy of RT and read the facility profile with interest (March 2004). As usual, I was glad to read of increased roles and profiles for RTs around the country. However, the article twice makes reference to staff members as physician assistants. Physician assistants are graduates of accredited PA educational programs and are board certified by the National Commission on Certification of Physician Assistants. PAs practice medicine at the direction of a supervising physician, a relationship codified by law in all 50 states. Therefore, respiratory therapists cannot be referred to or function as physician assistants.

—Steve Onder, PA-C, RRT
Dayton, Ohio