When Elena Saenz, RRT, NPS, a 30-year respiratory therapist (RT), recently observed a physician approach one of her staff members, who had been charting notes on a difficult-to-treat pediatric patient, to seek guidance on ventilator weaning, she knew she was witnessing an example of collaboration that was unlikely during her early days on the floor.

“In the past, physicians would not seek us out to ask whether we thought a patient would be ready to come off a ventilator,” explained Saenz, a licensed RT, neonatal pediatric specialist, and respiratory care supervisor at Phoenix Children’s Hospital Arrowhead Campus, Glendale, Arizona. On this day, however, “…both went in, assessed the patient, and made ventilator changes to ensure there was a good fit,” said Saenz. “That’s the collaboration you see more frequently now.”

As Saenz, her colleagues, and other therapists have found, long gone are the days of RTs being referred to as “tank jockeys,” “oxygen orderlies,” or “inhalation technicians” as supplemental staff to assist the healthcare team. Today, the title of therapist carries a well-defined scope of specialization, sense of autonomy, and expert knowledge that is essential to comprehensive care planning.

“Absolutely, doctors and nurses will come find therapists specifically to be at the bedside to make those critical decisions with them and to ask us questions about patients,” said Saenz.

With the healthcare industry’s need for more respiratory-related specialty services and as technology continues to rapidly advance, Saenz and other RTs see the profession as further progressing.

An Evolution and Transition

Much like any clinical specialty, the role of the RT has a storied history. The 1920s saw the establishment of what were known as the first official departments of “oxygen therapy” when Alvan Barach became known as a pioneer in respiratory therapy after making various important foundational contributions, including the first practical oxygen tent. In 1943, Edwin R. Levine reportedly began training technicians in what he referred to as “inhalation therapy” and is credited with introducing the first on-the-job training for such therapists and with forming the discipline’s inaugural professional society — the Inhalation Therapy Association based at the University of Chicago Hospital, Chicago.

Due to the size and weight of the earliest equipment, practitioners spent much time and energy manually transporting cylinders to and from patient rooms — firmly cementing their reputations as task-oriented professionals. But the height of the polio outbreak into the 1950s, in conjunction with piped-in oxygen capabilities, advanced respiratory equipment, and improved administration of therapeutic gas, began to transform the role. By the early 1960s, the American Registry of Inhalation Therapists had formed and instituted a new national examination, and by the mid 1970s, the professional designation of “respiratory therapist” became standard in the US and Canada.

And yet it perhaps wasn’t until the recent COVID pandemic that RTs truly became widely recognized for the versatile scope of practice and universal education that their credentials possess, said Randy Solly, MS, RRT, RPFT, AE-C, professor and program director of the Respiratory Care Program at Gwynedd Mercy University, Gwynedd Valley, Pennsylvania. “Prior to the COVID pandemic, not many people recognized everything that respiratory therapists can do,” said Solly, who has spent the last decade in education after working clinically for 20 years.

“Our profession really came to the forefront during [the COVID pandemic] because we were the ones managing the patients who required mechanical ventilators. And I think that perception stemmed from a lack of understanding on what we’re capable of doing.”

Specialization Has Brought Autonomy

With a growing number of RTs now holding specialized job descriptions, Solly and others believe the future of the career is currently being shaped. And as healthcare technology continues to expand, the assumption is that so too will the scope of RT practice. “With technology advancing all the time, we’ve become very specialized in what we do — specifically with different modes of mechanical ventilation for patients,” said Solly.

“That has changed so much since the time that I was practicing. The profession has also evolved in the sense that therapists are becoming more autonomous. We’re following respiratory protocols. And I think that’s a good thing.” According to the Bureau of Labor Statistics (BLS), RTs are among the fastest growing careers, with an expected growth rate of 12% by 2034. With more RTs reaching retirement age, there’s a smaller supply of therapists to draw from, resulting in an increased demand.

As a supervisor at Phoenix Children’s Hospital Arrowhead, Saenz managesa staff of 15 therapists for the 48-bed facility that holds 12 licensed beds for a pediatric ICU. A 1999 graduate, she began her career caring for adults before transitioning to pediatrics and neonates 18 years ago after relocating from a hospital in San Diego, where she had served as director of respiratory care. “My role looks a lot different than it did years ago,” said Saenz.

“At Phoenix Children’s, respiratory therapists are right there next to the nurses and the physicians taking care of patients and making critical decisions. We now have more responsibility and more critical thinking than we’ve ever had. It’s been a big difference for me in staying at the bedside.”

At Aya Healthcare, a California-based staffing and workforce solutions company, hospitals and other healthcare facilities are currently seeking more therapists due to increased prevalence of chronic respiratory issues in middle-aged and older patients, said Sophia Morris, executive vice president of client fulfillment.

Among their providers is Benjamin Cisneros, RT, who, over the past 10 years said his duties and influence as a member of the care team have continued to progress.

“Respiratory therapists are the Swiss army knives of the hospital,” said Cisneros, a per-diem therapist working in Los Angeles. “Many hospitals are now encouraging, or even requiring, bachelor’s or master’s degrees. With expanded autonomy, we’re shaping care plans, making critical recommendations, and being recognized as the pulmonary experts that we are. We respond to emergencies, assist in diagnoses, manage chronic respiratory conditions, educate patients, and support special procedures.”

He said the experience that he’s acquired combined with his education continues to open doors to various employment opportunities. “I can become a preceptor or a mentor,” he said. “Or I could pursue being a resource or team leader.”

In the Philadelphia region, Solly said he’s learned of former RT students who’ve secured jobs as patient assessors within hospitals and are responsible for ensuring that written orders are commensurate with discharge goals for improved health. “And it’s not a punitive type of role by any stretch,” he said. “There is a big push now, and rightfully so, where there’s more focus on preventative medicine as opposed to reactive medicine.”

Saenz is a staunch supporter of the range that pediatrics offers to RTs as a subspeciality at her facility, which has an established new-grad program. “We have three ICUs, which means we can be cross-trained,” she said. “RTs can start as new professionals learning pediatric assessments and starting on the floor learning generalized pediatric care. In the emergency department they’re learning traumas and in the pediatric ICU setting, they’re learning those critical skills of treating ventilated patients.”

Phoenix Children’s has also recently launched a dedicated transport team to better serve the community by bringing patients who require a higher level of care to the hospital for timely access to specialized services. The facility also includes RTs on various quality improvement projects and multidisciplinary teams aimed at improving safety in the workplace, including an MRI safety team.

“We’re piloting things here, and if it works for us, then a lot of our practices are applying these services because we’ve now fine-tuned them,” said Saenz. “This is an excellent career advancement for anyone who really stays within pediatrics.”

Compensation for RTs is also reflective of the value the profession holds today, said Saenz and Solly. “Although some may disagree, I think it’s a fair wage — at least in the Greater Philadelphia area,” said Solly. “I believe the health systems play well off one another. It’s not out of the realm in this area for therapists to earn between $80,000 and 95,000 per year and close to $50 per hour based on shift differential and other incentives.” National data from the BLS supports this notion, listing median salaries and hourly wages for RTs at $80,450 and $38.68, respectively.

At Phoenix Children’s, Saenz said administration makes a consistent effort to provide fair market compensation as well. “It’s a topic that across the nation is being discussed,” she said. “I think all healthcare organizations are trying to compensate fairly because of the incredible frontline work that we and others do, including nurses and x-ray technicians. Many clinicians are being looked at marketwise as frontline caregivers to be compensated appropriately.”

Challenges and Lingering Concerns

Still insurance reimbursement limitations related to RT departments being positioned as cost centers may limit RTs’ activities. Among the possible barriers affecting the utilization of RTs are inconsistencies that arise across different geographic and clinical settings. “In some cases, there’s been a slower progression and in some cases there’s been a faster progression,” said Solly. “Sometimes it depends on the locale in terms of where therapists are practicing. Your city hospitals and larger institutions tend to be more progressive. I think there also institutional- and staffing-type of structures that can be challenging. Some hospitals don’t have therapist-driven protocols, which limits what we can do.” He is encouraged, however, about advocacy work from organizations such as the American Association for Respiratory Care (AARC), which has consistently lobbied to change reimbursement policies for RT services.

Education and Further Advancement

“I tell people who are interested in this profession as a career that it is very rewarding and very dynamic,” said Solly. “Therapists can choose different paths and numerous credentials. From a global perspective, there is a variety of specialization in different disciplines, including neonatal, pulmonary function, asthma education, and outpatient. But you need to have a commitment to lifelong learning and adaptability. You need to be flexible and be willing to keep up with the latest technology and continuing education because that’s what’s ultimately going to benefit patients.” The AARC supporting RTs as physician extenders also creates more overall worth and variance, said Solly.