At Veterans Affairs, a new career path for a crucial health profession

If you've got trouble breathing, a respiratory therapist can do you a world of good. Recognizing the importance of respiratory therapy and the people who provid...

If you’ve got trouble breathing, a respiratory therapist can do you a world of good. Recognizing the importance of respiratory therapy and the people who provide it, Veterans Health Administration’s Maryland Health Care System has given its respiratory therapists a career boost. Now they’ve got a pathway to add advanced practice to their titles. Federal Drive with Tom Temin’s next guest spearheaded the effort. He’s chief of respiratory therapy for VA in Maryland, Daniel Whitt.

Daniel Whitt, BHS, RRT, RRT-ACCS, RRT-NPS, Member of the Political Advocacy Contact Team (PACT) and Adult Acute Care Specialty Section at the American Association for Respiratory Care (AARC)

Interview Transcript:

Tom Temin And just briefly, what does a respiratory therapist actually do?

Daniel Whitt A respiratory therapist is an allied health professional that’s skilled in treating and management patients with lung disease and lung disorders. So where they’re at the bedside, where they’re doing perf, where they’re doing deliveries, high risk delivery or extreme cases where patients are experiencing difficulty breathing or respiratory failure. We’re there to help support patients through those challenging times.

Tom Temin So the difficulty breathing could be the result of any number of issues. And for veterans, burn pit exposure, for example, would be a prime case of where one of the effects would be difficulty breathing.

Daniel Whitt Absolutely. Absolutely. And we’ve seen that. Right. So we’ve seen a lot of our people post-deployment, servicemen and women who’ve been exposed to toxic exposure or burn pits come back with pulmonary challenges and health issues associated with that. So respiratory therapists are really important in helping to diagnose and manage and treat those conditions.

Tom Temin And if someone has lungs that just don’t work as well as they should, there are ways you can actually get more oxygen into the system somehow.

Daniel Whitt If you’re experiencing what we call respiratory failure or hypoxic respiratory failure, naturally the first thing you’ll probably get prescribed is oxygen, supplemental oxygen, and help support vital functions of the body. And this can be progressive. You can go from needing oxygen support to needing mechanical ventilation to being on a cardiopulmonary bypass machine. So respiratory therapists are dealing with those individuals each step of the way.

Tom Temin Got it. Now, at the Maryland VA Health Center, there is now a new title for calling someone advanced in this effort. Tell us the background. What’s the purpose here?

Daniel Whitt Right. So we’re talking about the advanced practice, respiratory therapists. And this individual is an advanced practice provider that has received the requisite academic and clinical education to diagnose, manage and treat adult, pediatric and neonatal patients with cardiopulmonary diseases or disorders. This happens under the supervision of a licensed physician, and they are deeply involved with the care and management of patients. And this includes managing medications, prescribing therapies, prescribing medication and other diagnostic tests to track and care for patients with advanced chronic pulmonary disease.

Tom Temin It sounds like that you can do like 85% of what a doctor could do just on that pulmonary front.

Daniel Whitt Absolutely. You know, and I’m sure some of our doctor colleagues, opposition colleagues would agree that there is certainly a need for this type of specialized care, if you will. You know, for some time, respiratory therapists have been considered physician assistants in a sense that we support and we work under licensed physicians in their care and their treatment of their patients.

Tom Temin Sure. And by the way, within the VA system, are respiratory therapists, Title 38 employees?

Daniel Whitt They are hybrid Title 38 employees within the VA.

Tom Temin And what does that mean, hybrid?

Daniel Whitt That’s a bit of a combination between a Title five employee and a Title 38 employee. So Title 38 employees are your physicians and nurses. The hybrid 38s are typically your respiratory therapists, your perfusionists, your pharmacist kind of like the, I would say, the best of both worlds, but certain administrative tasks that respiratory therapists have or function in a title five capacity, along with more of the kind of the relates to benefits that we see that Title 38 counterparts have.

Tom Temin And do you get the pay flexibilities that are available under Title 38 relative to, say, the GS system under Title five?

Daniel Whitt We do have some mechanisms to request a special salary rate. However, our pay structure looks a little bit different than our Title 38 counterparts, and that’s something that hopefully, you know, we’ll work towards as agency and we’ll see some improvement there to make us a lot more competitive. But there are some mechanisms to help on the pay front.

Tom Temin We’re speaking with Daniel Whitt. He is chief of respiratory therapy for the VA Maryland health care system. And let’s talk about the genesis of this new advanced care idea, the advanced practice respiratory therapist. This generated in some sense outside of the VA system, in some private associations.

Daniel Whitt Absolutely. So for me, the APRT concept was introduced a little bit later in my career. However, the American Association for Respiratory Care and the National Board for Respiratory Care, along with Corps, had been working on the APRT concept in effort for some time. It wasn’t until about November of 2022 when the network had asked,and the network being VISN-5 had asked to submit joint proposals from the VA, the VHA, and the DoD. I saw this as an opportunity to introduce the APRT concept to my VISN lead. Whom, which at that time expressed to me, if this is something that I wanted to pilot, I could certainly try it at the Baltimore VA Medical Center, bring back the data that shows that this is a new emerging trend in best practices and that we could look to replicate that throughout the VA. So that’s what we did. So we sent up a resource request for individuals to occupy this position. We built and created an announcement. That announcement went out for solicitation and we did make a selection on Advanced Practice Respiratory Therapist, who has officially started in her new role last week, actually. So we’re excited about that here.

Tom Temin And so this is something you hope will replicate throughout the 167-odd VA medical centers throughout the country eventually.

Daniel Whitt Yeah, Yeah, absolutely. And that’s one of our strategic goals, is to refine and replicate this. So as we build and work towards really looking at the scope of practice of this advanced practice provider, we’re going to refine that as the position evolves. And then again, we will look to replicate that, we identified a few clinical areas where we see we definitely see a need for an advanced practice respiratory therapist to help support pulmonary health.

Tom Temin Right. And it’s also, I imagine, a good way to retain good people who would, you know, jump over to Johns Hopkins or, you know, all these big cities have great hospitals that, you know, make pay a little better. But a lot of people driven by the mission in VA then would be incentivized to stay to get that advanced level of title.

Daniel Whitt Absolutely, Tom. And it’s interesting you brought that up because one of the other, I guess, strategic endpoints, if you will, would be to establish a relationship or collaboration through the Office of Academic Affiliations to allow respiratory therapists that are already within the VHA to move up and advance academically to achieve the APRT and bring those services back to the VA. And we definitely see that that’s a win-win. That’s a win for our veterans and it’s a win for our profession.

Tom Temin And by the way, how did you come to your respiratory practice experience and to the VA?

Daniel Whitt Oh, wow. You know, it’s interesting I was an artillery man down in Fort Sill, Oklahoma, but I saw interest in being, at the time, they were called inhalation therapists or respiratory therapists. I wanted to go to Fort Sam Houston for training, I wasn’t able to really achieve that. So when I was discharged, I pursued that career field outside of the VA. I trained at University of Maryland Medical Center, for some time. I became credentialed in adult critical care and neonatal pediatric, as well as ECMO. And, you know, I thought I saw opening here at the Baltimore VA and decided, hey, look, this is probably a good opportunity for me. So I put my name in the hat and I was selected.

Tom Temin So a Army artillery man that became a VA respiratory therapist.

Daniel Whitt Quite a career change, huh?

Tom Temin Well, we’ll take it. And I imagine, too, that there must be the sense that in helping people breathe, whether it’s an infant, because, you know, premature babies, that’s their issue, is respiratory in many ways. And then those that might have had some exposure or maybe they smoked, whatever the case might be. But when you administer respiratory therapy, you must get the sense you’re helping with the most essential life function, which is the ability to breathe.

Daniel Whitt Absolutely. Absolutely. It’s very fulfilling. A lot of times people may or may not take breathing for granted. Certainly when you can help someone with that challenge of struggling to breathe or they find themselves in a situation where they are in poor pulmonary health or respiratory failure, being able to swoop in, if you will, and provide those supportive services and especially care, it means a lot to them and it certainly is a proud moment as a practitioner to be able to do that. Not all stories are success stories, obviously, but, you know, breathing is important. Like you stated, it’s a life sustaining function and it’s something that, you know, it’s great to be able to support that.


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