Results of Initial Training for Respiratory Therapists: Professional Concerns and Proposed Reforms

1. Results of the work and consultations on initial training for respiratory therapists January 2009

2. Professional concerns • Following a proposal from the professional order (Ordre professionnel des inhalothérapeutes du Québec - OPIQ) for reflection on initial training in respiratory therapy • And in light of the undertaking by the 40th Convention of the FSSS to ensure the representation of our members’ professional and institutional concerns The FSSS set up two ad hoc committees: The first committee analysed the impact of the reform proposed by the OPIQ for initial training in respiratory therapy: in November 2006, this committee submitted a brief to the OPIQ setting out a number of findings and raising various concerns about the reform proposed by the OPIQ A second committee was charged with finding out what respiratory therapists working in various settings and regions thought about the proposed reform • The work done gave us a better grasp of the situation and helped us undertake a broader process of thinking about it. We saw that it was necessary to take a stand on the issue, with a view to promoting the profession of respiratory therapist and helping those who practise it to meet the demands of the job market.

3. Reform of initial training in respiratory therapy presented by the OPIQ • CEGEP 3 years Content of CEGEP programme not specified • B.A. 2 years Specialties • Home care • Anaesthesia • Intensive care

4. Initial training at the present time • CEGEP 3 years • Content : Year 1: theory Year 2: theory and internships Year 3: 1 day a week of theory 4 days a week of internships

5. Report from the first committee on the reform of initial training in respiratory therapy proposed by the OPIQ FOUR THEMES 1- Positive aspects: • Training would correspond better to the diversity of clinical situations encountered in workplaces • Training would correspond better to the evolution of practices in various specialties over the past 15 years • Recognition of respiratory therapy as a profession and of its value for the health-care system • Potential impact on pay levels, in accordance with job evaluation criteria and maintenance of pay equity • Updating of Bill 90 • Training given in Québec would correspond better to that given in the rest of Canada • Attraction of the profession and Canada / Québec workforce mobility

6. 2- Negative aspects: • The reform would result in a distinction between two groups of respiratory therapists: CEGEP-trained versus university-trained • Longer training time / work force less available • Problem of accessibility and availability of training in regions • Economic impact / cost of training • Problem in the organization of work (replacement of respiratory therapists on annual leave or sick leave, posting of positions, job title, etc.) • Problem of the division of roles and responsibilities in the workplace • Deficit of 230 hours of training at the CEGEP level, dating back to 1992

7. 3- Pertinence of a reform in the current context • The committee is favourable to a review of the content and format of the current training in light of technological changes, responsibilities stemming from Bill 90 and the quality of services provided to the public • However, the committee is not comfortable with the OPIQ’s proposal and notes that it would leave a vacuum, putting a stop to the availability of new resources to work in the sectors most affected by shortages: intensive care, anaesthesia and home care

8. 4- Respiratory therapists’ reactions Our perception • Problem anticipated with respect to the obligation for respiratory therapists to undertake further studies versus recognition of experiential learning • Apprehension about the problems of getting access to part-time, distance or correspondence university courses • Of no interest to respiratory therapists at the end of their careers • Problem of leave for studies in the context of labour shortages • What about experienced respiratory therapists already working in the targeted sectors? • No plans for additional pay • What will be the place of new graduates in our public health-care system?

9. Conclusion The extent of the repercussions of such a reform on respiratory therapists’ living and working conditions requires consultations with our members

10. Report from the second committee on initial training in respiratory therapy Following the previous consultations, this committee developed and set in motion broader consultations with respiratory therapists belonging to the FSSS.

11. Here is the analysis of the resultsSample size:Eight unions replied to the questionnaires, for a total of • 74 questionnaires filled out by respiratory therapists Mission: • CSSS • CHU • CH Regions: • Estrie • Montréal • Nord du Québec

12. QUESTIONS :1- Respondents by age group • Between 20 and 29: 44% • Between 30 and 39: 19% • Between 40 and 49: 25% • Between 50 and 59: 12% • 63% of the respiratory therapists who replied were under 40 • 37% of the respiratory therapists who replied were over 40, and one third of these were eligible for retirement Respondents’ job status • Full-time: 50% • Part-time: 50%

13. 2- Number of years of experience • Between 0 and 5 years: 39% • Between 6 and 15 years: 18% • Between 16 and 25 years: 27% • 26 years or more: 16% 3- Do you work in more than one sector of activity? • Work done in more than one sector of activity: 72% • Work done in the same sector of activity: 28% • Mobility among different sectors by choice: 53% • Mobility among different sectors an obligation: 47%

14. 4- In which sectors of activity do you work and in which would you like to work?Sectors of activity Sectors of activity in which you would like to work • Operating room • Surgery • Medicine • Intensive care • Neonatalogy • Cardiology • Asthma clinic • Respiratory rehabilitation • Respiratory physiology • Emergency • Operating room • Neonatalogy • Intensive care • Emergency • Respiratory physiology • Cardiology and hemodynamics • Teaching and research • Home care • CHSLD • Medicine / surgery

15. 5- Do you think the initial training is adequate in the current context? • Yes 51% 74 people answered this question • No 49% 6- Should courses be added to initial training? • Yes 70% 64 people answered this question • No 30%

16. 8- In which fields of work are there training gaps? • Operating room (anaesthesia) • Intensive care (hemodynamics, cardiology) • Paediatrics / Neonatalogy • Psychology and helping relationship • Pharmacology

17. 9- At which level of education should this be added? • University 45% • CEGEP 31% • Don’t know 24% • 50% of respondents consider that an additional year of training is necessary, regardless of the level at which the training is given

18. 10- Are you interested in taking university-level courses?71 people answered this question • Yes 66% if conditions are favourable and recognition in the form of pay is added • No 30% 11- Are you in favour of the creation of two distinct respiratory therapist job titles? • Yes 39% • No 41% • No answer 20%

19. 12- How many hours of work would constitute reasonable equivalent experience for recognition of university training? 1,500 hours equal one year of full-time work • 1,500 hours 19% • 3,000 hours 23% • 4,500 hours 47% • Don’t know 19%

20. Summary of comments received in response to the questionnaire

21. Initial training is inadequate in the current context, given treatments for complex diseases, specialized and ultra-specialized care and various technological developments Sectors requiring better internships • Neonatalogy • Intensive care • Operating room • Paediatric internships • The internship is too short • The internship is too superficial and lacks content

22. Initial training issues Apprehensions about university training • Difficulty of doing enriching practical internships (limited internship placements and intake capacity) • Fewer prospects for internships in regions than in large cities like Montréal • Intake structures established by institutions receiving interns seem less well-organized for respiratory therapists than for nurses • Initial training doesn’t meet more specific workplace requirements in certain sectors • Initial training doesn’t correspond to the development of the profession • There is a shortage of specialized, stimulating settings to foster diversity in learning and contact with a variety of problems and issues • For people living in the regions, accessibility and costs are an obstacle to raising training to the university level • The lack of recognition of experiential learning for purposes of acquiring a university degree or credits for older and more experienced respiratory therapists

23. Fields in which a more advanced level of training is necessary: • Critical care (neonatalogy, intensive care, emergency) • Comprehensive and respiratory physiology • Pharmacology • Anaesthesia • Psychology and helping relationship

24. Conditions that should be met before transferring studies to the university level: • Continuation of a CEGEP programme in respiratory therapy as a prerequisite to university studies • Better overall compensation for studies or equivalent work experience (4,500 hours) • Possibility of leave from work with no loss of pay for continuing education • Retention and accumulation of seniority • Ease of access to near-by additional training at the university level • Possibility of having positions that foster skills development • Practical implementation of the deployment of activities reserved to respiratory therapists in their workplaces (Bill 90)

25. Based on these findings, the committee suggests: • Continuing to make representations to the relevant authorities on the need to review the respiratory therapy training programme at the CEGEP level • Recognizing the points on page 24 as desirable conditions for establishing a post-CEGEP level of studies • That the MSSS and the MESL recognize the sectors identified on page 23 as priority areas requiring a review of initial training • Improving access to training and more diversified internship placements • Planning for recognition of experiential learning for respiratory therapists already in the system if new post-CEGEP studies become a requirement for obtaining a licence to practise as a respiratory therapist • Not favouring two distinct training paths for obtaining a licence, so as to avoid developing two categories of respiratory therapists; instead, maintaining a standardized approach

26. Thanks To members for the work done by the two ad hoc committees First committee composed of: Mélanie Maloin, SEE en soins infirmiers et cardio-respiratoires CSN, Sainte-Agathe des Monts Michel Grégoire, Syndicat des professionnels en soins infirmiers et cardiorespiratoires de l’hôpital du Sacré-Cœur de Montréal Bertrand Du Sablond, Syndicat des professionnels en soins infirmiers et cardiorespiratoires de l’hôpital du Sacré-Cœur de Montréal Marie Bergeron, FSSS-CSN staff representative Second committee composed of: Michel Grégoire, Syndicat des professionnels en soins infirmiers et cardiorespiratoires de l’hôpital du Sacré-Cœur de Montréal Bertrand Du Sablond, Syndicat des professionnels en soins infirmiers et cardiorespiratoires de l’hôpital du Sacré-Cœur de Montréal Isabelle Leblanc, SEE en soins infirmiers et cardio-respiratoires CSN, Sainte-Agathe des Monts Marie Bergeron, FSSS-CSN staff representative