Academic Output of Fellows of the American Association for Respiratory Care

Discussion

We found that approximately half of RT FAARCs have published manuscripts. Those with both FAARC and FCCM designations had a large body of published work, with a median of 50 publications and an h-index of 18. The early-years FAARCs had significantly more publishing experience than those inducted in later years. The decrease may be related to the relatively small number of RTs with a large body of publications, with most inducted in the initial groups, but could also be related to the initial committee being primarily focused on scientific contributions while those who had made other significant contributions to the profession were nominated over time. When the initial committee leadership changed, their focus on who qualified may have shifted away from scientific contributions as the primary accomplishment for FAARC. It is also possible some RT researchers had a large body of abstracts but did not publish them in manuscript form.²³

Scientific advancement is critical to providing evidence-based respiratory care.^1,3 Given that most RT researchers are trained post graduation,^4,7 there may be limited role models for RTs interested in performing research or publishing quality improvement projects within their departments. Mentorship is critical for success in any field and of particular importance in research.^2,24 We were able to identify 97 RTs with at least 10 publications, indicating that there are likely limited RT mentors available for RTs interested in research. Whereas not recorded, many of these RTs have retired or are nearing the end of their professional careers. Lack of mentorship was reported as a barrier for RTs performing research, along with lack of protected time, limited opportunities, and lack of departmental support.⁴ RTs interested in research may need to look toward physicians or other professions for mentorship.²

A recent survey of RT leaders noted that < 15% felt research was an important achievement when considering someone for promotion.²⁵ This may be reflective of RT leaders not valuing research, having limited resources to support research, the need for RTs to provide clinical care, or other institution-specific challenges. Some RT departments or researchers may have published a large number of abstracts; however, this was not reflected in our study. We chose to focus on manuscripts as the peer review process is more rigorous and other centers can more easily apply the results.²³ Most departments do not have the resources to support full or part-time research RTs within the respiratory care department, and many RTs who are interested in research volunteer their time, become clinical research coordinators, or take teaching positions where research time is protected. Relying on volunteers to build a sustainable research model is challenging, especially when research or quality improvement work does not necessarily translate to promotion or increased professional opportunities.

We noted statistically significant differences in publications based on the highest degree earned by FAARCs. Those with doctorate, master’s, and unreported degrees had significantly more publications than those with a bachelor’s degree. This is not surprising as those interested in research careers likely pursued post-graduate education to learn the skills needed to be successful. Many have held or currently hold academic positions at universities where there are incentives and expectations to publish, and faculty must hold graduate degrees. In contrast to physician-scientists, few RT entry-to-practice programs include a rigorous research curriculum as their primary focus is to prepare RTs for clinical practice. In addition, many if not most programs will have difficulty identifying experienced faculty to facilitate research that is published in manuscript form, especially if not affiliated with a hospital or clinic where subjects can be recruited. Even when RTs are interested in research, they may have limited opportunities post graduation⁴ as many departments are struggling with staffing,¹¹ have limited resources, or do not prioritize research.²⁵ It is also possible some respiratory care departments have highly effective quality improvement and problem-solving systems but do not publish due to lack of time, interest, or ability.

The respiratory care profession needs clinician-scientists dedicated specifically to researching commonly delivered therapies, many of which require substantial resources but have little evidence evaluating their efficacy.³ Unfortunately, with budget cuts and significant staffing shortages throughout the United States, we believe it will become increasingly difficult for respiratory care departments to devote resources to research. It is possible that many respiratory care departments will need to be more restrictive in the services they can provide, with a focus on the most valuable or essential activities.^8,12 Implementing a value-based system of respiratory care resource allocation will be very challenging as it is difficult to get stakeholders to agree,¹⁷ especially when low-value or non-evidence–based therapies will be off-loaded onto other services, or if physicians feel their prescribing authority is being limited. Developing RT scientists is a challenge that will require a multifaceted approach as there are no simple solutions. Post-graduate mentorship, incorporation of research curriculum into entry-to-practice programs, formal mentorship programs through professional societies, and leadership support at the department level are all critical to developing and sustaining a large body of RT scientists.