"please keep me updated about oximeters "
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RRT-to-RPSGT: will you hire me?
Okay, here's the deal: I have been an CRTT since 1983, RRT since 1990. Long experienced in adult acute care, a bit of NICU, lots of home care, a bit of teaching. I'm in one of the BRPT Pathway #3 CAAHEP-Accredited Polysomnographic Technology programs, so next month, after only two semesters of part-time classes & 15 nights in the lab, I'll be eligible for the RPSGT exam. I'm not making any predictions but I have a good record with such exams, so for the sake of discussion, if I pass will you hire me?
Are you old guard RPSGTs who paid your dues for so long before being eligible for the exam a little pissed off about we RTs getting such a short path to eligibility? Will you hire us even though we have very little experience? Will it matter whether or not we have passed the RPSGT exam? Will you want to pay us differently? Will we be suspect until we prove ourselves?
Come on, let's hear it. Will I be back in the ICU by Christmas because no one will hire the RT retreads?
Are you old guard RPSGTs who paid your dues for so long before being eligible for the exam a little pissed off about we RTs getting such a short path to eligibility? Will you hire us even though we have very little experience? Will it matter whether or not we have passed the RPSGT exam? Will you want to pay us differently? Will we be suspect until we prove ourselves?
Come on, let's hear it. Will I be back in the ICU by Christmas because no one will hire the RT retreads?
Views: 441
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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I do not agree that turning sleep medicine into a drive through market is the answer. You guys can have your opinion I have mine. i take evaluating sleep a bit more serious than that. part of the problem with compliance now is that the SLEEP is not being treated. You can't treat one symptom of a disorder and expect things to get better. In my opinion that model may save money, but it will increase the noncompliance numbers. Franchising the sleep industry is not going to make it better. they have tried to do that with the walk in clinics. I do not know about you, but I will never got to one of those again.
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I agree that the system needs some tweaking I also respect banyons opinion. I was more or less expressing how I felt about his opinion. you can't however put all of the blame on the medical industry. Despite the conversations that we have had here weight gain is one of the biggest predisposing factors for apnea. MOST (not all) people gain weight due to there own unhealthy decisions. Yes it is our choice to be healthy or unhealthy. Then when something goes wrong the medical industry is expected to fix 20 years of bad decisions over night, or with a miracle pill. It is not that easy guys. half of my patients tell me that I am waisting my time. Half of those tell me they will not comply. Did you know that over 50% of all pts don't show up for there follow up appointments? That is a pretty high number. I have had doctor and pts alike tell me there is nothing to this science. What % of visitors to cpaptalk or sleep guide do you think continue with their therapy. I bet you it is not as good as we think. Those 2 groups represent a small number of apneac patients. Right now you would not be able to staff a plan like that with enough educated people. You would not have RPSGTs or RTs in those positions. You might reach more people, but the service would suffer even more than does now.
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To me thinking that we can fix the system by giving people Sleep disorder Dx and PAP devices the same we do double cheese burgers is not thinking outside the box. We have seen this before 1000s of times. To me the invention of the drive through will be our health downfall.
jnk said
The model of 'take-home study plus data-machine' for the patient would mean patients with central troubles and PLM and the like might not get found right away, but eventually high home-estimated AHI and continuing sleep trouble would show up who needed more attention and a PSG.
First of all is it all right for a doctor to make a decision without all of the information. that is what is happening when a Dr. makes a Dx based off of a "take home study" I also could probably introduce you to alot of CSA, complex apnea, CHF patients that might disagree with those statements. OMG jnk these are the people that need the treatment the most. You do understand that OSA will turn into CSA or complex apnea if not treated right. OSA does the damage CSA, complex apnea is the result. On top of that there are educational/support groups that are not currently being used.
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I saw that to. They have turned sleep education into the biggest pay it forward/chain email letter that the world has ever seen. 60,000 people all partaking in the largest unorganized event on the web.
Cindy Brown said:you're right Rock, it was just waved. And they put in a new pathway....#4
Cindy
Rock Hinkle said:I think that rule was just waved Mollete. I don't know I am getting confused.
Mollete said:Cindy Brown said:
Well, IMHO, anyone who can pass RPSGT deserves it, but that is not exactly my point. Rather, since AASM requires all technicians to be at least enrolled in A-Step by July 1, 2009 if they work in an accredited laboratory/center, at least they are making an effort to improve overall quality of technician. Because the fact of the matter is, it is not mandatory to become registered EVER. I think I'd be happy just to get everbody up to an entry level baseline with some sort of objective determination of that. And not just, "Oh well, my patients love me".The A-Step is no longer a requirement for "medically trained professionals" to sit the exam anymore.
mollete
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True. But you CAN treat one symptom FIRST, then go from there.
This is what is happening now jnk. The o2 desats of apnea are getting treated by PAP therapy. If pts do not go to follow up appointments or to A.W.A.K.E groups sometimes the bad sleep caused by apnea will not get treated. This drives down compliance and tolerance numbers. Pts do not use the support that is set up now. That does not set the ground work for a larger scale program. The formula supported by Banyon would be good for pts like you and him. Pt's who take an active roll in their therapy. Not all pts are like you guys. I also think that it is a little selfish to support a plan that only includes the demographic that you belong to. It is easy to sacrifice the group that does not show up to vote. Just to put things in perspective your links show that 15% of all apneac pts have complex/CSA. These are the same pts that would not get the correct treatment right away or maybe not at all. That is 2,100,000 people getting swept under the rug. Could you and Banyon live with that? I could not.
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Typical bureaucracy building to inflate salaries and inflate egos. You guys with all your acronyms are a danger to the public's health and finances.
JNK do you still think that was not directed at us? After child support and insurance is taken out of my check I bring home about $28,000. How is that threatening to the public's health and finances? I have 2 kids and a wife in school. Am I not to support myself. I would like to know what you do Banyon? You seem to have an inflated ego yourself.
Mollete said:j n k said:All the figures are estimates and may depend on whether you talk about who is being treated or who needs to be treated.
Utilizing your references and only those two entities, the "95% of the patients out there are simple obstructive apnea cases with no other "sleep" comorbidities" is already down to 75% to 84%. Considering all the other confounding comorbidities will bring that number down by another half.
j n k said:But the larger point, as I see it, is...
No, the point was Banyon has NFI what he's talking about.
j n k said:I understood Mr. Conner's questions to be related to entering the medical side of the sleep industry. I understood Banyon's reply to be related to a consideration as to the advisability of doing so, in view of possible directions of the overall industry.
If these comments represent Banyon's consideration:
Banyon said:Typical bureaucracy building to inflate salaries and inflate egos. You guys with all your acronyms are a danger to the public's health and finances.
then my "advisability" to him is that he should GFH.
mollete
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If we switch the gold standard to home testing how do you suppose we Dx the other 90 or so sleep disorders? Are those people to be left out of your plan as well? 1 in 2000 people have narcolepsy. that is another 150 to 200 thousand people that could go undiagnosed in your village pantry idea. I guess there is always webmd.
Sorry for the highjacking of your post Rock. it was nice to see all of the techs come together in this last page or so, regardless of acronym. Sleep is a common flag by which we all pledge our loyalty.
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Permalink Reply by Rock Conner RRT on
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No apology required. I have delighted in the discussion!
Rock Hinkle said:If we switch the gold standard to home testing how do you suppose we Dx the other 90 or so sleep disorders? Are those people to be left out of your plan as well? 1 in 2000 people have narcolepsy. that is another 150 to 200 thousand people that could go undiagnosed in your village pantry idea. I guess there is always webmd.
Sorry for the highjacking of your post Rock. it was nice to see all of the techs come together in this last page or so, regardless of acronym. Sleep is a common flag by which we all pledge our loyalty.
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I still think your sexy when you talk sleep.
j n k said:The idea of home testing was not mine or Banyon's. So neither of us can take one ounce of credit for it.
Remember, though, that treating something does not necessarily amount to sweeping anything under a rug. It just means the stuff not swept up in the first pass gets swept up in the second pass or the third. You sweep till you get it all, within reason.
Its like treating a headache. If OTC aspirin doesn't make the headache better, it may be time for a doctor. But suggesting everyone with a headache get tested for every problem that might cause it before trying aspirin may not be the right order for helping people with headaches.
Similarly, with the kind of protocol Banyon mentions (used now by some doctors and possibly much more in the future), people who continue to have daytime sleepiness and fatigue despite good AHI estimates from their home machines could then get the PSG and MSLT and whatever.
Again, that is not what I would argue for--I like PSGs for everyone, even the nonsympomatic, myself--but I don't think it would be the end of the world, and it is one of several ideas for reaching more people and saving some money along the way.
I can't speak directly to the question of whom Banyon had in mind. I assumed it was the overall system, not the people who do a good job in spite of the system. But what do I know.
The model Banyon pointed to was diabetes. It doesn't take any more brain power or education to self-titrate pressurized air than it does to self-titrate insulin, does it? Which is more dangerous?
You are right, though, Mollette. I have no access to statistics or words that are likely to help you understand what anyone means. I will now up my self-estimate of wrongness in the eyes of Mollette to 85%, if that's OK with you. Or should I go higher? ;-)
I leave the thread to the professionals.
jeff
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Permalink Reply by Judy on
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Rock Hinkle said
I still think your sexy when you talk sleep.
Giggle. Snicker. Choke. Snort. Guffaw. ROTFLMAO!!!
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jnk why are you arguing for something that you do not5 believe in? Well I might add. You and banyon got something going on?
Similarly, with the kind of protocol Banyon mentions (used now by some doctors and possibly much more in the future), people who continue to have daytime sleepiness and fatigue despite good AHI estimates from their home machines could then get the PSG and MSLT and whatever.
You assume that these "patients" in question have that much time. What you are suggesting could add time on to a diagnosis that they may not be able to wait for. At least with a psg and titration we know if they are complex or not despite protocol. I think that Banyons solution to the problem sacrifices more lambs than i am willing to give up. we are talking in the upwards of 3-5 million people who may not get the correct Dx due to incorrect information. Those numbers are based on my own calculations Mollete. jnk do not walk away from this conversation! you left me high and dry on the weight vs apnea one.
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I am going to start a "let's figure Mollete out discussion." Mollete you fascinate me!
Mollete said:j n k said:The model Banyon pointed to was diabetes. It doesn't take any more brain power or education to self-titrate pressurized air than it does to self-titrate insulin, does it? Which is more dangerous?
The flaw(s) in the "It's just like diabetes" syllogism is that those patients have already received their diagnosis and dose their insulin according to an assigned sliding scale. If you want to vary your CPAP settings from 8.0 cmH2O to 10.0 cmH2O based on weight changes, tossing down a six-pack, etc. knock yourself out.
On the other hand, if you've got polyuria and want to buy some insulin on the internet and start shooting yourself up, then GFL.
mollete
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