The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

The Inactive Medical Director: What Can Anyone Do?

George Burton, MD, Sunday, December 7, 1997.

The previous presentation has outlined the roles and functions of medical directors (MDs) in various clinical settings and in respiratory therapy training programs. A simplistic view of how things might function in the absence of such medical direction is to visualize settings in which he/she did not fulfill these roles and functions.

The current debate over medical direction of respiratory care services is fueled by the ambiguous and, often, contradictory requirements of organizations such as JCAHO and CoARC, who have occasionally downplayed the contributions made by medical directors of acute care hospital departments and accredited respiratory therapy training programs.

This presentation will select several common, frequently failed "functions" of MDs, and describe what impact less than optional MD activity might have on the employing hospital, skilled nursing facility (SNF), or respiratory therapy educational program (RTEP), for example:

1. Failure to encourage appropriate clinical utilization of respiratory therapy services. 2. Failure to protect traditional "turf" of RCPs. 3. Failure to support programs of RC departments, e.g. TDPs, smoking cessation program, etc. 4. Failure to endorse and support budget requests of RC departments. 5. Failure to model cost-benefit relationships of optimal RCP-physician interaction. 6. Failure to communicate national medical standards to RC departments, e.g. NAEPP Guidelines, CAP and COPD CPGs. 7. Failure to recruit physicians to instruct and clinically supervise students in RCEPs

What can be done to stimulate physician input and function in these important areas? A few suggestions will be offered, among which are:

1. Pay him/her. 2. Recognize and thank him/her. 3. Make his/her life easier, e.g. stress the RCP as Physician Assistant concept. 4. DO NOT attack competency; develop incentives instead. 5. Give him/her part-ownership of the process AND product. 6. Stress the "Captain of the Ship" role of physician in patient care. 7. Request his/her help in educating medical staff, technical staff, and students.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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