Editor's Note      Michael Jackson

Speaker's Report      Ruth Krueger

Speaker-Elect's Update      LaDawn Neary

Secretary's Report      Michelle Porter

Treasurer's Report      Barbara Fedak

Past Speaker's Report      Jonathan Lee

Physician Support      Lucy Kester

How to Respond      Tom Striplin

Membership Figures

The Publication Committee thanks all who submitted articles for this issue of The AARC Record. Once again, Pat Lee has played an invaluable role in assuring publication. We are all elevated by these commitments to our profession. Strive on diligently. [Top]

Many House members, through the P&T comments and by follow-up on the list serve, applauded the Keystone focus groups. Our goal in Tampa is to continue the networking opportunity by again doing focus groups on Friday afternoon.

The feedback I got from the list serve and the survey requested the following for focus topics.

1. Key steps in writing strong, meaningful resolutions
2. Transitioning affiliates to profit sharing and away from revenue sharing
3. HOD makeup -- How do we foster volunteerism, leadership development, loyalty and the desire to serve? Do we want term limits to foster/promote/push delegate leadership development within the affiliate
4. Help for affiliates to become more financially sound / responsible

We will again offer two topics. We will combine the second and fourth suggestions into one group, cover the third topic in one group and ask the Resolutions Committee to work on the first topic with articles in the Record, on the list serve when the call for resolutions is published and as the resolutions come to the committee. We have some great minds in the House that I'm sure will come up with some solutions to the problems that plague us. The outcomes from the last focus groups were compiled by George Gaebler and published over the list serve after Keystone. The resolution you received from Kansas is based in part on some of those outcomes. Where our education is heading had some great input as well. The information gathered during that group is helping to align the educators and managers in the House to enable us to work together with the EO/ BOD and membership to provide direction for our profession in the area of academics. Tapping the resources we have at our fingertips each time we come together by asking the right questions and then listening and following through is the key to helping to solve the challenges we face. The House can make a difference in how our profession changes and grows.

See you in Tampa. Come prepared to share your ideas and thoughts. [Top]

Throughout my year as Speaker-elect, I bombarded Ruth with emails asking, "Is there anything I should be doing?" Well, now that there is only a short time before I take office, I know my biggest responsibilities are not only to get my goals in place but also to put together the various HOD committees and chairs.

Continuing the mentoring and leadership process are part of my goals. This has been a key issue for several of our speakers as well as AARC presidents. So I've decided to continue and foster this process through my committee chair appointments. Why? Because in order to continue advancing into leadership roles in the AARC, you've had to have held certain positions or offices, and chairing a HOD committee would help meet this requirement.

Obviously the qualities and abilities of those in chair positions are important, but with the individuals in the HOD, finding these people is not an issue as anyone can fit these descriptors. Soooo -- as I put together my committee chairs for 2003, I am looking at a few things:

• Those individuals interested in committee chair appointments
• Those individuals who have not held chair appointments in the past
• Those individuals who have had prior chair appointments

I know this is going to be a difficult process because everyone currently in these positions has done a wonderful job. But in order to help accomplish my goals and give those wishing a leadership position a way to move on, I feel we really need to try and get new individuals into these chair positions.

Concerns are expressed at every meeting about the need to get more people interested and involved in the organization. This is my way of trying to accomplish this issue and I hope you all feel as I do and can support my decisions. Thanks for allowing me the opportunity to try. And as always, I am open to feedback and suggestions. [Top]

I'm honored that the AARC HOD body chose me to be their secretary, but I think I'm still trying to figure out exactly how to fulfill my duties and my term ends real soon! Don't let this scare any of you potential candidates, but here are a few insights to what I've learned as secretary this year.

1. Be prepared. Be ready for meetings, just like all delegates, but a little more. As secretary, I am required to read and edit resolutions with the help of the Resolutions Committee and input from officers. At my first meeting in this role we had 11 resolutions submitted! Talk about overwhelming! I was grateful to everyone that submitted, but couldn't believe the amount of email and phone calls required. In Tampa, we will discuss 3 thought provoking and well- written resolutions submitted by NY, KS, and OH. But even these 3 resolutions generated about 50 emails between other committee members and myself. I hope all of you have taken the time to read the current resolutions very carefully and discuss them with your boards. Everyone is busy, so please come to the meeting prepared.

2. Be early to your meetings, not just on time.

3. Be brave enough to ask for help when you need it. With the ego I have, this one is tough. I was very overwhelmed in Keystone. Please take the time to read ahead and do your duty as delegates. I will take the time to do my duty as your secretary. I won't promise you everything, but I do promise I will be in Tampa and will do my best on the resolutions. I'll be sitting on the stand, smiling at each of you, because I'll be prepared and besides, it is my last House meeting. I expect to have a great time, especially on Friday night after the meeting, when we all go out for one more drink together! [Top]

Budget for 2003
Speaker-elect LaDawn Neary and I have just completed next year's budget for the House of Delegates. We looked at expenses for the past 3 years and asked for input from committee chairs regarding their expenses. Last year Speaker Ruth Krueger and I, with the help of committee chairs, made significant reductions in the budget and were able to see a savings of $2758.00 to the AARC. This year it was more a task of fine-tuning the budget that was developed last year, but there will be a savings of $764.00 for 2003. Although many committees have not spent most of their budgets we felt we needed to leave in adequate amounts to cover things that sometimes are being paid for by places of employment. Many committee chairs are able to use phones and reproduction services where they work but that may not be possible for all future chairs. We appreciate the work that all committee chairs have done to keep expenses minimal and know that anything that can be done to limit expenses ultimately is a benefit to all members of the AARC.

AARC Finance Committee
The AARC Finance Committee met June 16, 2002 in Keystone, CO. Tony Lovio, CFO, did an extensive review of the 2002 financial statements and the 2003 Rates and Volumes recommendations to the board. He also conducted a detailed review of the performances of AARC investments. There was approval of non-budgeted expenses of an estimated amount of $500.00 for Scott Barstow to travel in order to represent the AARC at the Food and Drug Administration forum on June 7 to discuss safety and efficacy of medical devices in the home. Also approved was the allocation of approximately $10,000 to design and organize workshops for persons who want to sit for the National Asthma Educator Certification examination and the Registered Polysomnographic Technologist credential.

AARC Financials to Date
Annual total revenue is below budget by 17% as of July financials. Membership dues are below budget by 12% for the month of July and 15% year to date. Total members were budgeted at 31,525 for July 2002 and actual is 30,509. The gap appears to be growing in the budgeted versus new members which will impact budgetary projections.

Publication revenue is 16% below budget for the month and 9% for the year. RC advertising is slightly above budget year to date, but AARC Times is slightly below budget with the last two months below projections. There is an effort to reverse this by year-end and a projection that the RC budget will be exceeded by 10% and the AARC Times budget will meet or slightly exceed budget.

The Product area revenue continues to run behind for the year and it appears that this area may have been too aggressively budgeted. On the positive side, promotional item sales in 2002 are still ahead of this point a year ago.

In the expenses area there is an over-budget of 1% in the executive/administrative area with some of the extra expense due to internal systems consulting and contract labor during the year-end audit. While there are some savings areas, particularly in travel accounts, most other expense variations appear to be of a timing nature and will most likely catch up later in the year.

Some areas of savings, too many to list them all, are membership cost savings due to newsletter printing and postage cost savings of $25,000.00, Summer Forum permanent expense saving of $38,000.00, PACT conference expense savings of about $18,000.00 and publications savings of about $140,00.00.

In conclusion I must urge you to carefully read Past Speaker Jonathan Lee's article and carefully consider what he is saying to all of us. As time goes by less of us are supporting our professional organization in money and time and many others are benefiting from our efforts. We must find a way to reach those who say they don't see the value or don't have the time. We continue not to meet our membership projections, which in turn create a shortfall of revenue in all areas. Without membership gain eventually services may need to be reduced which is something that no one would want to see happen. We must make membership recruitment a priority and it needs to start with all of you who are leaders in your respective states. [Top]

Our Tampa meeting is coming up fast in the calendar and there is much to do to prepare. With the International Congress following our meeting it makes for an exciting and busy time for everyone.

Please give consideration to our election for officers and committee chairs, take time to speak with these candidates and ask your questions, get to know them as best you can so that you are making an informed choice for your leadership of the House for the next few years.

The work of the House this year has been challenging, rewarding and informative. It certainly seems that the delegates have clearly and successfully migrated to the two-day session, going on 3 years now, displaying preparedness and efficiency of all parties. Speaker Krueger has been highly successful in maximizing our agenda time while also reinstating focus groups to address issues and networking as well as data gathering for our decision making process.

Refresher on BOD actions on HOD Resolutions moved to the BOD:

#01-02-01 "Resolved that the AARC recommends a collaborative effort among the AARC, the NBRC and the CoARC, establish a strategy and timetable to change the current two-tiered credentialing system to a single entry credential for the respiratory therapy profession".
Was tabled by the House until the October meeting. As on the House floor, the Board had much parallel discussion on this matter. As discussed, Tripartite is already in place and the NBRC is conducting a workplace analysis survey to gain insight to the needs in the working environment to guide future credentialing examinations content and scope. Over the years there have been multiple studies and data that point to this approach.

#20-02-04 "Resolved that the AARC investigate why a parallel conference has come into being, what needs if any the AARC has not addressed that the parallel conference does, and identify what can be done to address if necessary".
The BOD accepted this resolution for information only.

#11-02-06 " Resolved that the AARC BOD investigate the implications of Chartered Affiliates changing their names to "AARC of (State Name here)" with a report back to the HOD in Tampa, 2002".

Discussion centered on the importance of protecting the name of the AARC. Additionally, this could create a conflict with any patron members of a chartered affiliate. The BOD referred this resolution to the Executive Office. This fall will be my last HOD/BOD meeting, and I would just like to thank you all for the opportunity to have served the AARC and the profession in this capacity. My time in the House has been full of exciting, enjoyable memories and wonderful people. I have been blessed to have these experiences enter my life. I have been privileged to work with you all; I thank you for your guidance, lessons, mentoring, patience and fun! [Top]

Physician support for the Respiratory Therapy profession has long been recognized as an essential ingredient for our success. We realize the benefits of physician support from our medical directors and ICU Intensivists in our daily work environment. Numerous physicians have provided invaluable information to the respiratory care community through lectures at our national meetings, participation in the AARC Journal Conference, and contributions to the Respiratory Care journal. David Pierson, M.D., FAARC, continues to make an outstanding contribution to our profession as editor of the Respiratory Care journal. Many other physicians have provided support as members of the AARC Board of Medical Directors (BOMA).

In 1996 when health care organizations sought to use substitute care givers, the American Society of Anesthesiologists (ASA) issued a Statement of Support for Respiratory Care Practitioners. The final paragraph of the statement reads: "ASA strongly supports the continued use of nationally credentialed Respiratory Care Practitioners working under the supervision of a qualified medical director as they are the most highly qualified health care personnel to deliver respiratory care services to patients."

Many physicians have advocated and encouraged respiratory care protocols. The American College of Chest Physicians (ACCP) published a statement (January, 1993) supporting the use of respiratory care protocols. Drs. James K. Stoller and Marin Kollef have each published randomized trials describing the benefits of using respiratory care protocols.

Once again, the ACCP is supporting our profession by addressing the recent decline in the enrollment for Respiratory Care education programs. The following excerpts are taken from the Statement of Support for Respiratory Care Programs issued by the AACP:

"In the United States, there is a growing crisis in providing quality Pulmonary and Critical Care services for our patients. There is currently insufficient numbers of qualified respiratory therapists, nurses, and physicians to care for the increasing number of patients with lung disease and critical illness. This crisis will worsen as the United States population ages and will increase the need for Pulmonary and Critical Care specialists. The number of applicants for all Allied Health professions, including respiratory care programs, has cycled with the economy. There have been significant declines in the rate of applicants during periods of low unemployment and high economic growth. Programs have reported starting classes as low as 25% of normal enrollment for the fall of 2000. In some areas of the country these reductions have led to reports of programs closing due to inadequate financial support. The American College of Chest Physicians is concerned that premature closure of Allied Health Programs, especially programs in Respiratory Care, will lead to a crisis in manpower in caring for our patients with cardiopulmonary illness. This population of patients is projected to more than double in the next 20 years. We feel legislators, academic institutes, and the public should be aware of the future needs of our patients. We believe that premature closure of allied health educational training programs will have critical consequences in terms of our ability to meet the health care needs of the population and that such program closures will exacerbate the already acute manpower shortage in the area of respiratory care. Maintenance and support of existing respiratory care educational programs is essential in order to meet the health care needs of our patients and is strongly encouraged."

Members of the Respiratory Care community are deeply indebted to the many physicians who have helped the field of Respiratory Care grow and develop into a profession devoted to excellent care of pulmonary patients. We look forward to continuing to work closely with physicians to educate ourselves, to improve current therapies, and to develop new techniques that will enable us to better care for our patients. [Top]

So many times we are asked the question by non-members: What does the AARC do for me? As frustrating as this question may be for respiratory care practitioners who choose to be in leadership roles within our organization, it opens the door of ignorance and allows us to share key aspects of the importance of the AARC to the survival of the profession. Many respiratory care practitioners are unaware of the national and state legislative initiatives pursued on their behalf by the AARC and its affiliates. What I have found when I have spoken to non-members is that many of them had no idea that we were doing so much on their behalf. The question we have to ask ourselves then is: Are we failing to communicate or are they simply not going to join no matter how much we do? The answer to that question most likely lies somewhere in between the two points.

We are all aware that being a member within our professional organization comes down to a personal choice and a level of responsibility that the majority of respiratory care professionals do not currently posses. Are there things we can do and are there things we can say to raise one's responsibility to their professional organization? I believe there are, and we must be ready to use a "part-guilt" and "part- we are looking out for you" strategy. We must try to make them feel bad for their lack of personal commitment while at the same time balancing that approach with support for their concerns and educating them on the importance of the organization's mission.

Many affiliates will comment that we send out newsletters, we have a web site, and we have local meetings to try and recruit new members. All of these initiatives are excellent, but apparently not enough to change the tide of recruitment and retention. What then, we ask ourselves, as we pull out the last hairs from our heads in a mad effort to get new members and retain the ones we have? It's extremely frustrating for respiratory care practitioners who possess the innate responsibility of being part of their professional organization, to grasp why the majority of practitioners just don't seem to care. Or do they care, and are we missing something else?

We have all heard the old adage "you have one time to make a first impression", nothing could be truer in our quest to recruit new members. As we stand up there in front of a group of people in our efforts to recruit, what we say and how we are perceived will have a major impact on the recruitment outcome. We can't (SLAM) the non-members (although we would like to sometimes), but we have to use a subtle dose of guilt that is buried within the importance of professional membership. If we make them the enemies or put their backs too far up against the wall, we lose.

Practitioners must realize the importance of legislative representation of the profession and that medicine is a competitive environment that is business orientated. Conveying an understanding to non-members that our profession needs to be proactively involved in medical affairs that impact the care of patients with cardiopulmonary disorders is essential. Relaying to them that the AARC spends millions of dollars per year on national and state levels to pursue an agenda that pushes to recognize the skills of a respiratory care practitioner is imperative. And finally, the importance of educating the larger part of the American population, that still does not know what a respiratory therapist is or does, is vital to our growth and stability.

And our answer is: We have done all that, we have said all that, and they still won't join! Exactly! Some never will, but many will, and it's the many we have to try and continually recruit. Many times it's sitting across the table from someone and talking to them on a personal level, other times it's the environment and the delivery that yields the positive outcome, and other times you just have to buy them a beer and tell them what asses they are for not stepping up to the plate.

The point is: The same delivery does not work on everyone in terms of recruiting. You must feel out your audience and use the optimal technique at the time to return the maximum benefit. So as we scream out our last belly ache about why we should not have to convince people to become members, we must remember that it is part of our turf. What do you mean, part of our turf ?? We are all in leadership roles, some by choice, some by job appointment, and that is what leaders do best, they get people to follow.

Looking forward to seeing you all in Tampa. [Top]

Active -- 23,446
Foreign -- 274
Honorary -- 23
Industrial -- 1,695
Life -- 51
Physician -- 197
Student -- 3,966
Special -- 738
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TOTAL -- 30,390