More ventilators are coming, but there’s still a shortage of people who can operate them

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Ventilators for critically ill coronavirus patients are in desperately short supply. So are the people who can operate them.

As U.S. deaths from COVID-19 mount, manufacturers from all industries are scrambling to make more of the complex hospital equipment that can breathe on behalf of lung-compromised patients. About 1 million American coronavirus victims might need a ventilator, according to some estimates—and the country currently has fewer than 175,000 of them.

But while medical-device companies, automakers, and 3D printers all spring into manufacturing action, some health experts are worrying about a related—and potentially equally tragic—shortage: that of trained respiratory therapists, the specialist health care workers who can often put breathing tubes down patients’ throats, and know how to adjust the delicate dial settings on their ventilators, without injuring or killing them.

“These are not plug-into-the-wall-and-go machines,” warns Julie Letwat, a health care lawyer with McGuireWoods in Chicago. “These have to be individually calibrated for patients—and if they’re not, the patient dies.”

Intubating patients and adjusting the delicate dial settings on their ventilators can be done by some doctors and nurses, although most are already inundated by other work from the surge of COVID-19 cases. And “we already have a shortage of nurses and physicians in the United States,” says Marcus Schabacker, a physician and the CEO of ECRI, a patient-safety nonprofit organization. “They’re already stretched when we have a bad flu season.”

In the United States, managing ventilators is mostly done by a specially trained group of health care workers called respiratory therapists. But there aren’t enough of them: One 2015 study found that in a crisis-level public health emergency, the number of available respiratory therapists would be the “key constraining component,” meaning the number of patients on ventilators would max out at 135,000.

Which makes some experts warn that all the recent efforts to step up ventilator manufacturing might be missing the real problem.

“You’re going to run out of personnel before you run out of ventilators,” Schabacker says.

Calling in reinforcements

In theory, the numbers should be less dire. There are about 150,000 licensed respiratory therapists in the United States, who could each manage up to six ventilators at once under good circumstances, according to Timothy R. Myers, chief business officer for the American Association for Respiratory Care. 

But “if you have critically ill patients, that ratio could go down,” he says. “That means you need more therapists.”

It’s a profession that’s fairly unique to the U.S., and one of its fastest growing. Becoming a respiratory therapist requires an associate’s degree, board certifications, and a license in all states but Alaska. The median annual pay in 2018 was $60,280, according to the U.S. Bureau of Labor Statistics.

But it’s also a profession that needed more recruits even before the onset of the coronavirus crisis—especially in some now-crucial locations. New York, which has become the center of the American crisis, “is among the states with the lowest concentration of respiratory therapists compared with the national average,” USA Today reported last week, citing an analysis of BLS data from 2018. “The concentration is similarly low in Washington, the first hotspot in the USA.”

Hospitals in general were seeing vacancy rates for respiratory therapists of between 9% and 12% early this year, before the onset of the pandemic, according to Myers.

“While it was a bit of a shortage, people were able to manage daily operations with some creative staffing and overtime,” Myers says. “But as this virus spreads, if hospital workers are getting exposed and quarantined or testing positive themselves, you’re depleting a workforce” that was already short-staffed.

Now hospitals and medical centers are trying to fill in the gaps by calling respiratory therapists out of retirement—or hustling them into the workforce early. Some states have streamlined their licensing requirements or waived fees for recent retirees, Myers says. He adds that others are also granting temporary licenses to students who have completed some of their respiratory therapy coursework, so that they can relieve hospital staff of some non-ICU duties.

Myers also offers a glimmer of hope: In the coming weeks, as medical-device makers and car companies fulfill their promises to manufacture tens of thousands more ventilators, there will be some fresh recruits to operate them.

They still may not be numerous enough to operate the new machines. But in the next two months, “there are about 6,000 to 7,000 [respiratory-therapist] students in the United States about to graduate,” Myers says. “So there is another potential workforce—a resupply, if you will.”

Editor’s Note: This story has been updated to emphasize that respiratory therapists operate and adjust ventilators in addition to intubating patients.

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