Switching From EM Into radiology?

[Birdstrike]

The last place I know who did it the owner radiologist is in jail. That’s why I say only really shady places do it.

Atlanta Radiologist Sentenced to Prison

However, the evidence showed that from May 2007 through January 2008, REDDY signed and submitted thousands of reports in his name without even reviewing the films that were the subjects of the reports. Rather, he had non-physician technicians known as Radiology Practice Assistants (“RPA’s”) review the film and prepare the reports. In some cases, REDDY directed the RSI staff to simply sign for him, and transmit the report as it he had prepared it. In other cases, REDDY accessed the system for the purpose of signing and submitting the reports. Either way, the majority of the time he never looked at and analyzed the underlying films, and the reports signed by him therefore did not bear his medical conclusions or those of any other doctor.

He was having medical assistants (MA) read the films, not mid-levels. MA's aren't even nurses, let alone mid-levels. You can get MA training in 9 months. He was letting them read films without even looking at them himself. Is this more indicative of blatant fraud, as opposed to mid-level encroachment?

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[skougess]

Wait, so there are actually places where midlevels are reading images?

That's honestly shocking to me. One of the things that's always impressed me about radiologists is their broad knowledge of pathology. You know, how every once in a while you get a report back with a diagnosis that you've never heard of before. I guess in the future I'll be seeing reports saying 'bilateral basal ganglia hemorrhages--correlate clinically" rather than Fahr syndrome.

If midlevels are reading images and PE is involved then it's just a matter of time...

“broad knowledge of pathology”

You could say that about all specialties.

“kid has conjunctivitis” -Kawasaki
“Young lady has a headache” -Pre-eclampsia
It goes on and on...

 

[Splenda88]

Wait, so there are actually places where midlevels are reading images?

That's honestly shocking to me. One of the things that's always impressed me about radiologists is their broad knowledge of pathology. You know, how every once in a while you get a report back with a diagnosis that you've never heard of before. I guess in the future I'll be seeing reports saying 'bilateral basal ganglia hemorrhages--correlate clinically" rather than Fahr syndrome.

If midlevels are reading images and PE is involved then it's just a matter of time...

Yeah. I would like to know that place where physicians are acting on mid-level "read."

Radiology and Pathology are arguably the two specialties where basic science that one learns in med school is EXTREMELY (emphasis here) important for the day-to-day practice of medicine.

 

[SirGecko]

He was having medical assistants (MA) read the films, not mid-levels. MA's aren't even nurses, let alone mid-levels. You can get MA training in 9 months. He was letting them read films without even looking at them himself. Is this more indicative of blatant fraud, as opposed to mid-level encroachment?

Per that article it was RPAs not MAs. Still inappropriate (some places do use them to prelim studies but I’m not a fan of that) but they do have more training than just an MA.

 

[Birdstrike]

Per that article it was RPAs not MAs. Still inappropriate (some places do use them to prelim studies but I’m not a fan of that) but they do have more training than just an MA.

I was just lifting the wording from the indictment. But, okay.

"United States Attorney Sally Quillian Yates said of the sentence, 'This physician fraudulently cut corners at the expense of the hospitals he worked for and the patients who were being treated. The Defendant produced tens of thousands of reports claiming to include his medical findings and diagnoses based on radiology studies that had been performed, but where all those interpretations had been performed by non-qualified medical assistants. This significant sentence is needed to protect the public from such an egregious breach of trust.'"

Are "RPAs" considered mid-levels, on equal footing as a PA or NP? I have no idea. But you can put me in the camp that doesn't want them reading my films unsupervised.

 

[Splenda88]

Per that article it was RPAs not MAs. Still inappropriate (some places do use them to prelim studies but I’m not a fan of that) but they do have more training than just an MA.

This is news to me. How is their training like?

 

[SirGecko]

This a news to me. How is their training like?

They are rad techs that get some extra training. I don’t have any personal experience with them where I work but they do exist. As far as I’m aware there is no where in the US where they can interpret studies unsupervised.

 

[Splenda88]

This is what we are dealing with. These are the people who will replace us.

 

[Taurus]

Are "RPAs" considered mid-levels, on equal footing as a PA or NP? I have no idea. But you can put me in the camp that doesn't want them reading my films unsupervised.

Yes, that is correct. It’s a long and convoluted back story. Radiology practitioner assistants (RPA) and radiology assistant (RA) are the equivalent of NP and PA in the radiology world (or at least they’re trying to be anyway). Most practices don’t use them or want them. They were kinda forced upon the profession. If they are hired, it’s usually for low end procedures or scut work. Radiology does not use midlevels like how it’s done in primary care, ED, or anesthesia. Midlevels are not a serious concern because economically and medicolegally it doesn’t make sense for them to do the bulk and biggest money maker in radiology. Namely, read images.

 

[Franzd'Epinay]

They were kinda forced upon the profession.

By whom? This whole thing is nuts.

 

[Kuratz]

For context, it was Penn that published a paper using Rad Techs (not RPAs) who trained for 2 months to read ICU chest x-rays. They looked at attending CXR throughput with Rad Techs vs. residents. Residents were not made aware that they were being included in a study, nor was time adjusted for time spent teaching residents. The paper came to the conclusion that Rad Techs had better efficiency for attendings than residents, which is patently ridiculous on all levels, not even considering the quality which was brushed off as a secondary factor. Further, they drew conclusions from an N=2 sample (LOL).

A PhD/MBA (I.e. a good for nothing snake trying to pad the CV) wrote the paper.

As you may expect, there was so much backlash that the publishing journal retracted the paper and Penn had to issue a statement. The uproar was pretty impressive.

You best believe no one was having any of that. And that was for low RVU, generally non-management changing, and overall relatively uninteresting studies.

There are VERY few places doing this, with Penn being the only I know of. To suggest it’s even on the horizon is out of touch. It doesn’t make sense to pay someone to read stuff that you have to read as an attending anyway.

Just some context to “midlevels are reading?!”

 

[Taurus]

And how much does a chest radiograph reimburse? It’s something like $5. Plain films are deceiving. They look like the simplest modality but to the trained and experienced observer they are the hardest to master. A finding that is obvious on CT can very subtle on plain films. The legal consequences for missing something even on plain films can be quite devastating however. Is it really worth the $5 to take on that liability when images never change?

Jury awards record $16.7M in lung cancer lawsuit

In what is believed to be Massachusetts’s largest medical malpractice award this year, a Boston jury awarded $16.7 million to the daughter of a Boston woman whose lung cancer was missed on a chest x-ray.

www.radiologybusiness.com

 

[dadaddadaBATMAN]

And how much does a chest radiograph reimburse? It’s something like $5. Plain films are deceiving. They look like the simplest modality but to the trained and experienced observer they are the hardest to master. A finding that is obvious on CT can very subtle on plain films. The legal consequences for missing something even on plain films can be quite devastating however. Is it really worth the $5 to take on that liability when images never change?

Jury awards record $16.7M in lung cancer lawsuit

In what is believed to be Massachusetts’s largest medical malpractice award this year, a Boston jury awarded $16.7 million to the daughter of a Boston woman whose lung cancer was missed on a chest x-ray.

www.radiologybusiness.com

Particularly under the retrospectoscope after some other imaging modality makes it obvious

 

[Birdstrike]

Particularly under the retrospectoscope after some other imaging modality makes it obvious

Exactly. 10 radiologist can't see the 'mass' on the chest x-ray.

But you can alway find a paid-hack to go back, after you've got a CT showing a mass down the road, and say, "See that tiny little gray blip? See? That's the tumor!"

"No, I don't see it."

"Look, it's right there, that grey streak. 👉"

*squint* *squint*

"Uh...yeah. YEAH. I see it now. Hang him!"


Retrospective bias is massive in the courtroom. Good lawyers know that and use it like a weapon.