Mid Level Creep in Radiology - California NPs can now interpret diagnostic images without a physician.

[medradthrowaway]

Nice jokester. The reliance of imaging on diagnoses has made radiologists probably the most important specialty in the hospital. You have it the other way around; there’s way more good radiologists than bad ones. I can probably say that a FM doc or Im doc half ass knows something then follows some algorithm to make decisions. That’s not happening in radiology.

Radiology is about pattern recognition. That's pretty algorithmic to me. I would even say it is much harder to train someone to be a good FM doc than it is to teach someone how to read scans. It just takes repetition. That's why people are looking into AI, which acknowledges the fact that radiology is probably most algo based out of all the specialties. You see x pattern = x disease/ differentials.

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[scoopdaboop]

Radiology is about pattern recognition. That's pretty algorithmic to me. I would even say it is much harder to train someone to be a good FM doc than it is to teach someone how to read scans. It just takes repetition. That's why people are looking into AI, which acknowledges the fact that radiology is probably most algo based out of all the specialties. You see x pattern = x disease.

A lot of medicine is pattern recognition. You recognize a specific set of symptoms and what it can be etc. Radiology is no different, you are right. But, to say that most radiologists are bad is just silliness. And, it doesn't make sense in the context of medicine and how it is practiced today. If a radiologist is bad, the patients treatment changes, and the patient will suffer, then you can easily note the mistake. Turn that around, a poor FM doc; which are basically FNP's but still better than FNP's, will be a referral monkey. Even in the ED, there is a wide range of skillset. I worked as a scribe, and doctors would talk behind their backs; saying so and so isn't good at procedures, orders too much etc.

 

[Kuratz]

Radiology is about pattern recognition. That's pretty algorithmic to me. I would even say it is much harder to train someone to be a good FM doc than it is to teach someone how to read scans. It just takes repetition. That's why people are looking into AI, which acknowledges the fact that radiology is probably most algo based out of all the specialties. You see x pattern = x disease/ differentials.

You are completely outing yourself as the med student that you are.

 

[medradthrowaway]

A lot of medicine is pattern recognition. You recognize a specific set of symptoms and what it can be etc. Radiology is no different, you are right. But, to say that most radiologists are bad is just silliness. And, it doesn't make sense in the context of medicine and how it is practiced today. If a radiologist is bad, the patients treatment changes, and the patient will suffer, then you can easily note the mistake. Turn that around, a poor FM doc; which are basically FNP's but still better than FNP's, will be a referral monkey. Even in the ED, there is a wide range of skillset. I worked as a scribe, and doctors would talk behind their backs; saying so and so isn't good at procedures, orders too much etc.

You make fun of FM and how they are "referral monkeys" yet you don't realize that "correlate clinically" on a radiology report is basically the same thing. All the hedging and CYA on these reports basically defer the dx to another specialist or consultant. I wouldn't say that most reports are like this but a good number of them are.

 

[Clean7795]

Primary care is heavily driven by algorithmic guidelines, that's why NPs have gained a foothold practicing independently without any physician oversight. I'm not saying they do a good (or even mediocre) job by any means, but they get by with overuse of specialist referrals and imaging. They have penetrated into specialties with algorithmic bread-and-butter because that's the easiest place for them to work.

You make fun of FM and how they are "referral monkeys" yet you don't realize that "correlate clinically" on a radiology report is basically the same thing. All the hedging and CYA on these reports basically defer the dx to another specialist or consultant. I wouldn't say that most reports are like this but a good number of them are.

The use of imaging itself is CYA much of the time. e.g. "Patient has chest pain and some elevated trops and ST changes on ECG... well it's probably a MI, but it could be a type A aortic dissection... better get a CTA". I feel no qualms throwing it back onto the referring doc since most of the time they don't provide enough history, or they're asking for a dx that's shouldn't need radiology, or if they just don't know what they're looking for.

Like the poster above you implies, if radiologists couldn't do what they do, imaging wouldn't be used or the specialty wouldn't exist in the first place. The reality is that imaging continues to skyrocket because we can make diagnoses others can't.

 

[2brads]

I don't know if you're all aware, but AB890 was amended to say, "For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA)."

NPs cannot interpret or perform diagnostic imaging.

 

[Noemata]

I don't know if you're all aware, but AB890 was amended to say, "For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA)."

NPs cannot interpret or perform diagnostic imaging.

This is really interesting, thanks for bringing it up. Can you expand on this a little more? I thought this bill gave them power to interpret imaging..

 

[2brads]

As originally written, under AB890 NPs could "order, perform and interpret" diagnostic imaging. But the pushback was so great that these provisions were amended prior to the final vote. The bill came out of committee in early August, which I think the OP was referring to. The final Senate vote was on 8/31/20 where the bill did pass. MBC and even the Board of RN's opposed the bill (it was supported by CA Assoc of NPs).

 

[Noemata]

As originally written, under AB890 NPs could "order, perform and interpret" diagnostic imaging. But the pushback was so great that these provisions were amended prior to the final vote. The bill came out of committee in early August, which I think the OP was referring to. The final Senate vote was on 8/31/20 where the bill did pass. MBC and even the Board of RN's opposed the bill (it was supported by CA Assoc of NPs).

Got it, thanks for the clarification!

 

[Cognovi]

LOL, ain't no attending gives enough of a damn to make a false impression on some medical student rotating through. Everything you've just said...good for you, but it's definitely not the norm (as others on here have attested to, neurosurg is notorious for reading their own images and not caring or waiting for radiologist reads). And I don't blame them, because to be honest, there are a lot of garbage radiologist reports out there. There are some exceptionally good radiologists and there are a lot of bad ones that like to hedge on every single thing. "Correlate clinically" didn't just become a joke out of nowhere.

I see individual attendings come to the reading room way more than I see medical students come down to the reading room with teams.

Having just finished a solo overnight rotation, I can assure you it is the surgical residents who call the most. I like these interactions because they bring in the clinical correlation and it's a collegial discussion. There were also times where the neurosurgery attending (on call at home) insisted to their resident (on call in house) to ask radiology about something. Neurosurgeons are pretty good at imaging but routinely ignoring the radiologist read will only get you in malpractice trouble.