Nurse practitioners in texas will be given the right to read CT, MRI, and such, oh gosh!!

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
There's "read" images, then there's "read and bill" for images. I assume that midlevels already "read" images and make decisions based on their interpretation, which is then confirmed or contradicted by the radiologist, and ultimately signed off by their supervising MD.
So I'm not sure what this legislation is actually trying to do.
 
I think it's a "read and bill" proposal... But most physicians won't treat their patients based on midlevels read.
 
Most bills in Texas legislature don’t pass. You can bet Texas radiological society will have an active part in making sure this bill is decidedly shot down. It does illustrate the troubling trend of the expanding midlevel scope of practice. Apparently no specialty is truly safe.
 
Indebt4Life said:
Click to expand...


Outcomes are the only thing anybody cares about, and right now outcome studies are the currency of the NPs and PAs. If physicians want to definitely prove their superiority of care, they need longitudinal prospective studies over multiple years comparing NPs practicing independently of physician advisement to those of physicians practicing independently of midlevel assistance.

Until then it’s all subjective ho-humming and conjecture, and the person who wins is the person who does a better job of making themselves look good. And physicians are having a hard time of it.
 
clutch21 said:
Most bills in Texas legislature don’t pass. You can bet Texas radiological society will have an active part in making sure this bill is decidedly shot down. It does illustrate the troubling trend of the expanding midlevel scope of practice. Apparently no specialty is truly safe.
Click to expand...

Agreed. If there is one state where nonsense gets tackled and shot down (figuratively and at times in practice), that would be Texas. Good ol'd Texas!
 
bronx43 said:
There's "read" images, then there's "read and bill" for images. I assume that midlevels already "read" images and make decisions based on their interpretation, which is then confirmed or contradicted by the radiologist, and ultimately signed off by their supervising MD.
So I'm not sure what this legislation is actually trying to do.
Click to expand...


Which midlevel "read" images and make decisions based on their interpretation? Can you name one?
 
Someone write up a proposal for a randomized controlled trial where we can directly compare radiologist and NP reads and their effect on outcomes. I’m sure that’d pass IRB.
 
Tiger100 said:
Which midlevel "read" images and make decisions based on their interpretation? Can you name one?
Click to expand...
Um... how about the legions of them that work pseudo-independently in academic centers? Where I trained (top 30 academic center), two of the 4 medical and neuro ICUs are almost solely staffed by midlevels during the day. The critical care attendings would come by in the mornings for two hours to round then go off and do "research." These midlevels would order chest XRs and "interpret" them in order to manage diuretic doses by themselves. They may or may not report it to the attending the following day.
I thought my institution was an anomaly until my wife started her fellowship at a top 10 academic center, and the mid-level presence was even worse.
 
bronx43 said:
Um... how about the legions of them that work pseudo-independently in academic centers? Where I trained (top 30 academic center), two of the 4 medical and neuro ICUs are almost solely staffed by midlevels during the day. The critical care attendings would come by in the mornings for two hours to round then go off and do "research." These midlevels would order chest XRs and "interpret" them in order to manage diuretic doses by themselves. They may or may not report it to the attending the following day.
I thought my institution was an anomaly until my wife started her fellowship at a top 10 academic center, and the mid-level presence was even worse.
Click to expand...

This is a common scenario that people reference when talking about how unnecessary radiologists are, but it's not a good example (although I know that's not what you were doing). Those images are still getting looked at by a radiologist, who will pick up the phone and let someone know if there's something really bad or unexpected going on. It's not truly independent. Irrespective of whether they look at the official report, these midlevels "interpret" these exams with the knowledge that they're being backed up.

We overread for one urgent care clinic where there is supposed to be a physician present, but there often isn't. That leaves midlevels to interpret their own radiographs until we can see them, which - due to stupid administrative decisions - can be as long as 72 hours later. That's the closest to true independent interpretation by midlevels that I'm familiar with. That, combined with their tendency to overutilized teleradiology for overnight radiograph prelims, makes me not too worried.
 
colbgw02 said:
This is a common scenario that people reference when talking about how unnecessary radiologists are, but it's not a good example (although I know that's not what you were doing). Those images are still getting looked at by a radiologist, who will pick up the phone and let someone know if there's something really bad or unexpected going on. It's not truly independent. Irrespective of whether they look at the official report, these midlevels "interpret" these exams with the knowledge that they're being backed up.

We overread for one urgent care clinic where there is supposed to be a physician present, but there often isn't. That leaves midlevels to interpret their own radiographs until we can see them, which - due to stupid administrative decisions - can be as long as 72 hours later. That's the closest to true independent interpretation by midlevels that I'm familiar with. That, combined with their tendency to overutilized teleradiology for overnight radiograph prelims, makes me not too worried.
Click to expand...
Totally agreed. I always depend on the final interpretation by the radiologist. My point was that I am not sure what the purpose of the legislation is, since mid-levels are already "interpreting" with radiology backup, and would never actually be able to "interpret and bill" for an image.
 
bronx43 said:
Totally agreed. I always depend on the final interpretation by the radiologist. My point was that I am not sure what the purpose of the legislation is, since mid-levels are already "interpreting" with radiology backup, and would never actually be able to "interpret and bill" for an image.
Click to expand...
The bill is proposing that NPs should be allowed to read and bill for there reads. 4 years undergrade, 4 years medical school, 1 years internship, 4 years residency, 1ish years fellowship before your an attending radiologist. But these politicians think that a few years of nursing school and a few years NP school they can do the same. It really is crazy. Some people are going to say I am hating on nurses and I'm not! I respect the amount of time required to be a competent radiologist.
 
NDcienporciento100 said:
The bill is proposing that NPs should be allowed to read and bill for there reads. 4 years undergrade, 4 years medical school, 1 years internship, 4 years residency, 1ish years fellowship before your an attending radiologist. But these politicians think that a few years of nursing school and a few years NP school they can do the same. It really is crazy. Some people are going to say I am hating on nurses and I'm not! I respect the amount of time required to be a competent radiologist.
Click to expand...
If that is actually what the bill is trying to pass, then they may as well add an addendum that tooth fairies should replace all dentists and storks should replace all OB/GYNs.
 
bronx43 said:
If that is actually what the bill is trying to pass, then they may as well add an addendum that tooth fairies should replace all dentists and storks should replace all OB/GYNs.
Click to expand...
Look what they have done to the field of Anesthesia. I have personally been in the OR when they insulflated the stomach the pt whent Brady asystolic and the nurse anesthetist bolted for the MD.
 
NDcienporciento100 said:
Look what they have done to the field of Anesthesia. I have personally been in the OR when they insulflated the stomach the pt whent Brady asystolic and the nurse anesthetist bolted for the MD.
Click to expand...

That's the best part of being a CRNA! Claim how awesome you are and want to be a doctor, but when **** hits the fan because you ****ed up then call the actual doctor so their license is in jeopardy and take the fall.
 
Piebaldi said:
Agreed. If there is one state where nonsense gets tackled and shot down (figuratively and at times in practice), that would be Texas. Good ol'd Texas!
Click to expand...

Tell that to the anesthesiologists. I worked at a hospital that literally had zero anesthesiologists. The entire hospital was staffed by CRNAs.
 
 
NDcienporciento100 said:
The bill is proposing that NPs should be allowed to read and bill for there reads. 4 years undergrade, 4 years medical school, 1 years internship, 4 years residency, 1ish years fellowship before your an attending radiologist. But these politicians think that a few years of nursing school and a few years NP school they can do the same. It really is crazy. Some people are going to say I am hating on nurses and I'm not! I respect the amount of time required to be a competent radiologist.
Click to expand...

The reality of the matter though I think is that most midlevels are not like this. Most stay in their lane and are respectful and know their limits. we have q
Matthew9Thirtyfive said:
Tell that to the anesthesiologists. I worked at a hospital that literally had zero anesthesiologists. The entire hospital was staffed by CRNAs.
Click to expand...

The anesthesiologists do that to themselves to a large extent. As I have posted, I went in for surgery, paid out of pocket for an anesthesiologist, and the anesthesiologist himself told me how a CRNA would be doing my case. When I said no, he asked me if there is anything he could tell me to change my mind. Seriously?
 
Piebaldi said:
The reality of the matter though I think is that most midlevels are not like this. Most stay in their lane and are respectful and know their limits. we have q


The anesthesiologists do that to themselves to a large extent. As I have posted, I went in for surgery, paid out of pocket for an anesthesiologist, and the anesthesiologist himself told me how a CRNA would be doing my case. When I said no, he asked me if there is anything he could tell me to change my mind. Seriously?
Click to expand...

Unfortunately for these scenarios it has be to coordinated ahead of time as the practice is a supervisory model. To request MD only would require scheduling to accommodate. And you wouldn't really know to do this unless you ask the surgeon as a request case.
 
Piebaldi said:
The reality of the matter though I think is that most midlevels are not like this. Most stay in their lane and are respectful and know their limits. we have q


The anesthesiologists do that to themselves to a large extent. As I have posted, I went in for surgery, paid out of pocket for an anesthesiologist, and the anesthesiologist himself told me how a CRNA would be doing my case. When I said no, he asked me if there is anything he could tell me to change my mind. Seriously?
Click to expand...

The anesthesiologists aren't the ones passing legislation that gives hospitals money for using CRNAs. I do agree that a lot of it is self inflicted though. Physicians are the ones training mid-levels, and it really boils down to the baby boomer generation being willing to completely destroy the profession for money. Not sure if gen x or millennials are any better.
 
2Fast2Des said:
Unfortunately for these scenarios it has be to coordinated ahead of time as the practice is a supervisory model. To request MD only would require scheduling to accommodate. And you wouldn't really know to do this unless you ask the surgeon as a request case.
Click to expand...

I did ask the surgeon when I booked and paid.
 
Piebaldi said:
I did ask the surgeon when I booked and paid.
Click to expand...

That's unfortunate then. Maybe there was disconnect when scheduled...? I work in an MD only group so patients will always get a doc and so they should for what is paid for. Unfortunately we all will be taken care of by probably underqualified mid levels and apathetic docs who are "supervising" them and so we will be screwed. Stay Healthy!
 
NDcienporciento100 said:
The bill is proposing that NPs should be allowed to read and bill for there reads. 4 years undergrade, 4 years medical school, 1 years internship, 4 years residency, 1ish years fellowship before your an attending radiologist. But these politicians think that a few years of nursing school and a few years NP school they can do the same. It really is crazy. Some people are going to say I am hating on nurses and I'm not! I respect the amount of time required to be a competent radiologist.
Click to expand...

Just trying to play devil's advocate: How many of those years of training helped you become a radiologist? Do radiologist need 4 years of med school and one year of internship?
 
NITRAS said:
Just trying to play devil's advocate: How many of those years of training helped you become a radiologist? Do radiologist need 4 years of med school and one year of internship?
Click to expand...
No doubt it requires all those years. Mid levels that think different "don't know what they don't know" think about that statement..... And in reference to the mid levels above that claimed that she works in a top 30 center and docs only come around for 2 hours and do research the rest of the time, I have worked in top 5 hospital and I can say without a shadow of a doubt that mid levels get bread and butter, only the straight forward cases and for you to say that mid levels do all the heavy lifting while doctors are off in some hidden room just doing research is untrue and laughable.
 
NDcienporciento100 said:
No doubt it requires all those years. Mid levels that think different "don't know what they don't know" think about that statement..... And in reference to the mid levels above that claimed that she works in a top 30 center and docs only come around for 2 hours and do research the rest of the time, I have worked in top 5 hospital and I can say without a shadow of a doubt that mid levels get bread and butter, only the straight forward cases and for you to say that mid levels do all the heavy lifting while doctors are off in some hidden room just doing research is untrue and laughable.
Click to expand...
Lol, wut? And who are you exactly? Are you a radiologist or clinician or med student or other?

So you "worked" in a top 5 hospital, and you are saying that the doctors are not mainly doing research? Lol, ok. So then what exactly are the faculty members at MGH, JHU or Stanford doing? Full time clinical duty? It's actually hilarious to even entertain this idea, since unless you have a R or K award, these places will literally shred your application.

I was a med student, resident, attending physician, and later became a fellow and consulting specialist in academia, and I'm telling you for a fact that these mid-levels at my previous institution are treating more complex cases than what is seen in your average community hospital. And I am also saying that their oversight leaves a lot to be desired.
You can huff and puff all you want, but this is reality. Also, I don't understand what your point is, because I don't actually agree with this model implemented by the leadership.
 
Last edited:
bronx43 said:
Lol, wut? And who are you exactly? Are you a radiologist or clinician or med student or other?

So you "worked" in a top 5 hospital, and you are saying that the doctors are not mainly doing research? Lol, ok. So then what exactly are the faculty members at MGH, JHU or Stanford doing? Full time clinical duty? It's actually hilarious to even entertain this idea, since unless you have a R or K award, these places will literally shred your application.

I was a med student, resident, attending physician, and later became a fellow and consulting specialist in academia, and I'm telling you for a fact that these mid-levels at my previous institution are treating more complex cases than what is seen in your average community hospital. And I am also saying that their oversight leaves a lot to be desired.
You can huff and puff all you want, but this is reality. Also, I don't understand what your point is, because I don't actually agree with this model implemented by the leadership.
Click to expand...
I'm a medical student that just matched radiology and yes I trained at a top 5 hospital and no not every doctor that works there has there own research lab and yes the midlevels get the easy cases, that is fact. Your implying that every doctor at these big names are doing major research and you could not be further from the truth. These places have over 1000 doctors, they all don't all get 30 hrs of dedication to research a week it's crazy. Yes they are doing lots of research but you make it seem like midlevels run the show and its laughable!
 
bronx43 said:
Lol, wut? And who are you exactly? Are you a radiologist or clinician or med student or other?

So you "worked" in a top 5 hospital, and you are saying that the doctors are not mainly doing research? Lol, ok. So then what exactly are the faculty members at MGH, JHU or Stanford doing? Full time clinical duty? It's actually hilarious to even entertain this idea, since unless you have a R or K award, these places will literally shred your application.

I was a med student, resident, attending physician, and later became a fellow and consulting specialist in academia, and I'm telling you for a fact that these mid-levels at my previous institution are treating more complex cases than what is seen in your average community hospital. And I am also saying that their oversight leaves a lot to be desired.
You can huff and puff all you want, but this is reality. Also, I don't understand what your point is, because I don't actually agree with this model implemented by the leadership.
Click to expand...

NDcienporciento100 said:
I'm a medical student that just matched radiology and yes I trained at a top 5 hospital and no not every doctor that works there has there own research lab and yes the midlevels get the easy cases, that is fact. Your implying that every doctor at these big names are doing major research and you could not be further from the truth. These places have over 1000 doctors, they all don't all get 30 hrs of dedication to research a week it's crazy. Yes they are doing lots of research but you make it seem like midlevels run the show and its laughable!
Click to expand...

Sorry buddy but from the med student perspective until you're actually managing the units there's more than meets the eye. Bronx is correct, these mid-levels run the show, attendings are usually non existent. This is from the top dog hospital to the community\regional hospitals. Attending oversight is minimal at best and I've seen and experienced the incompetent management that the sickest patients have to suffer at the hands of. It's truly a **** show and absolutely terrifying that medicine in this country has become this way.
 
2Fast2Des said:
Sorry buddy but from the med student perspective until you're actually managing the units there's more than meets the eye. Bronx is correct, these mid-levels run the show, attendings are usually non existent. This is from the top dog hospital to the community\regional hospitals. Attending oversight is minimal at best and I've seen and experienced the incompetent management that the sickest patients have to suffer at the hands of. It's truly a **** show and absolutely terrifying that medicine in this country has become this way.
Click to expand...
So are you saying the 1000 plus physicians from the hospitals he mentioned are all doing 30 plus hours research? Yes or no because that's what your implying?
 
2Fast2Des said:
Sorry buddy but from the med student perspective until you're actually managing the units there's more than meets the eye. Bronx is correct, these mid-levels run the show, attendings are usually non existent. This is from the top dog hospital to the community\regional hospitals. Attending oversight is minimal at best and I've seen and experienced the incompetent management that the sickest patients have to suffer at the hands of. It's truly a **** show and absolutely terrifying that medicine in this country has become this way.
Click to expand...
Raise your hand everyone last time you saw a midlevel do a bread and butter appendectomy....waiting......waiting....silence.That's because they don't.
 
NDcienporciento100 said:
I'm a medical student that just matched radiology and yes I trained at a top 5 hospital and no not every doctor that works there has there own research lab and yes the midlevels get the easy cases, that is fact. Your implying that every doctor at these big names are doing major research and you could not be further from the truth. These places have over 1000 doctors, they all don't all get 30 hrs of dedication to research a week it's crazy. Yes they are doing lots of research but you make it seem like midlevels run the show and its laughable!
Click to expand...
So a med student going into radiology is going to tell me what is happening in MICUs... lol, this place gets more amusing by the day.

You can believe or not, because it doesn't matter to me or anyone else in this world. But, the fact of the matter is that mid-levels are a huge presence and are only gaining traction in academia and the private sector alike.
 
NDcienporciento100 said:
So are you saying the 1000 plus physicians from the hospitals he mentioned are all doing 30 plus hours research? Yes or no because that's what your implying?
Click to expand...
Show me where ANYONE other than you said anything about 30 hours of research.
 
NDcienporciento100 said:
Raise your hand everyone last time you saw a midlevel do a bread and butter appendectomy....waiting......waiting....silence.That's because they don't.
Click to expand...
Lol, again, show me where ANYONE other than you said anything about mid-levels doing appendectomies.
 
bronx43 said:
Um... how about the legions of them that work pseudo-independently in academic centers? Where I trained (top 30 academic center), two of the 4 medical and neuro ICUs are almost solely staffed by midlevels during the day. The critical care attendings would come by in the mornings for two hours to round then go off and do "research." These midlevels would order chest XRs and "interpret" them in order to manage diuretic doses by themselves. They may or may not report it to the attending the following day.
I thought my institution was an anomaly until my wife started her fellowship at a top 10 academic center, and the mid-level presence was even worse.
Click to expand...
Here it is implied that they run off and do research after 2 hours clinic. If it's 8 work day then 6 hours are left for research 6 X 5days = 30 hours lol, if you believe this nonsense.
 
bronx43 said:
Lol, wut? And who are you exactly? Are you a radiologist or clinician or med student or other?

So you "worked" in a top 5 hospital, and you are saying that the doctors are not mainly doing research? Lol, ok. So then what exactly are the faculty members at MGH, JHU or Stanford doing? Full time clinical duty? It's actually hilarious to even entertain this idea, since unless you have a R or K award, these places will literally shred your application.

I was a med student, resident, attending physician, and later became a fellow and consulting specialist in academia, and I'm telling you for a fact that these mid-levels at my previous institution are treating more complex cases than what is seen in your average community hospital. And I am also saying that their oversight leaves a lot to be desired.
You can huff and puff all you want, but this is reality. Also, I don't understand what your point is, because I don't actually agree with this model implemented by the leadership.
Click to expand...
bronx43 said:
Lol, again, show me where ANYONE other than you said anything about mid-levels doing appendectomies.
Click to expand...
The post above said that midlevels get almost no oversight and if they get almost no oversight then surely there doing bread and butter appendectomys lol but there not......
 
You must log in or register to reply here.

Similar threads

Doc mu
Demo of gemini 2.0 reading a CT scan, opinions?
Replies
4
Views
2K
Cognovi
Cognovi
takanosuke
Which Imaging Pathway should I take: MRI or Cardiac Sonography?
Replies
1
Views
517
Cognovi
Cognovi
Promised_Consort
Will there be less IR independent programs in the next few years?
Replies
8
Views
1K
irwarrior
I
H
Atlas/textbook of Spine XR/MRI/CT
Replies
0
Views
610
HyperSonic
H
L
Xrays read an hour needed to make a living?
Replies
5
Views
2K
guytakingboards
G
Top