PA in Radiology?

[Fedfan1]

Would you ever see a PA in Radiology? If you would, what exactly would they do?

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[Pontifex Maximus]

I doubt it. Maybe in IR helping the attending, but there's really no need or place for a PA in the reading room.

 

[gluon999]

I doubt it. Maybe in IR helping the attending, but there's really no need or place for a PA in the reading room.

I have seen PAs in both IR and the reading room. They can do anything the doctor wants them to do (under supervision ofcourse). However, they do not give final reads.

 

[Pontifex Maximus]

Really? huh. Wouldn't have imagined that. What are they typically doing?

 

[penguin24]

PA's could help IR round on patients in the hospital. Or when a service consults IR, the PA can do the initial H&P, then the IR can do the actual procedure. I've seen it done

I really don't see how a PA can work into DxRads, as there really isn't much patient-care.

 

[Pontifex Maximus]

I really don't see how a PA can work into DxRads, as there really isn't much patient-care.

yeah, that's where I lost it. Are they just performing a resident-esque role and dictating?

 

[gluon999]

Really? huh. Wouldn't have imagined that. What are they typically doing?

They act just like residents. They read out with the attending before dictating reports.

 

[eddieberetta]

They act just like residents. They read out with the attending before dictating reports.

I believe the role will be limited. There is certainly potentially a role for the PAs in IR clinics and wards (in departments that admit to IR). But this is more of a traditional clinical PA role, dealing with simple medical issues on wards, seeing patients in the clinic and other routine medical tasks like the traditional PA model, not really radiology-specific and would obviously be quite limited.

There was some initial enthusiasm for using them in gastric procedures but as we all know, the volume of these has dropped significantly, in addition many groups have simply trained their regular RTs to do these. In interventional, only a few types of procedures are appropriate for delegation (i.e. thoras, paras MAYBE simple bx) and the radiologist has to be nearby in case there is a problem These are quick procedures anyway we can whip off between cases. And somehow even here it often doesn't feel right to delegate as many of these can be done without imaging, presumably the clinician sent them to us in radiology because of technical difficulty, coagulopathy etc, so it seems unreasonable to then go and delegate these cases to someone less trained that the referring MD! And PICCs are already done by regular techs and RNs.

What abut interpretation? Well this has been discussed at high levels in the radiology community and the bottom line is that in North America there is NO WAY radiologists will be delegating image interpretaiton to mid-levels. Sure, you could have several PAs working as residents and dictating or transcribing reports with VR, but unlike residents, the PAs will not be doing independent call. Since they also will not "graduate" into BC radiologists, there is actually little real benefit over, say, a secretary. (Plus when you and a resident miss something, you can blame the resident, and still have some credibility with other doctors 😀)

So while I see potential in a few select areas I do not anticipate a significant role. To me this is borne out by the fact that while there has been much talk over the past 5-10 y about PAs in radiology we come across very, very few!

 

[Taurus]

Here's a case where a radiologist allowed RPA's to do interpretation and then basically signed off on the reports without reviewing them. Of course, the doc was caught because the RPA's made mistakes and people became suspicious.

http://www.dotmed.com/news/story/10737/

I think this case made radiologists more cautious about allowing midlevels to read film. Radiologists are very sensitive about ceding turf. They already saw it with the cardiologists. They also see it with the NP's in general medicine.

 

[gluon999]

Here's a case where a radiologist allowed RPA's to do interpretation and then basically signed off on the reports without reviewing them. Of course, the doc was caught because the RPA's made mistakes and people became suspicious.

http://www.dotmed.com/news/story/10737/

I think this case made radiologists more cautious about allowing midlevels to read film. Radiologists are very sensitive about ceding turf. They already saw it with the cardiologists. They also see it with the NP's in general medicine.

That rad was quite simply very greedy and stupid. He deserves what is coming to him.

Frankly, I was a bit surprised too when I saw the PAs in action in the reading room. But the Rads were on the ball in thoroughly going over the scan with them. So the only time that the Rad saved was the time it takes to dictate. Nonetheless, he still has to review the PA report to verify it. Don't see how the Rad saves a lot of time with this setup but it is still in play.

 

[Taurus]

Radiology is very different than primary care. Pictures last forever and if you make a mistake lawyers can always go back and see if you missed something. Also, radiology requires a lot of book knowledge and there are so many little subtleties in the images. Anybody can see the fracture but you can miss the pneumothorax if you don't know what you're doing. This is ultimately how that doc got caught using the RPA's. There are big differences in the quality and accuracy of the reports when done by midlevel, even those specifically trained for radiology like RPA's are. Midlevels can do primary care because most of the time the patient doesn't have something life-threatening. Even if the patient is unstable, you send them off to the ED or specialist. (I won't go into discussion about the quality of care given by physicians vs. NP's in primary care here.) In radiology, you are "it" and you better know what you're doing.