PA Radiologist Reading Spine MRI's...What's your next move?

[drusso]

A local hospital recently hired "Physician Assitant Radiologists" to help read films. I didn't know this was "a thing" until now. I just got my first over-read back on a cervical MRI by Joe Blow, PA-C (rad). I've already called admin and expressed my concern. Admin said, "They're qualified; we're using them. Medicine is a team sport, etc." Apparently, the hospital can bill for them and get paid.

What's your next move?

Radiology Physician Assistant

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[painfree23]

I mean it’s happening in every field CRNAs, surgical assistants, PAs running family med/internal med clinics. Why’s radiology immune to it?

 

[hyperalgesia]

I think my next move would be to tell every patient and every doc you can about it. If we don't tell patients about the reality of "population healthcare", they'll never know. They'll believe the politicians and media that tells them how great our society will become when all costs are borne by the state.

 

[Aether2000]

I read all my own MRIs- had the patient bring the disc with them. Pain physicians should be able to read their MRIs with a more finely tuned reading than any radiologist or certainly PA since you have the advantage of actually having a detailed pain history and physical exam. Radiologists and their PAs/Technicians cannot possibly scrutinize a MRI as well as a pain physician looking for specific pathologies, and often will gloss over fine details such as osteophytes impinging on a nerve, nerve displacement, neural edema compared to the contralateral side, etc.

 

[willabeast]

Next move is to make sure everyone with a pain/spine fellowship can read MRIs better than PARs. Unless the PARs are immune to litigation, the attorneys will then eat them alive. My fellowship (i am retired now) was poor at teaching me diagnostic spine imaging. I was basically self taught with a lot of help from NASS. Docs need to be better than that. In terms of who taught who, I had quite a bit of trouble getting the local radiologists to teach me anything useful about reading spine MRI. Defending their turf methinks. PARs may be their turf!

 

[Ducttape]

Talk with your pen. Send a neutral letter to the hospital stating you do not agree with the PA reading your report and the medical liability you have to assume. Then let the hospital know that, until further notice, unfortunately you will be sending your referrals to other MRI suites.

I wouldn’t involve patients until they ask/are affected by it.

 

[painfree23]

How do you you get good at reading your own MRIs? Suggestions?

 

[willabeast]

Talk with your pen. Send a neutral letter to the hospital stating you do not agree with the PA reading your report and the medical liability you have to assume. Then let the hospital know that, until further notice, unfortunately you will be sending your referrals to other MRI suites.

I wouldn’t involve patients until they ask/are affected by it.

Be careful here. Referrals are a 2 way street.

 

[willabeast]

How do you you get good at reading your own MRIs? Suggestions?

NASS has some excellent CME spine DX imaging tutorials that are excellent. Do them a few times and you will be better than most. Totally worth it. Product Details Product Details

try to get into some weekly imaging conferences. might have to travel if you are in a small town. best ones have a mix of spine surgeons and radiologists. get CME so maybe can deduct travel expenses.?

 

[DODOCSS]

How do you you get good at reading your own MRIs? Suggestions?

if you don't know the answer to your question.

 

[Piebaldi]

Next move is to make sure everyone with a pain/spine fellowship can read MRIs better than PARs. Unless the PARs are immune to litigation, the attorneys will then eat them alive. My fellowship (i am retired now) was poor at teaching me diagnostic spine imaging. I was basically self taught with a lot of help from NASS. Docs need to be better than that. In terms of who taught who, I had quite a bit of trouble getting the local radiologists to teach me anything useful about reading spine MRI. Defending their turf methinks. PARs may be their turf!

I almost want to jump on the lawyer bandwagon and help them find unqualified midlevels to help sue! Ha!

 

[maxxor]

This is actually a red line for the ACR. I’d be very interested in knowing where PAs are interpreting imaging and issuing reports. PM sent.

 

[SSdoc33]

Whoa....

This is not good. What bothers me is that the tumor which will invariably get missed and the underlying liability. Docs have deeperr pockets than PAs. Will the pain doc who also doesnt see the endometrial tumor be on the hook now? Are the radiology PAs independent, or are there actual radiologists that will be sued for missing a mass, etc?

 

[Aether2000]

The hospital (and radiology group) don't give a flip about your protests. The best way to ensure quality and not turn yourself into a pariah in the hospital is to simply move your scans to another hospital. Give patients a list of your preferred radiology centers and hospitals and let the patient chose one of those.

 

[maxxor]

The hospital (and radiology group) don't give a flip about your protests. The best way to ensure quality and not turn yourself into a pariah in the hospital is to simply move your scans to another hospital. Give patients a list of your preferred radiology centers and hospitals and let the patient chose one of those.

As a radiologist, I care very much about keeping my referrers happy. It's absurd to hear midlevels are dictating cases.

 

[Keona]

While I’m a pcp I’m typically the one ordering the first mri. I would tell me patients if they chose that imaging location who is reading them and they’d mostly all pick elsewhere. Radiologists have given me several imaging diagnoses that I would have never thought of and had never heard of. I don’t see a PA acquiring that same breadth of knowledge.

 

[Aether2000]

Maxxor, I fear you are in the minority. It is just corporate medicine gone nuts. Why even bother having a PA when a MA with 2 years training in assisting in a physician's office could be trained and for a lot less money?

 

[hyperalgesia]

As a radiologist, I care very much about keeping my referrers happy. It's absurd to hear midlevels are dictating cases.

I believe it was @drusso who posted an example a few weeks ago of a "chiropractic radiologist" reading MRIs and presumably billing for reports. Incredible.

 

[deleted993114]

A local hospital recently hired "Physician Assitant Radiologists" to help read films. I didn't know this was "a thing" until now. I just got my first over-read back on a cervical MRI by Joe Blow, PA-C (rad). I've already called admin and expressed my concern. Admin said, "They're qualified; we're using them. Medicine is a team sport, etc." Apparently, the hospital can bill for them and get paid.

What's your next move?

Radiology Physician Assistant

Radiology Physician Assistant

onlinephysicianassistantprograms.net

Contact your state board.

However, do you really trust even the radiologist reads of your MRIs and CTs? In many instances (as they do not have an accurate history), their readings are usually flawed, as they miss the forest for the trees. How many times have you found far lateral discs that explain the patient's symptoms perfectly, while a two paragraph radiology report is focusing on all the other irrelevant findings?

And when radiologists describe stenosis, how many actually state the canal dimensions in mm or instead use "mild", "moderate", or "severe", which is arbitrary and in most instances tells you nothing?

Worse yet, the guys who will put ridiculous "readings" like "possible discitis" in the report when there are just Modic III degenerative changes that they simply won't call? It causes more harm than good, as one is medico-legally forced to order additional testing, simply because an incorrect read is put on the record in the first place.

I just look at the report afterward to see if there is anything they can add, and that is usually pretty rare.

Radiologists are going to be replaced first by contract docs overseas and then artificial intelligence. AI will make that whole specialty irrelevant in 20 years.

 

[SSdoc33]

Contact your state board.

However, do you really trust even the radiologist reads of your MRIs and CTs? In many instances (as they do not have an accurate history), their readings are usually flawed, as they miss the forest for the trees. How many times have you found far lateral discs that explain the patient's symptoms perfectly, while a two paragraph radiology report is focusing on all the other irrelevant findings?

And when radiologists describe stenosis, how many actually state the canal dimensions in mm or instead use "mild", "moderate", or "severe", which is arbitrary and in most instances tells you nothing?

Worse yet, the guys who will put ridiculous "readings" like "possible discitis" in the report when there are just Modic III degenerative changes that they simply won't call? It causes more harm than good, as one is medico-legally forced to order additional testing, simply because an incorrect read is put on the record in the first place.

I just look at the report afterward to see if there is anything they can add, and that is usually pretty rare.

Radiologists are going to be replaced first by contract docs overseas and then artificial intelligence. AI will make that whole specialty irrelevant in 20 years.

it is the extra-spinal stuff that i am worried about. i agree about your points within the spine

 

[lonelobo]

if you don't know the answer to your question, perhaps lone commie will spoon feed you for free

As usual your posts are about as helpful as a stick in the eye

 

[deleted993114]

it is the extra-spinal stuff that i am worried about. i agree about your points within the spine

yes- I see your point. I was only trained in reading MRI and CTs of the spine, hips and shoulders, and brain. I really suck at reading abdominal and chest CTs and would really need someone competent to read those.

I guess it is their legal risk- It's always funny until someone loses an eye- these ancillary providers make a ton of mistakes and a thirsty legal community is there to see that some pay for those mistakes. I would not want to sit before a jury not being board certified, let alone not a physician at all, if there was a complication.

I know you want quality reads for your patients, but it sounds like it is beyond your control. A few suits may change their minds.

 

[Jamiu22]

Contact your state board.

However, do you really trust even the radiologist reads of your MRIs and CTs? In many instances (as they do not have an accurate history), their readings are usually flawed, as they miss the forest for the trees. How many times have you found far lateral discs that explain the patient's symptoms perfectly, while a two paragraph radiology report is focusing on all the other irrelevant findings?

And when radiologists describe stenosis, how many actually state the canal dimensions in mm or instead use "mild", "moderate", or "severe", which is arbitrary and in most instances tells you nothing?

Worse yet, the guys who will put ridiculous "readings" like "possible discitis" in the report when there are just Modic III degenerative changes that they simply won't call? It causes more harm than good, as one is medico-legally forced to order additional testing, simply because an incorrect read is put on the record in the first place.

I just look at the report afterward to see if there is anything they can add, and that is usually pretty rare.

Radiologists are going to be replaced first by contract docs overseas and then artificial intelligence. AI will make that whole specialty irrelevant in 20 years.

This post smacks of a teeny bit of arrogance; learn to keep it in check, as medicine is a very humbling field.

As a radiologist, I'm a big proponent of referring providers reviewing images on their patients, because it is better patient care. It also makes the referring providers better at reading/understanding what is in our reports. You have a better vantage point, as the patient is right in front of you. Also, providing your consulting radiologist better indications/relevant history would also help them differentiate forest from the trees. I'm sure you would agree that "pain" in a terrible indication.

Of course there are some bad doctors (radiologist, surgeons, fam meds, psychs) out there - I personally don't think they are the norm.

Sorry for derailing the post! I don't think PAs should be putting in final reads on any radiology studies because your breath of knowledge matters, and without medical school and 6yrs residency/fellowship, I just see how you can get that breath of knowledge.

As to whether AI will replace radiologists in 20yrs, I call straight-bull-**** - you just don't know what you are talking about.

 

[lonelobo]

As to whether AI will replace radiologists in 20yrs, I call straight-bull-**** - you just don't know what you are talking about.

I would be willing to bet Radiology will drastically change in next 10 to 20 years especially when greedy ass doctors start replacing younger group members for less cost with AI technology..Why are you so sure this won't happen?

 

[Jamiu22]

I would be willing to bet Radiology will drastically change in next 10 to 20 years especially when greedy ass doctors start replacing younger group members for less coast..Why are you so sure this won't happen?

Yes, definitely every field will change in the next 20 yrs; the development in AI will continue and it will likely be better for patients at some time in the future. But as someone with multiple engineering degrees with some background in software development, I'm just a tab bit more in realistic w.r.t. how long it takes for perfection and adoption of new technologies. When it comes to health-care, it takes even longer to prove efficacy and safety.

Deep learning and neural network are the shiny new things we often hear about, however they are not proven with complex tax (yet). As they catch up with current imaging technologies, the imaging technologies themselves also improve, while also becoming more complex. It will eventually get there, but I seriously I doubt within 20yrs for full developemt/deployment to complete adoption i.e. to significantly impact the radiology job market!

 

[deleted993114]

This post smacks of a teeny bit of arrogance; learn to keep it in check, as medicine is a very humbling field.

As a radiologist, I'm a big proponent of referring providers reviewing images on their patients, because it is better patient care. It also makes the referring providers better at reading/understanding what is in our reports. You have a better vantage point, as the patient is right in front of you. Also, providing your consulting radiologist better indications/relevant history would also help them differentiate forest from the trees. I'm sure you would agree that "pain" in a terrible indication.

Of course there are some bad doctors (radiologist, surgeons, fam meds, psychs) out there - I personally don't think they are the norm.

Sorry for derailing the post! I don't think PAs should be putting in final reads on any radiology studies because your breath of knowledge matters, and without medical school and 6yrs residency/fellowship, I just see how you can get that breath of knowledge.

As to whether AI will replace radiologists in 20yrs, I call straight-bull-**** - you just don't know what you are talking about.

Sorry- I would agree that my post was arrogant. I have had my ass kicked periodically in medicine and agree that practicing can be humbling at times.

When I send someone for imaging, I ALWAYS state specifically the clinical reason for the imaging so that the radiologist can focus on a particular area that correlates with the patient's clinical symptoms.

As an engineer, I am sure that you have a far better perspective on the potential of AI to replace a good deal of radiology readings. So it is your perspective that AI is a long way from being implemented in reading films? Do you think that eventually this technology will replace reading many films?

In an era in which we can expect technology to improve with a greater role of "automated" interpretation of imaging, what do you see as the role of radiologists? Do you feel as though the role of radiology will be diminished as a result?

 

[katzen]

Contact your state board.

However, do you really trust even the radiologist reads of your MRIs and CTs? In many instances (as they do not have an accurate history), their readings are usually flawed, as they miss the forest for the trees. How many times have you found far lateral discs that explain the patient's symptoms perfectly, while a two paragraph radiology report is focusing on all the other irrelevant findings?

And when radiologists describe stenosis, how many actually state the canal dimensions in mm or instead use "mild", "moderate", or "severe", which is arbitrary and in most instances tells you nothing?

Worse yet, the guys who will put ridiculous "readings" like "possible discitis" in the report when there are just Modic III degenerative changes that they simply won't call? It causes more harm than good, as one is medico-legally forced to order additional testing, simply because an incorrect read is put on the record in the first place.

I just look at the report afterward to see if there is anything they can add, and that is usually pretty rare.

Radiologists are going to be replaced first by contract docs overseas and then artificial intelligence. AI will make that whole specialty irrelevant in 20 years.

Or “minimal” vs “no significant.” Yes, an actual measurement would be great.

 

[maxxor]

Or “minimal” vs “no significant.” Yes, an actual measurement would be great.

As someone who reads a fair amount of spine, what exact measurement of the canal would you like? Entire canal space including cord if any?

 

[deleted993114]

As someone who reads a fair amount of spine, what exact measurement of the canal would you like? Entire canal space including cord if any?

I think that one thing that is helpful is that when there is lumbar, or particularly cervical stenosis, documentation of the canal diameter at the affect level transmits very clearly the severity of stenosis to everyone involved. Severe, moderate, and mild appear to be subjective and does not really tell much.

A specific measurement is clear and transmits the same message to everyone.

I have encountered several radiologists who have done this, and I have expressed my appreciation to them. Of course, with cervical stenosis we look for upper and lower extremity symptoms, myelomalacia, hyper-refelxia, and a postivie Hoffman's sign to add additional information for those who are surgical candidates and who are not,

Again- apologizies, as I was a little snotty in my first post.

 

[callmeanesthesia]

As someone who reads a fair amount of spine, what exact measurement of the canal would you like? Entire canal space including cord if any?

Canal diameter including cord and CSF, not including the epidural fat. I’ve seen several reads noted as no stenosis where the patients have lipomatosis and the actual space left for the nerves is only 6-8 mm. fwiw I always put clinical info in the reason for exam. I would never be comfortable with a PA providing a read - might as well just take a weekend correspondence course and do it myself.

 

[clubdeac]

Radiology PAs in my area are doing most of the simple interventional radiology procedures including US and CT guided procedures such as chest tubes, central lines, LPs, epidurals, biopsies, drains etc. it’s unbelievable and maddening!!