PAs doing interventional radiology

[clubdeac]

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Are you guys now delegating all your CT guided solid organ biopsies, abscess drains, chest tubes, LPs, -centesis and central lines to PAs?? A large radiology group in my town is having their PAs do all these which seems absurd and scary. I'm not IR so interested in others thoughts on this

 

[NDcienporciento100]

Are you guys now delegating all your CT guided solid organ biopsies, abscess drains, chest tubes, LPs, -centesis and central lines to PAs?? A large radiology group in my town is having their PAs do all these which seems absurd and scary. I'm not IR so interested in others thoughts on this

Why does it seem absurd?

 

[deleted950463]

Why does it seem absurd?

Because it’s the majority (over 70%) of a typical IR’s work?

 

[clubdeac]

Why does it seem absurd?

Because this is the purview of a radiologist, not a PA. It is outside their scope no?

 

[Aurum]

The scope of practice of a mid-level depends on how much an attending is willing to cede and sign off on. At my shop (large academic center), the ultrasound guided procedures (thora, para, biopsy) are nearly entirely performed by midlevels with minimal attending supervision.

 

[clubdeac]

The scope of practice of a mid-level depends on how much an attending is willing to cede and sign off on. At my shop (large academic center), the ultrasound guided procedures (thora, para, biopsy) are nearly entirely performed by midlevels with minimal attending supervision.

A shop sounds right. Why'd you go to med school and then do another four years of a radiology residency when virtually anything you do can be done by a PA with on the job training at a fraction of the cost? To summarize your previous statement, radiologists are dispensable expensive commodities that once admin realizes can be replaced by much cheaper alternatives. This has caused major repercussions in other fields of medicine.

15 Docs Fired From Illinois Health System to Be Replaced With NPs

A leaked internal memo says they will be replaced with advanced practice nurses as 'patients have made it very clear that they want less costly care and convenient access for lower-acuity issues.'

www.medscape.com

 

[maxxor]

Why does it seem absurd?

Because you won’t be able to find a job once you finish training.

The midlevels won’t stop at the procedures the IR guys now consider beneath them.

 

[deleted950463]

The scope of practice of a mid-level depends on how much an attending is willing to cede and sign off on. At my shop (large academic center), the ultrasound guided procedures (thora, para, biopsy) are nearly entirely performed by midlevels with minimal attending supervision.

At my shop we train them to work up patients and consent. They are also trained to perform para only.

Can’t imagine IRs who are too uppity to place a needle or do a line.

 

[maxxor]

At my shop we train them to work up patients and consent. They are also trained to perform para only.

Can’t imagine IRs who are too uppity to place a needle or do a line.

Sounds like you use them as assistants.

Somewhere along the line, physicians (boomers) realized they could hire midlevels instead of partners. It's like every field decided they wanted to adopt the Anesthesia model. The incredibly stupid part for Radiology is that once you teach a non-radiologist an image guided procedure, it's gone from you forever. These IR midlevels will eventually leave and be employed by their surgeon referrers. Then they'll be really screwed.

 

[Dave1980]

It's a great model until the midlevel makes a really bad mistake and you are the radiologist "supervising" them from the reading room. I've seen at least one death and subsequent lawsuit due to the PA really f*cking something up. The rad got sued and refused to be the "supervising" doctor for any more midlevels.

 

[Cognovi]

In some places, scanning ultrasound is the purview of the radiologist. In the US, we decided somewhere along the way that it is okay to have an ultrasonographer do the scanning in the vast majority of situations. I think this is a good model to think through the hypotheticals of midlevels and 'radiology extenders' in other areas of radiology.
-how do we maintain our skills in this setting
-how do we train the next generation on these skills
-how much time does it save us
-how much money does it make us after accounting for nonradiologist pay
-do we lose desirable aspects of the job such as patient contact
-does the quality of our service suffer

 

[GoPelicans]

In some places, scanning ultrasound is the purview of the radiologist. In the US, we decided somewhere along the way that it is okay to have an ultrasonographer do the scanning in the vast majority of situations. I think this is a good model to think through the hypotheticals of midlevels and 'radiology extenders' in other areas of radiology.

I'm an R1 and I really wish we had exposure to this. Older attendings go into the room with the tech all the time and troubleshoot a difficult scan because doing the scans was part of their training. I will never have this expertise. In a one month US rotation I did exactly zero scans myself.

 

[maxxor]

In some places, scanning ultrasound is the purview of the radiologist. In the US, we decided somewhere along the way that it is okay to have an ultrasonographer do the scanning in the vast majority of situations. I think this is a good model to think through the hypotheticals of midlevels and 'radiology extenders' in other areas of radiology.
-how do we maintain our skills in this setting
-how do we train the next generation on these skills
-how much time does it save us
-how much money does it make us after accounting for nonradiologist pay
-do we lose desirable aspects of the job such as patient contact
-does the quality of our service suffer

The biggest difference between this and pushing things off to midlevels is that well run places use sonographers to get standardized views from a scripted protocol.

When CT and MR started, they also had attendings at the consoles deciding what to do in real time, and then we delegated operation of the machines to technologists after standardized protocols were created.

However, the core competency of the radiologist was the interpretation. Similarly, the core competency of the IR is the performance of an image guided intervention. And to some extent evaluation of if one is needed, but really, that is also done by your referrers. By delegating their core competency to a mid level, they are essentially saying “i am not needed to fulfill my core competency”.

Referrers (and other physicians) will take note. It’s the same phenomena with disrespect of anesthesia. If you aren’t needed in the rooms, why exactly do we need you when a CRNA will do? (Yes I know why anesthesiologists are essential, but it’s the same logical path).

 

[Clean7795]

Ultimately the only way this will change is if more DRs pick up the needle to do these procedures. At some places IR case load is too high to handle these procedures, which any DR should be able to do.

The midlevel issue is one that is prevalent throughout all of medicine.

 

[ZJz4]

So long term, are you considered about scope of practice impacting IR? Or mostly just see NPs/PAs just doing the bread and butter when IR doesn't have time to do them

 

[IRattending2021]

So long term, are you considered about scope of practice impacting IR? Or mostly just see NPs/PAs just doing the bread and butter when IR doesn't have time to do them

most places are not training PA to do interventions. My buddy went to a residency in east coast where they were aggressively training PA. She had caused multiple significant complications (like drain in bowel, central line mishaps, etc) while the time she was being trained.

it’s unacceptable.