Once we train these individuals to operate, they will eventually gain independant practice rights, and then there's no reason why the clinicians need you at all.
More importantly, we are the imaging experts, and need to maintain as much control over imaging as possible. GI doesn't train surgeons to do ERCP's and EGD's, nor does Cardiology train other physicians to do caths.
Why on earth should we train people to supplant us, knowing that in the future, with just a little change of legislation, those same individuals could be getting hired by the GI docs and cardiologists.
I have considered these scenarios before and your points are duly taken. Perhaps I am being overly optimistic and blinded. We have RA/RPAs with us who have been a godsend for our IR dept. Not enough IR staff (a lot have gone to PP over the years) and were it not for them, the IR fellow would be doing a whole hell of a lot of PICCS and less interesting cases. The RA/RPAs we have were trained on our tab. We absolutely love them. THESE guys are loyal and have been with our department for 20+ years... But what is to say the young RAs/RPAs won't strike out on they're own. Every one is entitled to pursue what is in their best interest. Nuc med techs have already jumped ship to work for cardiologists (No call, better hours!)
Now as far as nonradiologists using RPA's to read studies and rubber stamp their work...
If they wanted to do this, why would they even need the RPA (apparently they make >2x what a regular rad tech makes) when they could just hire a regular tech to do the study and dictate it themselves? Besides no good orthopod or neurosurgeon will operate without seeing the MR for themselves. As far as a/v fistula work, its not always easy. I think you'd still need IRs to do them. I don't think nephrons could bail out an RPA if they ran into trouble.
Now if we lost the PICC work, barium, and even if we lost mammo (low pay, high risk), some rads I know would be celebrating (its all lower RVU). It
would be a loss to lose the higher end, more interesting advanced neuro and MSK imaging and MRA.
It would be nice to have some sort of medical professional to hold pressure on groin sticks, take the sheaths out of a/v fistulas, pull tubes, g-tube checks, PICCs, etc. You don't have to be a radiologist to do these things. In fact an indentured serv... I mean med student would be ideal (free!), but an RPA would be a cost effective (ok not cheaper than a 40K resident or 60K fellow) alternative.
Perhaps training rads midlevels is not the most prudent thing for the future of radiologists... I haven't heard of them threatening radiologists elsewhere, but then again, they haven't been around long enough.
I think the cat's been let out of the bag, RAs/RPAs are here to stay. What do propose should happen? That they be shut down? How? And worsen the rift between techs and radiologists?
Interesting point you make about other specialties not training outsiders. There is a curious and disturbing tradition of training our competitors in rads. Radiologists developed echo, cardiac cath, cardiac nucs and gave it lock, stock and barrel to cards. We currently accept cards fellows into our cardiac imaging fellowships. And Neurologists and neurosurgeons into our INR fellowships.
Radiologists did
most of the pioneering work in peripheral vascular interventions (OK, a few vascular surgeons like Gruentzig were there too.) At places like UCSF where IRs trained vascular surgeons in endovascular -- look what's happened! I think eventually cardiology will likely take it from VS like candy from a baby
at gunpoint.
As far as IR goes, hopefully with a more clinical model of practice we can reclaim a bit of lost territory (wishful thinking?) and hang on to the newest batch of innovations- the onc work...