Rise of Radiologist Assistants

[salmonella]

Is there anyone concerned about the rise of radiologist assistants? Are they going to take jobs away from radiologists, kind of like what CRNAs did to anesthesiologists?

http://www.healthpronet.org/ahp_month/06_06.html

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[MacGyver]

Is there anyone concerned about the rise of radiologist assistants? Are they going to take jobs away from radiologists, kind of like what CRNAs did to anesthesiologists?

http://www.healthpronet.org/ahp_month/06_06.html

Depends. Can RAs use the same ridiculous "we dont practice medicine, we practice _______" argument that the nurses have used to write their own scope of practice?

Thats the real question.

 

[hans19]

Is there anyone concerned about the rise of radiologist assistants? Are they going to take jobs away from radiologists, kind of like what CRNAs did to anesthesiologists?

http://www.healthpronet.org/ahp_month/06_06.html

If you understand the nature of radiology training and if you understand the nature of the current legal environment, you have your answer.

If you think an RA will be reading MRIs for orthopods and neurosurgeons, then you have a lot to learn. There is a very high quality of interpretation expected from subspecialists clinicians, many times they aren't satisfied a read from a general radiologist. Most demand reads from MSK or Neuro fellowship trained radiologists.

Currently, at my institution the RAs are employed to handle the typically lower RVU IR procedures such as PICC lines and G tube checks, so that the interventionalist can focus his/her time on the higher RVU or more complicated procedures such as Chemoembo, RFA, PCN's, Caval filter placements, foreign body retrievals. They do no interpretations. Not even a CXR for pneumothorax.

If you have been keeping up with radiology, or at least doing a little bit of research, you would know that the two biggest threats to radiology are much closer to home. First, it is encroachment from nonradiologist physicians. IE Neurologists wanting to bill for their own reads. Cardiologists reading CTA and cardiac nuclear medicine and doing peripheral interventions.

Secondly it is Capitol Hill's draconian measures to contain health care expenditures due to logarithmic increase in imaging. Most of this has been attributed to self-referral of imaging by nonradiologists, namely cardiology. The solution has been not to enforce the current anti-self referral Stark II laws, or to close the loopholes therein. Rather, the powers-that-be have taken the easy way out and have decided to slash reimbursement across the board. HMOs and insurance companies will follow suit.

For the umpteenth time...
The threat to radiology is NOT RAs.
The threat to radiology is NOT foreign outsourcing.

The sky is not falling. Despite declining reimbursements and turf wars, radiology will continue to innovate and remain at the forefront of modern medicine. Radiology will endure.

 

[f_w]

I have to disagree here.

RAs might not be a factor to the detriment of radiology at this time, but they will become one in the future. Every midlevel profession known to mankind decided at some point that they can do the job of the 'supervising' medical specialty better than the respective specialist himself. It is only a question of time until the RA racket has matured enough for some of the more zealous members of their group to seek A. interpretation priviledges B. direct reimbursement from medicare.

Some radiology practices already use RAs to interpret the 'low RVU, low complexity' stuff like plain radiographs, bone-Ds and carotid ultrasounds. The rads just signs the reports. It is a slippery slope and in no time the ARRS will claim that based on these examples RAs can safely do interpretation work. From there to independent practice and direct reimbursement is only a small step. I believe that the ACR has done the profession a huge disservice by endorsing the RA business. In addition to the key challenges of self-referral and budget cuts, this will be another nail in the coffin of our specialty. 20 years from now, smaller hospitals will be covered by teams of hospital employed RAs who might send some of the more complex MRI work to corporate teleradiology ****** and keep the cheap and cheerful stuff (body CT, head CT) within their own group. The hospitals will be happy because they can bill global and don't have to deal with those pesky radiologists.

 

[MacGyver]

I have to disagree here.

RAs might not be a factor to the detriment of radiology at this time, but they will become one in the future. Every midlevel profession known to mankind decided at some point that they can do the job of the 'supervising' medical specialty better than the respective specialist himself. It is only a question of time until the RA racket has matured enough for some of the more zealous members of their group to seek A. interpretation priviledges B. direct reimbursement from medicare.

Some radiology practices already use RAs to interpret the 'low RVU, low complexity' stuff like plain radiographs, bone-Ds and carotid ultrasounds. The rads just signs the reports. It is a slippery slope and in no time the ARRS will claim that based on these examples RAs can safely do interpretation work. From there to independent practice and direct reimbursement is only a small step. I believe that the ACR has done the profession a huge disservice by endorsing the RA business. In addition to the key challenges of self-referral and budget cuts, this will be another nail in the coffin of our specialty. 20 years from now, smaller hospitals will be covered by teams of hospital employed RAs who might send some of the more complex MRI work to corporate teleradiology ****** and keep the cheap and cheerful stuff (body CT, head CT) within their own group. The hospitals will be happy because they can bill global and don't have to deal with those pesky radiologists.

I agree with you in general, but I think the pathway is a little different:

Step 1: RAs come into existence. Rads docs uneasy with them, dont know how to use them, they remain largely irrelevant.

Step 2: $$$$ Rads docs figure they can make a HUGE amount of money by having these RAs interpret stuff for them. For now, just really basic stuff thats not hard to read at all.

Step 3: Mo $$$$$ Faced with Medicare cutbacks, rads docs figure they can make up for the loss in revenue by sourcing more of their work to RAs. First it was just routine CXRs on healthy people. Now its complex MRIs for complex medical patients with many different chronic diseases

Step 4: Mo $$$$$. Instead of reviewing quickly every film that the RA reads, the rads docs make a calculated gamble that only X% of films actually need to be confirmed by a real radiologist.

Step 5: Years pass by. Rads docs roll in the money generated by their RAs.

Step 6: After several years of collecting data, the RAs are ready. They propose a bill in State X changing their status to full readers with no rads doc supervision necessary. Radiologists come out of the woodwork to fight it, but their arguments fall on deaf ears. Senators claim "You already let RAs work independently reading the most complex films with very little film review, we see no reason to let these arbitrary and needless supervision rules stand. RAs being able to read films will save this government a ton of money on health costs"

Step 7: Slowly but surely, the other states follow in STate X's direction. After all, if it works in one state, why wont it work in another?

 

[salmonella]

That's how they look at pap smears now: pathology assistants do the initial screen and only show the pathologist suspicious/abnormal slides. That will be very cost effective, and government totally allows that to happen. In the future, radiology may operate that way as well?

 

[yaah]

That's how they look at pap smears now: pathology assistants do the initial screen and only show the pathologist suspicious/abnormal slides. That will be very cost effective, and government totally allows that to happen. In the future, radiology may operate that way as well?

That's been happening for many, many years in pathology. Pathology assistants don't do it - cytotechnologists do it - it's actually a separate training program (a graduate type program). Pathology assistants now do some work that residents formerly did, freeing residents from some of the mundane stuff we would have to do so we can learn more.

 

[f_w]

I agree with you in general, but I think the pathway is a little different:

Step 1: RAs come into existence. Rads docs uneasy with them, dont know how to use them, they remain largely irrelevant.

Step 2: $$$$ Rads docs figure they can make a HUGE amount of money by having these RAs interpret stuff for them. For now, just really basic stuff thats not hard to read at all.

Step 3: Mo $$$$$ Faced with Medicare cutbacks, rads docs figure they can make up for the loss in revenue by sourcing more of their work to RAs. First it was just routine CXRs on healthy people. Now its complex MRIs for complex medical patients with many different chronic diseases

Step 4: Mo $$$$$. Instead of reviewing quickly every film that the RA reads, the rads docs make a calculated gamble that only X% of films actually need to be confirmed by a real radiologist.

Step 5: Years pass by. Rads docs roll in the money generated by their RAs.

Step 6: After several years of collecting data, the RAs are ready. They propose a bill in State X changing their status to full readers with no rads doc supervision necessary. Radiologists come out of the woodwork to fight it, but their arguments fall on deaf ears. Senators claim "You already let RAs work independently reading the most complex films with very little film review, we see no reason to let these arbitrary and needless supervision rules stand. RAs being able to read films will save this government a ton of money on health costs"

Step 7: Slowly but surely, the other states follow in STate X's direction. After all, if it works in one state, why wont it work in another?

Today will stand as a sad day: The day I had to agree with McGyver and disagree with hans19.

Unfortunately we are already between steps 2 and 3 of your '7 steps to doom' plan. I don't think it will play out quite as smooth as it worked for the PA racket, but the day will come soon that 'CBRPA vs. Associated Radiologists Inc' will be decided by some state supreme court in favor of the RPA racket. 'greedy radiologists' will be forced to 'allow RPAs to provide services for the needy underserved of our state' and other nauseating crap will be all over the papers.

P.S.
State X will be Oklahoma.

 

[Taurus]

Today will stand as a sad day: The day I had to agree with McGyver and disagree with hans19.

Unfortunately we are already between steps 2 and 3 of your '7 steps to doom' plan. I don't think it will play out quite as smooth as it worked for the PA racket, but the day will come soon that 'CBRPA vs. Associated Radiologists Inc' will be decided by some state supreme court in favor of the RPA racket. 'greedy radiologists' will be forced to 'allow RPAs to provide services for the needy underserved of our state' and other nauseating crap will be all over the papers.

P.S.
State X will be Oklahoma.

Sad. Sounds like a redux of the CRNA vs. anesthiologists theme. The oldtimers are selling out future generations of radiologists to make a quick buck today. Best way to compete is to move up the food chain and keep on specializing.

 

[hans19]

http://www.asrt.org/media/pdf/governance/2007HODPositionStatements.pdf

This is no different than what ultrasound techs are doing NOW at many institutions. They scan and decide if a study is adequate, long before we have the time to look at and dictate it.

Nowhere does it say the scope includes primary interpretation of films. RPAs will help with fluoro, line placements, but they will not interpret.

The routine CXR is one of the most complicated studies to interpret correctly.

Sure anyone can pick up the tension pneumo or the ginormous mass, but there are subtle things that can easily be missed. Its bad enough when radiologists makes misses, but if an RPA misses something, he/she'll be hung out to dry.

So what if the RPA wants to sling barium? Read the $7 CXR? fine. You think an orthopod is gonna even listen to an RPA MRI read of a knee? Half the time they disregard what we say. Same for neurosurgeons. You think they are going to trust an RPA? They'd rather read it themselves and bill for it.

In the end if we don't find a solution for the shortage of radiology man power, non-rads will find one for us. Why not have RPAs help with the lower RVU simple procedures so we can focus our efforts on higher RVU studies/procedures? PICC lines are a service many radiology groups have to provide as part of a contract with the hospital. Now would you rather focus your 10 hours a day on PICCs OR ports, chemoembo, plasties, RFA?

Why tie up a radiologist for a morning slinging barium, doing a DHT placements or LP, when he could be reading MRs, PETs and CTs? There are only so many radiologists, so many hours in a day, but a limitless supply of work (so it seems)

The reason rads has continued to pay well despite decreasing reimbursements is increased productivity-- thanks to PACs, faster scanners, VR for faster transcription turn around. More studies read/unit time. RPAs IMO are the next step in that direction.

RPAs have neither the authority nor credibility to interpret films for clinicians. As it stands now, the threat from RPAs is minimal. The real threat comes from Washington and the cardiologists.

 

[Flankstripe]

Count me in as someone who is highly concerned about the RA and RPA movement. The next level of the game after these individuals become skilled in whatever facet that they are trained in (whether that be fluoro, PICC lines, fluoro LP's/myelograms, etc), is that it takes only a quick change of legislation for those individuals to work outside the auspices of radiology.

Much like ultrasound techs can be hired by a cardiology group to pump out echos (self-referred, of course), or by neurology/vascular surgery for carotid or vascular studies (again, self-referred), there is no reason that these RA's RPA's could not be hired by clinicians for all sorts of self-referred garbage in the future.

Imagine an ID group that picks up an RA/RPA to place PICC lines in every long-term antibiotic patient in the city.

Or a GI doc now being able to order upper GI's/BE's on every single self-referred patient. It wouldn't matter if the report is garbage, because that patient is going to get an EGD/colonoscopy anyways. Except that now, there's an additional couple other reimbursable studies to add to the procedure tree (the same way cards will do an echo, followed by a nucs study, followed by a cath, etc).

Or a nephrology group that picks up an RA/RPA to do all the fistulagrams/plasties/declots.

Or an orthopods office to crank out even more meaningless plain films. Heck, if the RA/RPA gained "rights" to interpret the MSK MRI, it wouldn't matter much if the report was inaccurate, because both the images and report need never leave the imaging center/orthopod's office; that patient will be buying a knee scope regardless. Not having radiologists in the loop means that they don't need to send the images to a PACS system for peer-review; it can all stay in house.

Many specialties could cherry-pick these individuals to help run ever more self-referred imaging. Once radiologists are outside the equipment loop, there is a complete loss of control and restraint on imaging. Then imaging costs increase even more, and additional rounds of global cuts will go into effect.

I think that training RA's/RPA's is a short term solution that has the possibility of creating markedly more problems than it addresses.

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.

 

[hans19]

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...

 

[GammaRay]

I don't see RA's as "the next great threat to Radiology." If anything, Radiology is at more risk of being ripped apart by non-radiologists through self-referal. It's not too far-fetched to envision a future where each and every medical/surgical subspecialty has its own "imaging fellowship" (Cards is doing this already, of course). What's scary is that these fellowships could be quite legitimate. For example, my institution is designing a cardiac imaging fellowship (under the division of Cardiology) that is designed as follows:

1. 2 years total
2. 6 months of CT and MR cross-sectional imaging (body only, no neuro or MSK) -- this is done in collaboration with the Radiology Dept. at another hospital (I guess our radiology dept had the guts to say "Hell NO!")
3. 3 months CTA/MRA
4. 3 months nucs
5. 6 months CCTA
6. 6 months cardiac MRI

With training like this, it's hard to argue against cardiologists doing their own imaging (at least not from a patient care POV). I have also heard rumors that our neurology and oncology departments are each planning their own separate imaging fellowship programs (neuroradiology and oncologic imaging-mostly PET and CT).

 

[MacGyver]

[

Nowhere does it say the scope includes primary interpretation of films. RPAs will help with fluoro, line placements, but they will not interpret.

Why not? Radiology NPs ALREADY interpret. If they can do it, I guarantee you the RPAs will get those privileges too

So what if the RPA wants to sling barium? Read the $7 CXR? fine.

I thought you just said that CXR is too hard for RPAs to interpret? Now you are conceding it to them? Do you have any idea what % of films are CXRs? Thats the bread and butter of radiology. You've got a major problem if you are conceding 50% of your clinical practice right off the bat.

You think an orthopod is gonna even listen to an RPA MRI read of a knee? Half the time they disregard what we say. Same for neurosurgeons. You think they are going to trust an RPA? They'd rather read it themselves and bill for it.

In my experience, surgeons and other specialists could care less who read the film. They dont bother to look up credentials.

In the end if we don't find a solution for the shortage of radiology man power, non-rads will find one for us.

Agree 100%. If the shortage of rads is not corrected, government will correct it for you by opening the floodgates to midlevels or allowing foreign docs to flood in.

Why not have RPAs help with the lower RVU simple procedures so we can focus our efforts on higher RVU studies/procedures?

Because its just a stepping stone. You are sorely mistaken if you think RPAs are just going to accept their status quo without ever pushign for expansion. Every midlevel field that has ever existed has been successful in greatly expanding their initial scope of practice. Read that last sentence again and tell me why RPAs will be an exception.

The reason rads has continued to pay well despite decreasing reimbursements is increased productivity-- thanks to PACs, faster scanners, VR for faster transcription turn around. More studies read/unit time. RPAs IMO are the next step in that direction.

Ahh yes here is the reason why midlevels have encroached on everybody's territory. It always starts with the greed of doctors. Making 500k isnt enough, so you got to hire RPAs so you can bank 800k instead. Anesthesiology used EXACTLY the same logic with CRNAs. What could it hurt? Allow CRNAs to do the simple stuff, and let the MDAs get paid for "superivising" them. Of course, MDAs at that time didnt realize that eventually the CRNAs would be successful in lobbying for independent practice. Tell me again why RPAs will be different.

RPAs have neither the authority nor credibility to interpret films for clinicians. As it stands now, the threat from RPAs is minimal. The real threat comes from Washington and the cardiologists.

All it takes is one state to rewrite the scope of practice laws. Maybe it starts in Oklahoma, New Mexico, or some other rural state that doenst draw a lot of attention. But then the domino effect starts.

Dont say I didnt warn you.

 

[Flankstripe]

I don't see RA's as "the next great threat to Radiology." If anything, Radiology is at more risk of being ripped apart by non-radiologists through self-referal.

My concern is that these RA/RPA's could potentially make it that much easier to self-refer than ever before. Order a meaningless study, get the RA/RPA to both perform and dictate it (picking up both technical and professional fee), then do the definitive test anyway (whether that be a cath, endoscopy, knee scope, whatever).

The reason that a GI/cards/orthopod group would do this rather than dictating the study themselves is that having an RA/RPA doing it all frees the physician to do the knee scopes/caths/endoscopy.

We argue that RA/RPA's free us from doing mundane low RVU work. That same argument will work for the other clinicians once they hire our RA/RPA's! For them, it's also passive income, generating revenue for the clinicians without the MD actually needing to do anything. Write the order for an imaging test, pick up a pile of change, and still have 5 full days a week to see patients and do procedures.

The difference is still that since they control the patients, they could cherry-pick all insured patients and have those patients run through the RA/RPA in their private office/imaging center. Demanding patients, or uninsured patients will be funnelled to the local hospital radiology group.

The amount of self-referral that this could unleash, in my mind, is astounding.

Particularly if given the above scenario where other specialties develop mature imaging fellowships. Have the RA/RPA dictating the cardiac CT/MR under "supervision", and then get it signed off under the cardiologist. The cardiologist then does the cath anyway, and now collects fees on both studies, except that the cardiologist didn't have to invest much significant time into the MRI, yet still potentially takes both the technical and professional fee for it.

Let that cycle develop for a few years, and we WILL see more and more reimbursement cuts to imaging, as self-referral bleeds the insurance and goverment coffers further.

 

[Taurus]

The Achilles' Heel in rads, like in path, is that we don't see our own patients. We depend entirely on the referrals from other physicians. That's why cards are kicking our asses and why we can be outsourced. Is there a movement in rads to make it a priority to get us in front of the patients?

 

[GammaRay]

My concern is that these RA/RPA's could potentially make it that much easier to self-refer than ever before.

Agreed

 

[hans19]

I think you've missed my points.

No radiologist, including myself, supports RPAs giving primary or any other interpretation of films. Its not the best thing for patient care. RPAs as it is envisioned, will help radiologists focus more time on reading films and less on doing radiology scut. Just like during the pre-PACs era, it didn't take long to figure out that hanging films was not the best use of a radiologists time. Tracking down the phone number of a referring clinician to report a critical finding was not the best use of a radiologists time. These are all tasks handled administrative assistants in the real world (but by residents in academics ;P).

It is the lack of radiology manpower which leads do a gap in the availability of radiology services which is part of the argument for clinicians wanting to just read the films themselves.

Here an analogy: All pilots are trained how to properly inspect the exterior the plane before flight. But in the commericial airline industry, the pilot doesn't stroll around the outside of his 747 before the flight. The pilot knows where the fuel goes in, but he doesn't pump the gas. He knows where the cargo hold is but he doesn't load the baggage. He knows a good martini, but he doesn't mix the drinks. These things all things the pilot can do, but these are not the best use of the pilots energy or time. So what do the maintanance crew, ground crew, fuelers, baggage handlers, and flight attendants all have in common? They don't fly the plane. Chances are they wouldn't even know how! Furthermore, no passenger would tolerate anyone but an instrument rated-pilot flying the plane. If I were a highly paid commercial airline pilot a competitive market, I would not be worried about the ground crew, or baggage handlers. I would be worried about cargo plane pilots and perhaps helicopter pilots retraining and advancing to compete for my job. I'd also be worried about the cost-cutting measures in the airline industry. Sound familiar?

Back to radiology. I'm not worried about non-doctors taking my job. I am concerned about the clinicians who think they can safely practice radiology are trying to do it for themselves.

With regard to clinicians not caring who's name is on the report: If you are in a town long enough, you know which orthopods consistently get good results with hips and knees or spines and which are slow and sloppy... You know the one's you wouldn't even let lay hands on your mother (Your mother-in-law-- thats another story.) Like surgeons, there are good radiologists and bad radiologists. Any clinician who's in the know can tell you which radiologist makes the best calls, and which radiologist gives reports only good for lining a bird cage. So why would a clinician trust the report from an RPA, when they don't even trust reports from certain radiologists?

As far as clinicians using RPAs to self-refer: A smart clinician isn't going to hire a 100K/year RPA to read films for them and just collect the technical fee. They would just read it themselves and pocket the 100k. The clinician would have to accept liability for the RPAs work, so he'd be a fool not to look over all the studies for himself. So why pay someone 100K to do something you are going to do yourself, anyways? Suppose hypothetically we have a scenario where RPAs are interpreting studies on their own. A smart RPA isn't going to work for a clinician for a fraction of the revenue he generates when he could make many times more working for himself/herself. RPAs increasing self referred imaging - less likely.

Lets say for the sake of argument, CXRs they make up 20% of the studies performed, they would account for MUCH LESS than 20% of the total revenue. Again its the concept of RVUs. Productivity per unit time. I'm not conceding CXR to RPAs. My point is that if NP/RPAs end up reading a few CXRs and bill for it, sure I wouldn't be happy, but it wouldn't be the end of the world, especially if I spent that 20% of time reading more CTs and MRs.
As far as RPAs reading MRs, quite a few radiology residents feel inadequately exposed to MRI training during their 4 years of radiology training and are opting for MR fellowships. Do you seriously think an NP/RPA will be reading these to the standards of subspecialty clinicians after 2 years of RPA training?

Are RPA's a threat to my livelihood? YES!!!

But so is getting struck by lightning.

#1 threat = self referral. Threats from offshoring and RPAs take a back seat.

This is only my opinion. But you can ask any radiologist. He'll/she'll likely tell you the same.

I am intimately aware of the issues in radiology Mac, but thanks for your concern.

 

[salmonella]

"I am concerned about the clinicians who think they can safely practice radiology are trying to do it for themselves."

The big argument made by clinicians to read their own imaging studies is that they are at better positions to correlate radiological findings to their patients' clinical conditions. A neurologist can relate lesions on brain CT to neuro exam findings; Cardiologists can better appreciate patient's cardiac conditions and progression by looking at nucs and echo themselves. This seems to be nicer continuity of clinical care.

 

[f_w]

Count me in as someone who is highly concerned about the RA and RPA movement. .
.
.
.
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.

Wow, I am gone for 3 days and someone uses up all my arguments...

 

[f_w]

This is no different than what ultrasound techs are doing NOW at many institutions. They scan and decide if a study is adequate, long before we have the time to look at and dictate it.

Which is another problem in and by itself.

Nowhere does it say the scope includes primary interpretation of films. RPAs will help with fluoro, line placements, but they will not interpret.

Which the ASRT wrote into the 'consensus' paper in order to get the endorsement of the ACR. (what was that proverb with the camels nose again ?)

Its bad enough when radiologists makes misses, but if an RPA misses something, he/she'll be hung out to dry.

Actually, they won't. Because they won't be held to the same standard.

So what if the RPA wants to sling barium? Read the $7 CXR? fine.

That was exactly the argument that the people who made money off the PAs and CRNAs in the early days used. (I work at a hospital without a single anesthesiologist on staff. our CRNAs have nice lake houses).

You think an orthopod is gonna even listen to an RPA MRI read of a knee?

Of course they will. Mainly because they will profit off keeping that study completely 'in-house' without having to deal with those pesky radiologists.

In the end if we don't find a solution for the shortage of radiology man power,

There is NO shortage of radiology manpower:
-- There is a shortage of people who are willing to put up with the inflated egos in academic radiology departments for a 60% discount on market rate salaries while being expected to work PP RVU numbers.
-- There is a shortage of people willing to work for sub-market conditions in multi-specialty groups.
-- There is a shortage of people willing to bail out hospital administrators who managed to poison their relationship with the established hospital radiology group and now need to hire replacements.
-- There is a shortage of people willing to work a 1 radiologist shop in the woods or out on the prairie.
-- There is NO shortage of people interested in partnership track positions in well diversified, equipment owning single-specialty radiology groups.

Why not have RPAs help with the lower RVU simple procedures so we can focus our efforts on higher RVU studies/procedures?

Read flankstripes post on 'why not'.

PICC lines are a service many radiology groups have to provide as part of a contract with the hospital.

PICC lines are a nursing task.

The reason rads has continued to pay well despite decreasing reimbursements is increased productivity--

And people working longer hours.

VR for faster transcription turn around.

VR as a positive factor in radiologist productivity ? What planet are you on (could that be planet academia which orbits around reality?)

RPAs have neither the authority nor credibility to interpret films for clinicians. As it stands now, the threat from RPAs is minimal.

You buy into the propaganda from the RA/RPA lobby today and fail to see the threat down the road.

 

[Taurus]

I'm in the camp that sees RA's as competition. It conjures up visions of NP's, PA's, and CRNA's. I also agree that self-referrals from other specialties are not good. Both are big problems. Question is, what is the radiology specialty as a whole doing about these issues? Are we watching the beginning of a slow and painful decline of the specialty, especially after the cuts start in 2007? Is radiology the next pathology (huge decline after cuts were made a few decades ago)?

 

[hans19]

FW, I agree PICCs can be done by nurses, but do you mean in PP you don't do ANY PICC lines?!? Do you do ANY central lines?

True, all I know about radiology is what I see around me in academia, and rumors from recent grads out in PP. I haven't heard any opinion either way on RAs/RPAs by PP radiologists as of yet.

I defer to FW and the other PP big dogs on this issue.

 

[biers6]

Someone mentioned that NPs already read films in radiology. Could someone elaborate on that? What kind of training do they have? Where do they work pp/academic (I haven't seen anyone)? Is this common? What kinds of film do they read? What's do radiologist typically pay them? Feel free to e-mail if you prefer. Thanks.

 

[f_w]

Haven't encountered any NPs doing interpretations.

I have worked with NPs in IR. Their scope of practice was similar to the PAs, except that they did a bit more of the primary care type work for the patients who had IR as their primary service (e.g. liver tumor patients).

 

[MacGyver]

Someone mentioned that NPs already read films in radiology. Could someone elaborate on that? What kind of training do they have? Where do they work pp/academic (I haven't seen anyone)? Is this common? What kinds of film do they read? What's do radiologist typically pay them? Feel free to e-mail if you prefer. Thanks.

Take a look at this job posting. And then somebody needs to call the head of radiology at UW and tell him that he's selling out his profession.

Radiology - Teaching Associate
The Department of Radiology at the University of Washington is seeking a faculty member at the level of Teaching Associate to join the Harborview Medical Center Department of Radiology. This position is open until filled. Direct experience in Radiology, Cardiology, Nuclear Medicine, Ultrasound and Interventional Radiology (IR) is preferred, but not required. This position will provide general support to the Department of Radiology Faculty as assigned. He or she will coordinate with subspecialty fellows, residents and faculty the pre-procedure assessment and long-term follow-up of patients upon whom imaging and image-guided procedures will be, or have been, performed and will assist referring clinical services in identifying those patients in whom additional imaging services are required. Other duties will include interpreting radiographic studies, performing procedures independently, monitoring cardiac stress tests, performing history and physical examinations, ordering and review of relevant laboratory and imaging studies, prescribing medications as needed, corresponding with patients and their summary providers and providing relevant patient teaching. Teaching responsibilities will include assistance in the training of Radiology residents and subspecialty fellows and residents, focusing on long-term clinical management. Other activities will include but are not limited to community outreach, conferences, lectures and grand rounds.

Radiology is an active and growing department that enjoys close integration with other departments and physicians to ensure the University of Washington and Harborview Medical Center provide outstanding comprehensive care.

Candidates for this position must be a currently licensed Registered Nurse Practitioner (ARNP) or Certified Physician Assistant (PA-C) with prescriptive authority, licensed in or eligible for licensure in Washington State and have current BLS and ACLS certification.

 

[biers6]

So, it doesn't sounds like they're really reading films, correct? (despite those few words in the ad)