SAY NO To "RPA's"

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Taurus

Paul Revere of Medicine
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There's an interesting discussion going on AuntMinnie about RPA's.

http://www.auntminnie.com/forum/tm.aspx?m=84190&mpage=1&key=

Current and future rads should be aware of this and prevent RPA's from becoming another CRNA's.

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Posted by radsdude12345

Enough is Enough!!! We should stand up against RPAs and not let this progress!!! Supporting RPAs is the epitomy of being a radwhore!!! Hiring cheap labor to help you if you are busy hire more rads or a NP/PA. Need help with fluoro/IR hire an IR doc or an NP/PA, we donot need to create a whole new field with new accreditations. NO!!!! We donot need to give a specific title to help rads. Glorified RAs should not be allowed to read imaging. I have had enough!!! Cards, ortho, neuro, and every speciality whats to read their own images, now non-MDs want to!!!! Come on RediCat if you want to learn radiology I have a way its called 4 years of med school and 5 years of residency. Enough with people trying to take shortcuts!!!!! You need a foundation. I did 4 years of undergrad, 4 years med school, 5 years residency, and 1 year fellowship to read images, so no RA should be certified. ACR should say no and everyone should say NO!!!!! Is it enough we have to worry about outsourcing to India now we have to worry about homegrown outsourcing!!!!! NO WAY!!!!! If you have excess images hire an extra rad, even daytime telerads by a US licensed rad would be better. RPAs are the true form of RADwhores. We as a speciality should learn from others and not repeat the mistakes of optho, internists, and anesthesia, we should not train others to do our JOB!!!! RPAs want to read images and hospitals will hire them to cut costs. We should not allow this slippery slope to continue or even start. We as a MD speciality should not HIRE RPAs or recognize them as anything more than glorified RTs. Any schmoe can recognize a mass, but the differential is what seperates an MD from other fields. We as doctors should stop looking for short-term benefit and screw over future generations. If you guys donot believe me look at this "half-radiologist" and "we are training with radiologists the entire time":
http://www.radiologytoday.net/archive/rt_110804p26.shtml

http://www.radiologypa.org/DesktopDefault.aspx

THIS MUST STOP!!! I PERSONALLY DONOT WANT TO OPEN PANDORAS BOX!!! Take a stand, because I will not hire these individuals, recognize their title, and have written to AMA and ACR and my local state representative. Also, write to universities that offer this program and say there is no market and I use the word univeristy in loose quotes. NO MORE!!!

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In an ideal setting I can see the benefit of an RPA. However, I agree with the OP. The whole "mid-level" provider thing and "rural" demand really provides fodder for these sorts of things. The sad thing is, if RPA became a widespread well-known career path and RPA's became very numerous, some rural areas probably would benefit. However, I am betting that RPA's would quickly get greedy and decide to set their sights elsewhere. Rural areas would still be underserved, and the market in other areas would be saturated. I'm not even a resident, I don't have experience, I don't have numbers. But insofar as human greed is as predictable as the rising sun, it's logical.

Perhaps because I'm not a resident and I don't see the real difference in practice between NP/PA and MD's, CRNA's and MDA's, RPA's and MD's, part of me can't help but wonder if we're seeing that in some ways the current state of medical education has its credentials rooted more in tradition and esotericism than in efficient, thorough, skilled education. I mean, if you can train someone else to do my job for a fraction of the cost I paid for medical school, and in half the time, and pay them half the amount I would predictably make, one has to wonder where the problem is, and what exactly it is that makes medical education so much better. I've forgotten just about everything I've learned in my first two years of medical school, I think third year is a mammoth joke. I can't imagine fourth year will bring an epiphany of medical knowledge either. I'm not trying to be a traitor, nor am I saying that RPA's, CRNA's, NP/PA's are equivalent... but I am saying that if MD is supposed to mean something more then maybe it's time to critically revisit medical education in this country and backup the symbolic superiority of MD preparation with reality.
 
I am saying that if MD is supposed to mean something more then maybe it's time to critically revisit medical education in this country and backup the symbolic superiority of MD preparation with reality.

I agree. I think that the current medical education model is woefully outdated. Physicians are starting their careers at such a late stage compared to other fields and with much higher debt. I think we need to streamline the entire medical school + residency process. We should either try to integrate medical school with college like they have in other countries or combine med school with residency. Unfortunately, medicine is rooted in tradition and so our leaders have their heads stuck in the sand on this. While that happens, we're watching the nurses who are less constrained by tradition creep up on our medical turf. It's the classic business story of how the old lumbering mega-Corporation, aka IBM, falls behind to smaller, but nimbler competitors, aka, Microsoft, Google, etc.

The CRNA's are ruining the anesthesiology field for physicians. Don't let the RPA's do the same to radiology. RPA = CRNA.
 
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I agree. Much as I hate to "pirate" this threat into a discussion about medical education, the reasons behind the rise of mid-level providers is very much entangled with the consequences of the current medical education process, imho.

My limited view: Physicians spend 4 years in college, then 4 years in medical school (unless you did a 6 year combined program, uncommon). That eight year period generally incurs anywhere from 150-300k in debt. Then add interest. Then, after four years of medical school, a crop of graduates are produced who feel neither comfortable nor competent, and probably aren't, to actually manage the care of patients. Enter residency, where the "real" learning takes place, during which time a person is paid, not a ton but at least it's not negative dollars. After 3-5 years of residency training, physicians enter medicine as a practicing independent physician, usually in their early to mid-30's.

Now, send in the mid-level providers, who received their education in about half that time (or less) and a fraction of the cost. Overall they do an adequate job, their training was very heavy in skills, being taught according to standards rather than pimped from the background of a subset of physicians.

You see, the problem with medical education for me is that during clerkships, you learn basically nothing. Yeah, sure, you get pimped and so you might learn some nuggets from the experience of a very small subset of physicians. Procedure-wise it's pretty well understood that medical students are lucky if they learn to insert a foley or start an IV. And even if you get to do something, odds are you won't get to do it again. There is no real motivation to let students do or learn anything because 1.) they haven't chosen specialities yet and may not need such opportunities, 2.) they will get the chance in residency, and 3.) people in residency now need the opportunities more because they're closer to having to do it without supervision.

I have no idea how medical education should be restructured. But I think that we need to do better at incorporating objective standards. I think a national standardized third year curriculum, both in terms of knowledge and skills, would be a good first step. Yeah, I know medical schools meet "LCME standards" now, but let's face it... my knowledge level coming out of internal medicine is probably very different from someone at any other school. It shouldn't be the exact same of course, but there should be some baseline standards. And I don't care what anyone says, the shelf exams do not measure knowledge. I am an idiot who can't manage patients to save my life and I do well on shelf exams, that proves they're worthless. Step 2 CS is a ridiculous attempt at ensuring students have basic interview and physical exam skills. Each school is granted permission to confer M.D. degrees; in my opinion Step 2 CS is a slap in the face that basically says, we don't trust you to evaluate your students. As a precedent, that weakens medical education as a whole. I firmly believe skills should be evaluated and standards met before getting an M.D., but I think schools are more than capable of doing this if a standardized national curriculum was created.

Bottom line is, we are where we're at because of problems in the medical system that run through every vein, no pun intended. There is not a single aspect of the medical system right now that does not need serious overhaul. I think the emergence and relative success of mid-level providers is a testament to the failure of medical education, and to a larger exent, the failure of our healthcare system.
 
In an ideal setting I can see the benefit of an RPA. However, I agree with the OP. The whole "mid-level" provider thing and "rural" demand really provides fodder for these sorts of things. The sad thing is, if RPA became a widespread well-known career path and RPA's became very numerous, some rural areas probably would benefit. However, I am betting that RPA's would quickly get greedy and decide to set their sights elsewhere. Rural areas would still be underserved, and the market in other areas would be saturated. I'm not even a resident, I don't have experience, I don't have numbers. But insofar as human greed is as predictable as the rising sun, it's logical.


This is absolutely key. I'll go back to my longstanding mantra:

THERE HAS NEVER BEEN A MIDLEVEL GROUP THAT WAS "SATISFIED" WITH ITS CURRENT SCOPE OF PRACTICE AND AGREED TO STAY THERE.

EVERY MIDLEVEL GROUP THAT HAS EVER EXISTED HAS FOUGHT FOR AND EVENTUALLY BEEN GRANTED MASSIVE EXPANSIONS IN THIER SCOPE OF PRACTICE.

So, give a big **** YOU to the fools (mostly older academic chair radiologists who are trying to make a quick buck from these midlevels) who try to lie to your face and tell you that RPAs will never try to gain wider scope and push radiologists out.
 
RPA's are a huge threat to radiologists in the future if we allow them to flourish. Thankfully, there's an alternative, the Radiologist Assistant (RA). The RA has the support of the ACR and other organizations. There are already 6 schools while RPA's only have 1.

Here's some info about ACR's take on RA's.

http://www.acr.org/s_acr/sec.asp?TR...D=0&CIDQS=&Taxonomy=False&specialSearch=False

For comparison, look at the RPA's own comparison between the RPA and RA.

http://cbrpa.org/pdf/RPAvs%20RA.pdf

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Can perform procedures independently within the main health care facility or at satellite facilities and communicate with radiologists via teleradiology, phone, e-mail or fax on cases.

Initial evaluation of plain film images and procedures, separating normal from abnormal

Preparation of a dictated technical report on initial evaluation of images and procedures for radiologist review

Allowed to interact with other health professionals concerning patient management or imaging procedure

Obtains patient consent, provides instructions, discussed alternatives, initiates medical documentation and discharge summary

Can perform some invasive procedures independently, once competency has been attained

Can order additional imaging procedures in a different modality, when warranted and is then checked and approved by the radiologist

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To me, it's freaking scary. They are doing procedures with no or minimal supervision, preliminary reads, preparing reports, interacting with other healthcare workers independently, interacting with patients, ordering new images from different modalities without having to talk to the radiologist. Jesus Christ! They're a mini-rad!! If we allow this continue, we would be following the same road that the anesthiologists took with the CRNA's. If we couple RPA's with outsourcing and other specialties wanting to do their own imaging studies, it's a road to radiology ruin. This has to stop. I sure as hell won't hire an RPA. I would hire a tech or may be RA if they are no threat in the future.
 
I agree with the above. While I am only a medical student, my PA cohorts are already running circles around us (attemtping to at least) and this has got to stop! The point was brought up that sure the nation is in DIRE need of healthcare access but the "help" in turn decides to stay where they weren't needed in the first place! I love the fire that I am reading in this forum, and I just want to say that I will keep this fire going. You guys are just now starting a wave in academic reform, we need more academic reform. You guys will someday be the leaders at these American academic centers and can effect change and I want to be part of this (way way later by the way). So keep up the fire and don't forget that your duty is to the patient and to your colleagues!
 
As long as radiologists treat RPA's or RA's as techs and do not give any special consideration to their degrees, I don't think they will become a problem. Techs in radiology are important and we can't do without them. However, if we let them do everything except the final reads while we're sipping our lattes in the lounge, then we're in big trouble. They will follow the same path that the CRNA's took. If their numbers grow large enough, they will organize politically and fight for autonomy. They will claim that they can do everything except the final read. They will even create a "Doctor of RPA" degree. Sound farfetched? Then take a look at this:

"The Department of Nurse Anesthesia recently received approval from VCU’s Board of Visitors for an innovative clinical doctorate, the Doctor of Nurse Anesthesia Practice (DNAP). The DNAP is a post-master's program designed for CRNAs who wish to expand their knowledge in the areas of patient safety, evidence-based practice, education, and leadership. An optional dual-degree (MSNA/DNAP) program will be available for students matriculating in the master’s program. The proposed starting date for the new program is Fall 2007, pending final approval by the State Council on Higher Education for Virginia and the Council on Accreditation of Nurse Anesthetists. Additional information will be forthcoming over the next few months."

http://www.sahp.vcu.edu/nrsa/

Those nurses now have the gall to create a "doctorate" in anesthesia. :mad: Last I checked, a doctor in anesthesiology was a physician who went to medical school and anesthesiology residency. Midlevels never cease to amaze me anymore. :rolleyes:
 
In an ideal setting I can see the benefit of an RPA. However, I agree with the OP. The whole "mid-level" provider thing and "rural" demand really provides fodder for these sorts of things. The sad thing is, if RPA became a widespread well-known career path and RPA's became very numerous, some rural areas probably would benefit. However, I am betting that RPA's would quickly get greedy and decide to set their sights elsewhere. Rural areas would still be underserved, and the market in other areas would be saturated. I'm not even a resident, I don't have experience, I don't have numbers. But insofar as human greed is as predictable as the rising sun, it's logical.

Perhaps because I'm not a resident and I don't see the real difference in practice between NP/PA and MD's, CRNA's and MDA's, RPA's and MD's, part of me can't help but wonder if we're seeing that in some ways the current state of medical education has its credentials rooted more in tradition and esotericism than in efficient, thorough, skilled education. I mean, if you can train someone else to do my job for a fraction of the cost I paid for medical school, and in half the time, and pay them half the amount I would predictably make, one has to wonder where the problem is, and what exactly it is that makes medical education so much better. I've forgotten just about everything I've learned in my first two years of medical school, I think third year is a mammoth joke. I can't imagine fourth year will bring an epiphany of medical knowledge either. I'm not trying to be a traitor, nor am I saying that RPA's, CRNA's, NP/PA's are equivalent... but I am saying that if MD is supposed to mean something more then maybe it's time to critically revisit medical education in this country and backup the symbolic superiority of MD preparation with reality.

The truth is, during medical school you may feel inadequate as far as the practical day-to-day ward stuff goes, although that starts to get better towards the end of 4th year. But what you do build is a tremendous knowledge base that in some sense is latent, and you may not realize at first how broad it is. When you get about 6 months into internship that stuff wakes up in a practical sense and you learn the day-to-day routine very well and get used to handling emergencies on the floor and in the ICU. And then you realize that as the MD (or DO) you are the ultimately responsible party and know more (a lot more) than any nurse or mid-level provider around you. All that learning has not gone to waste. By the end of intership, you will be both amused and alarmed by what mid-level providers do not understand about the human body, and by the loose oversight that many of them practice under.

In order to be a safe independent medical provider, it really takes about 4 years of dedicated schooling and then 3+ years of residency OJT. Anything less is clearly beneath the standard of care. The irony is the people who agitate for increased scope of practice for lower level providers usually don't have the requisite training to provide basic safe care themselves. Somebody who wants to act like a doctor has the opportunity to go to medical school and become a safe practitioner.

For a radiologist, medical school (and many would say a good well-rounded internship) is absolutely essential as a starting point. A 4 year residency is barely enough to learn to be a basic competent general radiologist. Even reading chest x-rays well enough to catch the lung nodule that the internist missed takes years. Learning the appearances of all the various pathologies on different imaging modalities, knowing the importance of these findings and their followup both clinically and radiologically takes time. There is no substitute for adequate training. It just takes a long time and you are not safe to be on your own until it is done, and that is why it is expensive.

We can cut corners as a society, but it is up to the medical profession to counteract this trend and protect the integrity of our profession and the safety of our patients.
 
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