Radiologist assistants (RA)

[Taurus]

As if government cuts in imaging reimbursements and threat of outsourcing weren't bad enough, here's a new front on the (once?) mighty radiology specialty. RA's! I can't help but feel that radiology is under siege and we're gonna lose out. And don't give me that spiel about organizing and applying political pressure. If doctors knew how to do that, medicine in general wouldn't be in the mess it finds itself in now.

http://www.acr.org/s_acr/doc.asp?CID=2540&DID=23840

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[wes2308]

it looks like the RA will not interpret exams - so it doesn't seem like a big deal

 

[tigershark]

As if government cuts in imaging reimbursements and threat of outsourcing weren't bad enough, here's a new front on the (once?) mighty radiology specialty. RA's! I can't help but feel that radiology is under siege and we're gonna lose out. And don't give me that spiel about organizing and applying political pressure. If doctors knew how to do that, medicine in general wouldn't be in the mess it finds itself in now.

http://www.acr.org/s_acr/doc.asp?CID=2540&DID=23840

All of medicine is under seige by these various mid-level providers. Radiology is probably the safest on this front because we are "knowledge workers" and not a hands on technical field. It's much easier for these PA types to argue that they can do technical procedures and floor work than it would be for them to argue they can read CT and MRI studies without an education equivalent to a radiologist.

Radiology has many battlefronts but mid-level encroachment isnt one of them.

 

[hans19]

As if government cuts in imaging reimbursements and threat of outsourcing weren't bad enough, here's a new front on the (once?) mighty radiology specialty. RA's! I can't help but feel that radiology is under siege and we're gonna lose out. And don't give me that spiel about organizing and applying political pressure. If doctors knew how to do that, medicine in general wouldn't be in the mess it finds itself in now.

http://www.acr.org/s_acr/doc.asp?CID=2540&DID=23840

Its is true we are under siege. But medicine in general has been under siege in this country for the last 20 years.

I challenge you to find ANY country in the world, where a doctor is better reimbursed than in America. That is not to say complacency is acceptable. But even with cuts in reimbursement radiology, (even medicine in general) is a pretty sweet gig. Look at other similar 1st world countries. In the more developed countries in Western Europe and South America, attending radiologists make little more than American residents. An attending in east Asia and a UK consultant radiologist make about 40% of what the typical American attending radiologist makes when converted to dollars (PPP). Canadian rads may make the similar figures to an American radiologist, but he/she is paid in Canadian dollars, and the income tax rate is much higher in Canada.



Furthermore Medicare funding IS a zero sum game. The funding pie is only so large and will not grow in the forseeable future. If one specialty gains a reimbursement code or gets a funding increase, that means a code in some other specialty got cut. Radiology is lucky to be at the forefront of technology and gets its hands on well-reimbursed new modalities. IE Breast MR, new interventions which are initially well reimbursed. Older technologies tend to get cuts in reimbursement.

When primarily IR did vascular stenting it reimbursed well, but now in the era of vascular surgery predominant stenting, funding has been cut. Each stent after the first gets only fraction of the reimbursement of the first.

When coronary CTA gets its own reimbursement code it will likely mean that diagnostic cath reimbursement will get cut, which is a threat to cardiology. CTA of the vessels will subplant the diagnostic caths that vascular surgeons took from radiologists.

If you think its the radiology climate is that bad, you are free to pursue another specialty, or move to where you think radiology is better. No one is holding a gun to your head.

Many, including myself, think that radiology continues to have an excellent future. If you decide to pursue radiology, I encourage you to be active in the ACR and do your part to contribute to research to further the field.

Good luck.

 

[f_w]

The ACR is sponsoring the radiology assistant program. ACR aides in getting legislation passed to get RAs recognized. While I disagree with the scope of the RA program, I wouldn't call it an area where we are 'under siege' at this time.

 

[PaddyofNine]

While I disagree with the scope of the RA program.

Can I ask, how so, f_w? Could ya elaborate?

 

[f_w]

Can I ask, how so, f_w? Could ya elaborate?

Right now, there is no defined midlevel provider in US radiology. The techs acquire the images, the radiologist interprets them. Interventional radiology departments at times will train a PA or NP to do a limited spectrum of procedures, but in diagnostic radiology they are few and far in between.

The history of PAs, paramedics, optometrists and NPs has shown that midlevels rarely want to remain under supervision in the long-run. While most are happy with their role, there are allways some zealots who tend to congregate in the professional organizations. They start pushing to expand the scope of practice and try to get independent of physician supervision. Payors and goverment on the other hand are very willing to support the proliferation of midlevels. Their fees are lower and often they are content to be hired as employees of hospitals or corporate medical providers.

So, while I am glad about the help I can get from PAs and NPs, I don't think it is good for radiology to grow a group of 'specialty trained' midlevels who will start to eat our cake 10-15 years from now. So, right now the 'siege' is coming from other groups, but once RAs and RPAs have a critical mass, they might create a new front.

 

[bigfrank]

Right now, there is no defined midlevel provider in US radiology. The techs acquire the images, the radiologist interprets them. Interventional radiology departments at times will train a PA or NP to do a limited spectrum of procedures, but in diagnostic radiology they are few and far in between.

The history of PAs, paramedics, optometrists and NPs has shown that midlevels rarely want to remain under supervision in the long-run. While most are happy with their role, there are allways some zealots who tend to congregate in the professional organizations. They start pushing to expand the scope of practice and they start to get independent of physician supervision. Payors and goverment on the other hand are very willing to support the proliferation of midlevels. Their fees are lower and often they are content to be hired as employees of hospitals or corporate medical providers.

So, while I am glad about the help I can get from PAs and NPs, I don't think it is good for radiology to grow a group of 'specialty trained' midlevels who will start to eat our cake 10-15 years from now. So, right now the 'siege' is coming from other groups, but once RAs and RPAs have a critical mass, they might create a new front.

Excellent post.

 

[Docxter]

The ACR sponsored RA program was in reaction to the growth of RPA programs, which started at Weber State University in Utah and was spreading. I guess it was designed to "reign-in" independent mid-level practice and bring it under physician (i.e. radiologist) supervision. I agree that one wouldn't know how it will work out in the long run.

 

[f_w]

Actually, the radiology midlevel thing has a longer history. I believe the military trained radiology midlevels in the 70s as a pilot project, it sort of spilled out from there.

Another precendent is the 'reporting radiographer' in the UK. The national health service has a shortage of radiologists and no plan or concept on how to fix it. So as a fix, they started to train suitably qualified technologists to interpret a limited scope of studies (e.g. skeletal plain films).

By the way. A PAs scope of practice is defined by what the supervising physician allows you to do. So even today, a diagnostic radiologist can train a PA to perform image interpretation (you might have a problem with your malpractice carrier if you did that, but that is on a different page). A lot of the things touted as the 'new frontier' for the RAs and RPAs are things that a regular PA or NP and often even a well trained tech can do.

I must say that I find the idea of offering a path for advancement for our technical staff is great. There are many individuals in radiologic technology who have the academic capacity to advance further. Today, they will often choose a different field as radiology technology is sort of a dead end. Having this path for advancement to become an RA or RPA could serve to attract more of these individuals into the RT profession which is a good thing.

 

[PaddyofNine]

That's pretty interesting. I know they're talking about bringing in radiographer reporting here in Ireland as well. I think it's a great idea - there're some people I work with who have been looking at plain films day after day for ten years or more, and they could spot a fractured scaphoid or a pneumo from across the room - I think they should definitely be allowed and encouraged to use their expertise.

There's also a bit of a radiographer shortage - not really sure why. I think that for a paramedical career, the money is excellent (esp. for the likes of CT on call) and it's a relatively cushy job!

We have a problem in that there's hayuge waiting lists for public scans at the moment - for example in the radiology department I work in, I know there's an outpatient CT queue of something like 500 patients. The head of our health service is trying to combat this by asking the radiographers to convert to shift work, working until 8 in the evening, or on Saturdays, etc. (They currently work 9-5). I think the plan's gonna hit a bit of a brick wall, though - the unions seem to be saying "No way".

A bit OT I know but it's interesting to see the different roles of radiographers on different sides of the pond - would I be right in saying that our guys seem to have a lot more autonomy?

 

[f_w]

there're some people I work with who have been looking at plain films day after day for ten years or more, and they could spot a fractured scaphoid or a pneumo from across the room -

The reporting radiographer RA or 'super tech' should not be based on experience alone but the result of a defined rigorous course of schooling. (While I have worked with many excellent techs, some, even after 20 years in the field won't be able to name a major joint).

The RA is actually not designed to interpret studies. The only way how the ACR managed to shove this down members throats was the premise that the RA doesn't interpret any studies. In my humble opinion, it is only a question of time when RAs will push for (and get) interpreting priviledges.

 

[zzz1]

The reporting radiographer RA or 'super tech' should not be based on experience alone but the result of a defined rigorous course of schooling. (While I have worked with many excellent techs, some, even after 20 years in the field won't be able to name a major joint).

The RA is actually not designed to interpret studies. The only way how the ACR managed to shove this down members throats was the premise that the RA doesn't interpret any studies. In my humble opinion, it is only a question of time when RAs will push for (and get) interpreting priviledges.

Then why did ACR want to champion this RA program in the first place? Why pick up a stone and drop on one's own foot?

 

[f_w]

Then why did ACR want to champion this RA program in the first place? Why pick up a stone and drop on one's own foot?

Goood Question !

I think the reasons are twofold.
On one hand, there is this college in Utah that trains specialized PAs as 'radiology PA'. I believe that many of the students who graduated from this program where RTs before. But the development of their curriculum and the development of their scope of practice is outside of the sphere of influence of the ACR. While the emphasis of this RPA business is on interventional and procedures, there is nothing in the books that keeps them from interpreting a limited scope of studies.
On the other hand, the ARRT, the organization of radiology techs was pushing to get a path of advancement for their constituents, essentially with or without organized radiologies support. ACR made their support of ARRTs push for the RA programs contingent on the specific exclusion of interpretation from their scope of practice (at least for now).

So, one could say that the decision to pick up that stone is a bit motivated by the fact that there are two other people already standing there willing to drop something on your foot. Also, by dropping the stone yourself, you can try to aim in a way that it just crushes 2-3 minor toes rather than a substancial part of your weight bearing apparatus

 

[txguy]

Goood Question !

I think the reasons are twofold.
On one hand, there is this college in Utah that trains specialized PAs as 'radiology PA'. I believe that many of the students who graduated from this program where RTs before. But the development of their curriculum and the development of their scope of practice is outside of the sphere of influence of the ACR. While the emphasis of this RPA business is on interventional and procedures, there is nothing in the books that keeps them from interpreting a limited scope of studies.
On the other hand, the ARRT, the organization of radiology techs was pushing to get a path of advancement for their constituents, essentially with or without organized radiologies support. ACR made their support of ARRTs push for the RA programs contingent on the specific exclusion of interpretation from their scope of practice (at least for now).

So, one could say that the decision to pick up that stone is a bit motivated by the fact that there are two other people already standing there willing to drop something on your foot. Also, by dropping the stone yourself, you can try to aim in a way that it just crushes 2-3 minor toes rather than a substancial parts of your weight bearing apparatus

LOL! Great post!

-tx

 

[MacGyver]

f_w is one of the few doctors on this whole damn site who understand that you have to think LONG TERM with these midlevels, not just short term.

The ACR is thinking short term only. They fail to see the writing on the wall.

Look the bottom line is there has NEVER been a group of midlevels who were happy with the status quo. Every single group of midlevels that has ever existed in medicine has pushed for (and gotten) independent practice to some degree.

Even the PAs have gotten more independent. IN North Carolina, the only regulations are that an MD has to review 10% of charts ONCE EVERY 6 MONTHS. No on-site presense, no cosignatures required for any meds. That means PAs run their own clinics, with the MD never even setting foot on the premises.

I think telerads is a more immediate threat than these RA guys, but still its important to recognize that this a trojan horse. They come in, promising to accept the status quo and be happy little workers under radiologist's control. But some day, 5 years or 10 years down the line, their tune is going to change and they are going to go to the state legislatures to write their own scope of practice.

You know the real problem here is radiologists themselves. There will be some radiologists who will openly embrace these RAs, and use them as money making tools. They will give them tremendous amounts of autonomy so they can cobill for their services and vastly increase their total number of films read per day. These sell out radiologists are exactly like the fools in anesthesiology who sold out the profession to CRNAs by co-billing Medicare for their services. Well eventually Medicare wised up and said we arent paying gas docs anymore for this, we are going to reimburse CRNAs directly.

Be warned, I promise you many rads docs will take this approach. They see $$$ in the short term and are totally unconcerned with long term consequences.

 

[f_w]

Approval from McGyver, I must have said something wrong.