October 01, 2010
The potential for radiologist assistants (RAs) to transform radiology still faces considerable bureaucratic and political hurdles.
If all states in the U.S. eventually recognize RAs, "there will be a significant change in how we perform radiology," said Paul Ellenbogen, M.D., a diagnostic radiologist at Texas Health Presbyterian Hospital in Dallas and co-presenter of the RSNA 2010 course, "The Continuing Evolution of the Radiologist Assistant in the Medical Imaging Environment" (See sidebar).
Still in its infancy—the first RAs graduated and began entering the workforce in 2005—the RA profession has strong support from the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT) and the American Registry of Radiologic Technologists (ARRT®), which jointly endorsed the new category in 2003. Later that year, the nation's first RA educational program began at Loma Linda University in California. Today, 13 RA education programs exist in the U.S.
Nevertheless, RAs are still trying to find a place in the big picture of healthcare. Specifically, RAs face two hurdles: First, like the Centers for Medicare & Medicaid Services (CMS), many insurers refuse to reimburse for RA services, primarily because they are not considered medical providers; and second, 22 states do not license, regulate or even recognize the role of RAs, sharply limiting the duties they can perform. Individual states regulate nonphysician practitioners such as RAs.
Another sticking point: CMS now requires personal supervision for RAs, meaning the supervising physician must be in the room during the procedure. ACR, ASRT and ARRT and the Society of Radiology Physician Extenders are advocating for direct supervision for RAs, under which the supervising physician needs only be present on the premises, immediately available to offer assistance and direction.
While ACR, ASRT and ARRT have been lobbying state legislatures to recognize RAs, many lawmakers are gun-shy about supporting such initiatives due to the increasing number of ancillary medical professionals lobbying for increased responsibilities, Dr. Ellenbogen said.
For example, nurse anesthetists are seeking to perform anesthesiologists' duties and physician assistants (PAs) want increased autonomy over patient care. The resulting "turf wars" have made legislators hesitant to support any new medical professional role, Dr. Ellenbogen said.
RAs Create Niche
RAs and radiologic technologists (RTs) differ primarily in their level of education: RAs are qualified RTs who go through additional training that qualifies them to perform selected invasive procedures.
"Radiologist assistants perform a wide variety of procedures and duties, including patient pre-procedure assessment and follow-up care, routine fluoroscopic studies along with some interventional procedures like arthrograms, paracentesis/thoracentesis and drainages," said Christine Lung, CAE, vice-president of public policy for the ASRT and a co-presenter of the upcoming RSNA 2010 session.
Even in these turbulent economic times, Lung believes RAs are a boon to radiology practices and hospital departments. "Studies have shown that radiologist assistants increase efficiency in the patient care setting and patient satisfaction in the radiologic care they receive," she said.
If RAs are able to perform selected procedures and act as patient liaisons of sorts, radiologists will be able to devote more time to interpretation and diagnosis, noted Dr. Ellenbogen. "Just as the PA assists the physician, surgeon, internist or other physician, the RA assists the radiologist," he said. "If all RAs were authorized to do selected procedures, radiologists could concentrate on the more complex procedures. This would result in greater productivity by the radiologist, and in turn, lead to faster response times and possibly shortened length of patient stay."
Roles of PAs, RAs Overlap
Meanwhile, another trend threatens to affect the RAs' role. An increasing number of PAs are finding work in radiology departments and performing most of the same duties as RAs, but with the added advantage of being licensed medical providers.
Although PAs are moving into radiology at higher rates, ACR contends that the RAs' specialized training gives them an advantage, according to Dr. Ellenbogen. "We think the RA is the better person to do the job," he said.
Even though RAs possess valuable skills, they are not able to perform many of the duties that a PA can, including making hospital rounds and discharging patients, according to Kenneth Trulson, PA-C, with Interventional Radiology and Vascular Surgery in San Jose, Calif.
"RAs are going to be relegated to the cath lab, and that's really all they can do," he said, adding that RAs are more beneficial to outpatient radiology practices than hospital departments.
Still, Trulson thinks there is a place for both RAs and PAs in the radiology field. "I don't think anyone is invading anyone's turf," he said. "It comes down to what works for each group. We're all here to treat the patient."
Even so, many states do not allow PAs to perform radiologic procedures, Lung said.
"Since the radiologist assistant is a radiologic technologist, he or she can perform specialized technical aspects of the procedure as well as patient care duties," she said. "Radiologist assistants are specifically educated to work in radiology for radiologists and are highly skilled in radiation safety and protection by virtue of their radiologic technologist training."
Ultimately, the choice between RA and PA should be determined by the needs of the individual practice, Trulson said. "Healthcare providers need to take a little time, do their homework and find the right person to fill their needs. I think we can all coexist quite well."
RA Symposium Emphasizes Teamwork, Patient Safety
The RA Symposium at RSNA 2010 will comprise four refresher courses designed to meet the educational needs of the RA as defined by the American Registry of Radiologic Technologists. Sessions are:
- Pediatric Imaging: The Radiologist and Radiologist Assistant Team Approach To Clinical Service
- Chest Pain—Imaging Clinical Pathways with Considerations of Diagnostic, Cost and Patient Safety Issues
- Vascular Interventional Cases: The Radiologist and Radiologist Assistant Approach to Patients in the Vascular Suite
- The Continuing Evolution of the Radiologist Assistant in the Medical Imaging Environment
Registration for RSNA 2010 is under way at RSNA.org/register.