Session defines scope, future of radiologist assistants

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CHICAGO, Nov. 29—In a session on radiologist assistants (RA) and radiologist practitioner assistants (RPA) on Wednesday at the 93rd annual meeting of the Radiological Society of North America (RSNA), Paul Ellenbogen MD, FACR, chair of the ACR commission on human resources, led a panel discussion on the future of the scope of practice for both positions.

According to Ellenbogen, the number of radiologists in the U.S. has not increased at the same rate as the number of imaging examinations. The workforce has increased at a rate of 1 to 1.5 percent while workload increased to 11,000 to 13,900 procedures per year or 6,000 to 9,100 relative units per year. “The demand for imaging has increased and we do not have the workforce to meet that demand,” he said.

“If we had an RA who could do everything that a radiologist can do, we would no longer need radiologists—training could be done in less time, for less money,” according to Ellenbogen. “On the other hand, if we did not have RA then the scope of practice would be zero.”

Ellenbogen and the panelists said they foresee the future of RAs and RPAs to converge into one position—the RA. “We do not anticipate RAs to be a replacement for individual diagnostic practitioners, but merely an extender.”

Jerry Reid, PhD, said the challenge to determining the scope of practice for RAs is in assessing qualifications. “How do we know when someone is qualified to practice as an RA?” he said. “When someone knows the underlying principles, can apply the knowledge and perform the scope of practice jointly defined by the ASRT/ACR.”

Reid said that the ACR surveyed 1,000 radiologists and 71 RPAs to determine the scope of work for RAs. What they results identified were 66 activities that an RA can perform under varying levels of supervision, both direct and general. Regardless of the results of the survey, the “supervising radiologist or hospital facility still provides the final definition of the RPA scope of practice,” he said.

John Patti, MD, FACR, offered a physicians perspective on the practice of radiologist extenders by saying “There is a need to meet the demand and workload driving us in one direction but fear is driving us in the other—fear that they will replace us.”

Ellenbogen said that a commission, the Inter-societal Commission on the Radiologist Assistant, has been formed to address these issues related to the practice of radiologist extenders and to work towards a definition of the true scope of practice—what it is today, what it will be tomorrow and what it will be 20 years from now.

“All of these efforts will not go anywhere unless we can somehow get reimbursements for RAs,” Reid said. The Centers for Medicare and Medicaid Services (CMS) does not currently offer reimbursements for the scope of work for RAs.