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Radiologists Increasingly Turn to Physician Extenders

As radiology practices grow busier and more complex, many are turning to physician extenders (PEs) to help in a variety of areas. In fact, two types of PEs — physician assistants (PAs) and nurse practitioners (NP) — are experiencing significant growth as radiologists face ever-mounting workloads.

Radiologists Increasingly Turn to Physician Extenders

While PAs and NPs make up the greater number of PEs, radiologist assistants (RAs) — another type of PE — are gaining a greater foothold in radiology where the specialized nature of RA training is demonstrating value.

The history of PEs dates back several decades. PEs emerged in the 1960s as mid-level providers who could help alleviate the impact of physician shortages experienced at the time, including in radiology.

The number of NPs and PAs accelerated over the ensuing decades, and job growth shows no signs of abating. In 2017, more than 234,000 NPs were licensed in the U.S., according to the American Association of Nurse Practitioners (AANP) — almost double the total from 2007. PAs numbered more than 115,000 in 2016, according to the National Commission on Certification of Physician Assistants, a 6.3 percent increase over the previous year.

The growing number of radiology practices with PEs on staff are reporting positive experiences.

“Every practice is different, but I have yet to hear of someone who took on a physician extender and regretted the decision,” said Thomas A. Shin, MD, an interventional radiologist with the DuPage Medical Group in Lisle, IL. “They improve workflow, help manage the workload and generally improve the radiologist’s day.”

“We have an increasing workload due to the volume of cases and the unpredictability of scheduling residents and fellows,” said Charles O’Malley, MD, a diagnostic radiologist at the Cleveland Clinic, Ohio, where PEs have been on staff in the abdominal section of the radiology department since last year. “PEs make everything run more efficiently. They have been very helpful to us.”

Nationally, the radiology workload has increased over the past several years, particularly on the diagnostic side. (See, “Survey Shows Radiology Salaries Dipped Slightly in 2017” ).

PAs, NPs Have Interventional Focus

Each type of PE has a unique set of qualifications and scope of practice, as dictated by individual state regulations.

PAs are licensed health care professionals who directly provide medical care under physician supervision; NPs are registered nurses with advanced clinical training who provide medical assistance under physician supervision, or in some states, independently. Both PAs and NPs have obtained a master’s degree as the minimum qualification, while many NP programs have transitioned to doctoral degrees. Both are licensed in all 50 states.

NPs and PAs have similar scopes of practice. Typically, both can conduct physical examinations, diagnose and treat illnesses and order radiologic studies, although duties vary according to state regulations, which also dictate whether PEs require direct physician supervision.

According to a literature review, the impact of PEs is evident in the interventional radiology suite, where they can assist radiologists by performing vascular access, drainages and other lower-level procedures, according to Vicki Sanders, MSRS, associate professor at Midwestern State University in Wichita Falls, TX, and president of the Society of Radiology Physician Extenders, one of several physician extender associations.

Along with Jennifer Flanagan, MSRS, Sanders authored the 2015 study, “Radiology Physician Extenders: A Literature Review of the History and Current Roles of Physician Extenders in Medical Imaging,” in the Journal of Allied Health.