The manpower shortage: Are physician extenders the answer?
Dr. Shaw de Paredes is a Professor of Radiology and the Section Chief of Breast Radiology at the Medical College of Virginia of Commonwealth University, Richmond, VA. She is also a member of the editorial board of this journal.
The manpower shortage in radiology continues to grow as the rate of imaging examinations supersedes the rate of newly trained radiologists beginning to practice. The population of adults over age 50, and, therefore, the number of imaging exams, is skyrocketing. Radiologists, particularly interventional radiologists, have taken on many of the procedures previously performed by other specialists. How do we maintain the coverage of all these services and provide the proper quality of care? Is there a role for nonphysicians in this process?
Many other specialties have long used nurses, physician's assistants, nurse practitioners, and midwives to provide varying levels of patient care. Some radiology practices now utilize such individuals to assist them--helping with interventional procedures, obtaining consents, and counseling patients. All of this certainly allows the radiologist to manage a larger volume of work and to prioritize the physician-specific aspects of care--interpretation of images and performance of procedures. However, now there is discussion about expanding the role of nonphysician providers--training "super-techs" and nurses to actually perform some of the procedures and even interpret studies. In the vast majority of cases, I think that this is wrong.
Over the years, I have had the good fortune to work with several particularly outstanding mammography technologists--women with an excellent "eye" and the ability to discern subtle findings. Does that mean that they should be reading screening mammography? I don't think so. I have an interventional technologist who has trained many physicians in the theory of stereotactic biopsy, yet I don't think that she should be performing the procedures. Any experienced breast interventionalist knows that the technical aspect of performing the procedure is most often not difficult, but the ability to troubleshoot and confidence in proper lesion targeting is complex and requires great skill. Screening mammography is one of the most difficult interpretative examinations that we perform, yet some believe that a technologist could perform this task. The same is true for many other areas of radiology.
The use of physician extenders to perform procedures in academic institutions can impact residency training by reducing the number of studies available for the radiology residents to perform. In addition, the training of nonphysician providers to perform billable studies that radiologists have traditionally performed for years opens the door for other specialists to recruit these individuals and to compete for these services.
I do believe that our efforts should be placed on improving residency education, increasing the number of radiology residency positions, and guiding our residents into the subspecialty areas with the greatest shortages. If we can utilize nonphysicians to assist us in our daily work, we may be able to be a bit more efficient. However, I strongly discourage the utilization of these individuals to replace us in interpretating images and performing procedures. What, then, was the purpose of college, medical school, radiology residency, fellowship, and board certification?