With radiologists already working at record productivity levels, there is not much room left to maintain income levels by working harder. Many radiology practices are now considering the use of nonphysician providers to gain efficiencies in their radiology departments. There can be significant benefits to the use of these individuals; they can perform many tasks with limited supervision, which, in turn, frees up the radiologist to become more productive. Many of these providers move easily from other specialty areas, like surgical or primary care practices, into interventional radiology. In other cases, the nonphysician providers have worked with radiologists or were radiologic technologists before they obtained additional training.
Groups thinking of hiring such providers should carefully weigh differences in the training and experience of potential employees and consider the reimbursement ramifications. The radiology practice needs must be matched to the hiree’s education and experience. Also, rules on reimbursement differ depending on how the nonphysician provider is trained and licensed and states may restrict which functions they can perform. Some practices plan to be reimbursed for the services of nonphysician providers while other practices may view an increase in radiologist productivity as adequate return on investment.
There are five categories of nonphysician providers that apply to the specialty of radiology: nurse practitioner (NP), clinical nurse specialist (CNS), physician assistant (PA), radiology assistant (RA), and radiology practitioner assistant (RPA). Each has an educational background designed to prepare the degree- or certificate-holder for a unique role in healthcare.
NPs are registered nurses who have completed advanced nursing education, usually a master’s degree, and training in the diagnosis and management of common medical conditions, including chronic illnesses.
CNSs are advanced practice nurses, usually with a master of science degree in nursing. These professionals do not typically have a radiology background. However, their training and experience do apply to interventional radiology, specifically to performing noncomplex procedures, obtaining preexam histories and physicals, and providing postexam evaluation and management services.
PAs are broadly educated as medical providers and are regulated in all states, typically by medical boards. Educated as medical generalists, they can work with physicians in virtually any specialty, including radiology and its subspecialties. Some of the common responsibilities of a PA in radiology include obtaining patient histories and performing physical examinations, carrying out fluoroscopic tests and procedures and needle biopsies, inserting and removing central and peripheral venous catheters, and performing pre- and postprocedure evaluations and postprocedure follow-up. PAs may administer conscious sedation and they commonly provide first-assist services in the procedure room. They often serve as a point of contact between referring physicians and the radiologist. Because the supervising physician delegates responsibilities to the physician assistant, the PA’s role can flex to fit the needs of the radiology practice.
