What is the Role of Physician Extenders in Radiology?

A look inside the October RFS Journal Club


November 2015

In the current world of physician shortages and demand for more affordable care, the extent of advanced practices providers’ role in health care is a topic of interest. Some predict that the country’s demand for physician services may soon exceed the supply, creating a drive for the increased utilization of nurses and physician assistants in clinical practice.

In an attempt to evaluate this subject, Nahara Anani Martínez-González et al. conducted a meta-analysis on published controlled trials that compared nurse-led care with that of primary care physicians’. A total of 26 studies discussed in 36 publications were included in the analysis, ultimately comprising 38,974 participants. The researchers assessed the care provided in each study based on five different categories: satisfaction, quality of life, hospital admission, mortality, and costs.

As has been historically demonstrated, patient satisfaction scores showed a significant increase with nurse-led care. Interestingly, this effect seemed to diminish in studies of ongoing care, non-urgent care visits, and longer follow-up episodes. Hospital admissions were significantly reduced with nurse-led care and these results were even stronger in studies of ongoing care, non-urgent visits and longer follow-up episodes. Mortality was also reduced with nurse-led care. Again, reduced mortality increased more when researchers examined ongoing care, non-urgent visits, and longer follow-up episodes. Nurse-led care seems to have a link with better patient satisfaction, decreased inpatient admissions and lower mortality, particularly in longer episodes of care.

Another study conducted by Duszak et al. evaluated the trends in non-vascular invasive radiology procedures performed by physician extenders from two large hospitals. By reviewing Medicare claims from 1994 through 2012, the study demonstrated that claims from physician extenders have dramatically increased at a faster rate compared to other providers. The increased utilization demonstrated by Duszak et al. suggests a growing demand for health care providers.

The growing roles for physician extenders and other health care providers can lead to some concerns, particularly when applied to the imaging specialty. Will physician extenders remain strictly within the procedural domain or can they be incorporated into diagnostic roles? If so, to what degree? Physician extenders might be beneficial if trained in emergency diagnostics, which would allow specialized radiologists to focus more on their own fields.

In this dynamic health care climate, how will the increased use of physician extenders affect the goals of the ACR’s Imaging 3.0™ initiative? It is possible that physician extenders will become the new face of radiology to patients and referring physicians, allowing physicians to remain hidden in the reading rooms. On the other hand, physician extenders might simply aid in strengthening a radiology department.

What affect will the increased use of physician extenders have on resident education? As training programs become more equipped with physician extenders, it is possible that lower level trainees might be shorted out of performing certain procedures, allowing valuable experience to be lost. What will be the outcome be if residents become increasingly trained by physician extenders rather than physicians?

The answers to these and other questions posed during the meeting remain largely unanswered and unresearched, noted Richard Duszak Jr., MD, FACR. Larger and more statistically significant studies need to be performed before implementing changes in the delivery of health care. As the increased use of physician extenders seems to be inevitable, radiology needs to embrace new roles for these providers and take an active stance in regulating how they are further incorporated into the practice of radiology.

By Travis Fuchs, MD, radiology resident at SUNY Downstate Medical Center in Brooklyn, N.Y.

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