We need to speak up against this bill - protect PA's and NP's

[navyflyPAC]

Well put. Couldn't have said it better.

[NeoTrion]

Navyfly I agree with creating roles like you said. The issue is that this role was created starting with RPA's over 10 years ago. Part of my point was that this was a long time in coming, and I know RPA and RA were possibly seeing this as an issue with PA-C's in the future. We are late getting to the table, and now we may not get a seat. They have been working towards this for quite some time. I fully agree that a Navy corpsman will run me over in trauma/ER, but I will run circles around them in radiology and/or nuclear medicine. I also used the comparison to illustrate that our profession had doctors making the same exact comments about us when our profession was getting started. That is part of the strength that made me want to be a PA-C. We will both help each other where the other is weak. In RA everyone has the same background with different levels of experience. At least in my hospital, especially in nuclear medicine, it was so much more than "just running an MRI machine." We were also a children's hospital, so we had to deal with assessment, sedation, and lab values. The point is that do you want to have to teach someone from the basement about kVp, mas, pnumbra, particle density, radioactive decay, generator dilution, etc.... In nuclear we made our own nuclear doses, either through cyclotron, reactor, or generator. That was me and not a pharm D looking over my shoulder, and it was part of my scope of practice. It took me 4 years to learn, and longer to be extremely proficient at it and the instrumentation. Perhaps your training in the navy covered this, but I know my mother (whom was also a navy corpsman) admits she did not nearly have the knowledge of lab values and possible false values before she went back school. You want someone with that knowledge so you can hit the ground running and actually learn from a different perspective what they have seen 1,000 times. In the ER and primary care the primary candidate is you, but in radiology it is a tech. No disrespect to you or the Navy intended Navfly73, but you have to be able to see the parallels.

 

Toppdog you have red my mind exactly with your replies. Your examples are right from where I was coming from.... Hence my subtle comment about the name change as well... LOL

[NeoTrion]

I think if you really want to look at an issue with RA/RPA's, it is in the case of personal accountability. PA's and NP's have to register with the state board of medicine (at least in Texas), and you can see who their supervising physician on record is, what complaints they have had filed on them in the past, education and experience, etc...... Besides what they tell me, how do I know Dr. Smith - Radiologist's license is who they are working under that day. If something were to go wrong during to procedure, what is to stop Dr. Smith from saying "I didn't train him/her and had no idea Mr. RA was doing a LP in room 1. I have never supervised this RA and barely know them. Whoever put that on the release is wrong." I would think that medicare would want to know with whom the buck ultimately stops should a medical mistake occur. To that end, what are the procedures in place for any medical mistakes made by RA's? Do they report directly to medicare, or would it be the supervising radiologist responsibility. If it is the radiologists responsibility, then what is to stop such a mistake from falling through the cracks since Dr. John claims he is not the RA's supervisor. Who do I complain to?

 

The ARRT is actually a registry and not an issuer of licenses. Do all 50 states recognize RAs/RPAs as persons with the minimal competency to conduct these procedures due to their passing the registry test with the ARRT? How do some of these states know they are even working in this capacity if there is no true state licensing or identification of these individuals? Does the ARRT inform them of an applicant that has passed their registry as an RA and has a residence in their state? Most states require the licensing and identification of people that can medically administer ionizing radiation, but not someone that can possibly kill by conducting an invasive procedure? So there is no individual licensing, record of accountability, or supervising physician on record for these individuals to be viewed by the public. Is the education that the ARRT deemed appropriate to be an RA also endorsed by AMA, and not just by what a handful of radiologists and technologists believe to be appropriate? While an internal med doctor and a family practice doctor may not know a whole lot about radiology, they do tend to know about invasive procedures. I would think they might have some slightly different thoughts on what they would want to see in the education of an RA. At this time there is entirely to many unknowns to go forward with legislation like this.

 

The only issue is if they come back in 3 or 4 years and figure out the issues here, there won't be a leg to stand on for keeping this from happening. A good strategy would then be to try and implement a certification and/or residency to flood this area with specialty PA's. This would nullify any advantage a technologists experience would have and raise our value in radiology. It would also create a seat at the table with the ARRT and ASRT with a PA-C being able to administer ionizing radiation. To me complaining about the origin of an RA would just be denying how the humble beginnings of how the PA got started. I can see the ARRT trying to draw a similarity in that fashion. I think the better idea would be to attack them on the details of their supervision and their practice. Politics loves the details, and everyone in the government wants to be able to point the finger and someone when things go wrong.

[Ho0v-man]

To be honest I am surprised this is just now coming up. I graduated from a Radiology school 8 years ago, and they were training RA's (then called RPA's) from Weber State University in Utah. They basically started the program to pick up a shortfall in Radiologist when it came to active procedures and to also read studies. They had a fight with the ARRT because the ARRT didn't want anything to do with these then RPA's, but then saw the potential to regulate another type of certification and decided to crack down. They threatened any RT that went through Weber's program with the loss of their registry if they practiced as an RT. Eventually a deal was struck with the ARRT and the RA test was formed, which is why you see RA's now instead of RPA's. I remember talking to a Radiologist about changing the rules for billing 6 years ago and he commented that the "P" makes all the difference when it comes to billing. So now we are in the present, and the profession has progressed to this. I hate to tell you guys, but there is also a similar program doing the same thing for nuclear medicine in Arkansas that has been in existence for 4 or 5 years.

 

Your scope for RA or the nuclear side of things is whatever your radiologist feels comfortable with you doing. Some read just the normal films and present them, do fluro procedures, while others are pretty advanced. I have seen some that basically assist only and just read and present to the radiologist for approval vs others that are pretty independent. But they always work under a radiologist license and have no license of their own, so to be honest they would be more like advanced technologist or "super techs" as was stated earlier. Of course the education is centered mainly with radiology in mind, right down to the pathology, so naturally anything medical beyond radiology (like performing a good PE) is out of their reach education wise. All the RA's that I worked with could write orders in radiology, but they had to be cosigned by the radiologist before they left the department. If they were in Radiology then whatever they wanted was ordered under their radiologist (say an xray for line placement). With the current rules they are not allowed to do anything invasive without the radiologist in the department, and again it is the radiologist that decides what he/she can do independently. I know in Texas they are not allowed to even hit the fluro button for medicare patients (just like PA-C's), although there have been loop holes and grey areas found for RA's due to their RT status.

 

Personally I looked at both of these options and choose the PA-C route because I want to be able to have my own patient load and ability to get out of radiology. I feel the education I have gotten so far has made me far more well rounded than what I saw with the RA's. The only thing I do say is their is no substitution for experience. I think we can agree with the medics out there that this is the case. I spent a lot of time in just nuclear medicine alone, and I doubt many people in the PA world could touch me in that department, especially when it came to dosages of beta emitters for palliative treatment or other cancers. Even the radiologist refereed to us on these matters because nuclear wasn't something most radiologists new much about or wanted to learn. Pictures were one thing, but treatment was quite another. My point is that 9 times out of 10 a "super tech", at least in nuclear, will be more adept than a PA-C in these cases, hence the nuclear RA program. My personal feeling is that I would like to see a PA-C specialty exam in radiology or nuclear, but we are slow to adopt or even formally review a matter (ex. name change). In that case groups like this will eventually try to move in and take our place at the table while we figure out where we want to sit.

 

Just be aware that these people have been doing fluro, LP's, MRI, CT, and in some cases VI with radiologists for years in the trenches. In radiology they will almost always have the advantage of time and experience, just like Dr. Stead felt the medics did in our profession. I happen to agree with the forum on the issues of biopsies and some of the VI issues, but it would have been nice to have an organization that might have seen this issue more than 10 years ago. Just my .00000001 cents worth as a person and a member of both sides.

 

 

RT ® (CT) (MR) (N) ARRT

CNMT - NCT NMTCB

PA-S

 

Well put. I've been a technologist for about 4 years and you and I both know there's some fantastic techs out there that could do a lot of stuff solo with some very minimal training. If you've been a flouro tech for 5 years, do REALLY need the radiologist to do a barium swallow? And I think these guys that have over 10 years experience before going to RA school are probably doing fantastic jobs. But what about the tech who gets into RA school 1 year after graduating x-ray school. That's a disaster waiting to happen! It's similar to RN's going to NP school after being a nurse for 1 year (they always turn out great, don't they?). Technologists are not taught anything about keeping people alive. In fact, we're so limited we aren't even legally allowed to put a pt on O2. Since they aren't taught anything about stabilizing a pt and aren't allowed to even prescribe medication, I think I'll ask them to step away from me with that bx needle. I also think there should just be a post-grad residency/fellowship/whatever you wanna call it to train PA's to take this over since they're much better equipped to do so.

 

I also can't believe this is a new topic. RA's/RPA's are not exactly a new concept.

 

RT ®(CT) ARRT