Masters of radiology panel discussion: radiology extenders--challenges and opportunities to balance the demands of our changing work environment.

INTRODUCTION. Each quarter, the AJR will publish the transcripts of the Masters of Radiology panel discussion hosted by Dr. Howard P. Forman and Dr. Marcia C. Javitt. The panel will review topics of importance to the field of radiology and share their unique insight into how these issues are shaping or will shape the future of the specialty. Javitt: We define radiology extenders as practitioners who work under the supervision of radiologists: physician assistants, nurse practitioners, “super” technologists. These physician extenders provide certain types of care that previously were given by radiologists to address the increasing demand for radiology services in the face of staff–physician shortages and de­ clining reimbursement. The radiology extender is a complex topic. The pros and cons of this issue depend largely on your specialty, your location, and your department. Radiology extenders definitely make us more efficient at our jobs from a labor standpoint and can help address acute staffing shortages or situations in which there are limits on the amount of time worked by house officers. They have allowed us to improve our efficiency and workforce capabilities, can improve the patient’s access to care, and can reduce repetitive tasks that we often find ourselves facing. On the con side, these challenges are complex as well. House officers may have trouble relating to the radi­ ology extenders. There may be a loss of direct or indirect subsidies for medical education. There is also the risk of problems with patient acceptance and with satisfaction and per­ formance issues on the part of residents. Additionally, the Centers for Medicare and Medi­ caid Services may recalculate how procedures that are performed by radiology extenders are reimbursed, which could significantly impact the reimbursement for our work. What’s more, once you train radiology extenders, they can then go out and work for nonradiologists. In short, if someone has a way to make us more efficient, then more power to them if they can implement that plan. Monsees: We took all of these issues into consideration when we contemplated radiology extenders as we tried to figure out how to improve our efficiency. And because we’re in breast imaging, there were financial issues, so we had to figure out a way to be fiscally responsible to the department as well. We did not want to use radiology extenders to do procedures; we wanted to limit those to our residents and fellows. However, we decided we needed some class of individual to help us become more efficient. We do a lot of communications, including a great deal of direct interaction with patients, because we’re dealing with breast imaging. We decided to try to see how they could help us in this regard, and we resolved to try nurses—they [nurses] have now become very important to our process. They don’t duplicate our technical staff and, in fact, are revered by our techni­ cal staff. They are also now a constant in the lives of our patients and play an important role in the continuity of care. We weren’t sure how we would do this, but we started this program about 6 or 7 years ago and hired an experienced oncology nurse. Even though she didn’t have experience in breast im­ aging, she was very smart and compassionate and really wanted to learn a new field. And you talk about an investment—it did take a long time to train and educate her about breast imaging. It took a long time before she could pull her own weight; I’d say a minimum of 6 months. There was the understanding that she would work with us as a seasoned professional, that she would make suggestions, and that we’d also make suggestions as to how she could help us and perform some of the time­consuming tasks we were doing. One of the things that we had Forman et al. Masters of Radiology Panel Discussion