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For other articles and previous issues click here. August 16, 2004 Coming
Soon: Radiologist Assistants The first class of these new allied health professionals is now training in California. Amid the majestic sweep of southern California’s San Jacinto Mountains, 10 technologists described as “the cream of the crop” are poised to redefine the scope of their profession. Enrolled in one of two programs at Loma Linda University (LLU), these trailblazers will, in 2005, step forward to become the nation’s first radiologist assistants (RAs), embarking on an exciting new career path while providing a blueprint for other radiologic technologists to follow. Industry sources describe this contingent in many ways: as pioneers, ground-breakers, and ambassadors. Once graduated from their flagship program, the newly minted RAs will perform patient assessment, patient management, and numerous interventional procedures, freeing radiologists to spend their time reading exams. In exchange, they will command higher status, more authority, and earn more—a projected annual income of $90,000 to $95,000. Extender Origins The blossoming of the RA concept may be a simple matter of timing, taking off only when the mounting radiologist shortage demanded a break with tradition. In 2002, the American Society of Radiologic Technologists (ASRT) launched exploratory discussions with representatives from the American College of Radiology (ACR), the American Registry of Radiologic Technologists (ARRT), state licensing agencies, and the National Society of Radiology Practitioner Assistants. Subsequent meetings yielded a template for the ARRT’s envisioned RA certification model, outlining a standardized curriculum at the bachelor’s level (or higher) supplemented with formal clinical training under a supervising radiologist. In 2003, officials gave LLU the green light to launch its landmark program. By fall 2005, a new national certification examination and unique credentials will await the private institution’s first graduating class. While the initial supply of RAs will arrive as a statistical trickle, 10 more institutions that already have radiography programs plan on quickly following LLU’s lead: Midwestern State University in Texas; University of North Carolina at Chapel Hill; the University of Medicine and Dentistry of New Jersey; Bloomsburg University of Pennsylvania; Northern Kentucky University in Highland Heights; Ohio State University in Columbus; Quinnipiac University in Hamden, Conn.; State University of New York Upstate Medical University in Syracuse; University of Alabama at Birmingham; and Virginia Commonwealth University in Richmond. Each institution will determine its own entrance requirements, program length, and cost. Competitive Spots While part of the constraint is purely administrative—the pool of qualified educators is miniscule, thus hinting of additional career opportunities for RAs—another part of the equation involves winning hearts and minds. “We recognize that the first 50 to 100 graduates really need to be outstanding,” Powers says. “They really need to be embraced by the field because the RA is new and different and a big shift in responsibility. Frankly, there’s a real reluctance to embrace it—not by the radiography community at large, not by radiologists who understand the many benefits, but by other members of the medical community. People are comfortable with established relationships. When you introduce an unknown, you can’t expect it to be embraced immediately.” Challenges and Rewards While the new designation will open doors to the world of interventional medicine to RAs, they will not perform interpretations—preliminary or final—of radiologic examinations. Powers notes that the ARRT canvassed radiologists and RPAs about this very issue, asking which procedures they believed appropriate for RAs. “Their responses,” he notes, “included everything from joint aspirations and needle biopsies to lumbar punctures and physical assessment of patients. We’re talking about a whole range of things.” Yet, the consensus opinion also underscored the need for a clear division of labor. “Patients want to see their images interpreted by a specialist,” he says. “We’ve all agreed that’s not going to happen for the foreseeable future.” In practice, then, RAs will find themselves working under three levels of supervision: general, direct, and personal, each linked to a procedure’s complexity. The ARRT’s competence survey indicates that, at the general supervision level—the most autonomous—RAs could obtain medical histories, perform venipuncture, administer oxygen, and more. Direct supervision would allow RAs to perform a t-tube cholangiogram, hysterosalpingogram, and retrograde urethrogram, among others. Personal supervision is required for some venous catheter placements for dialysis, breast needle localization, and in certain myelograms. “Supervision would be either in-house or by direct contact,” says James Borgstede, MD, FACR, chair of the ACR board of chancellors. “In this era of teleradiology, you might even have an RA on the phone with a radiologist, but for the most part, this will involve direct in-house supervision. None of us envision an RA extender performing procedures while the radiologist is at home.” Another popular misunderstanding depicts the RA as a “watered-down” RPA. Powers disagrees. “Just as RPA roles vary—depending on the needs of employers—so too will RA roles. In all truth, the greatest difference between the two is probably in the name.” Powers anticipates a time when the RPA programs and credential will “fall under the RA credentialing system.” A complicating factor in achieving that objective is the existence of two certification boards, licensing exams, and honorary societies. State-by-state Battle “It’s the ASRT’s position,” he says, “that the RA scope of practice is an extension of the RT, meaning that separate licensing laws probably aren’t necessary.” He does allow, however, the need for the ASRT having to make a persuasive case in key state houses. “We may find that certain states will not permit advanced practitioners to practice there, or will not allow them to perform certain procedures,” he says. “New York, for instance, prohibits technologists from injecting contrast medium, so this would probably extend to the RA as well.” Among the many unknowns: how RAs will impact the training of resident radiologists. “Some of the skill sets traditional to resident training are no longer as prevalent,” Powers explains. “By adding an RA to that mix, the resident might get even less practice. Long term, however, I am encouraged. Creating a cross-cultural mix that finds RA students taking classes with med students, pharmacy students, and/or doctoral nursing students will benefit everybody.” As program director of LLU’s RA programs, Laura Alipoon, EdD, RT(R), has a front-seat view of the development of RAs. “Our students are the leaders in their field,” she says. “They’re high achievers with an average 10 to 14 years of experience. We received a lot of applications. Part of our selection was based on grade point average, part on interview, and part on how well the candidates presented. Some applicants just weren’t qualified. And, frankly, we turned some away because they didn’t exhibit sufficiently critical thinking, people skills, or the ability to hold their own with a radiologist.” Curriculum Overview “Notably,” she continues, “seven of 10 students were offered tuition reimbursement [by employers]. Some are having their entire tuition paid, with the understanding that they will work for the radiology group after they complete the program. We’re hoping this tuition support becomes the template for the nation.” Reflecting on the Loma Linda 10 who make up the first RA class, Alipoon says they’re beginning to shift people’s view about their possibilities in radiology. “They are really changing minds. They’re ambassadors, pioneers. At one group practice, one of the radiologists said he was totally against the RA concept. He said he wouldn’t work with them. All of that changed when one of my students went there and dazzled the entire group. That same radiologist was so impressed that he took [the student] under his wing.” Alipoon allows that the RA model does not have universal appeal. “Some groups may be too big, some too small, some may have residency programs and won’t see where the RA fits in,” she says. “For many places, however, it is very doable.” Looking Ahead And so, in the final analysis, what does the RA movement mean for the consumer? Taking on this key question, Powers comments, “I think this means a high continuity of care for patients. The RA can take a patient all the way through the process—from physical assessment to analyzing records to completing the examination and postexam process. The RA will really take the time to respond to the patient’s concerns and questions. This is a big moment for all of us.” — Matthew Robb is a freelance writer based in the Washington, D.C., suburbs. He is a frequent contributor to Radiology Today.
Hawkins, 37, brought talent, education, and experience to the RA program when it commenced in fall 2003. In addition to possessing a BS in radiology sciences, he has specialties in MR, CT, angiography, and cardiovascular angiography. He even once considered enrolling in a physician’s assistant program or tackling medical school, “but when Loma Linda’s RA program was announced last year,” he says, “I embraced it.” Assessing the 18-month certificate program, he says, “it’s intense. The students have exceptional talent. Even though I had been in the industry for 14 years and know cross-sectional anatomy, there was a steady learning curve. In clinic, the radiologists interact with me essentially as a radiology resident and they’re presenting quite a bit of information that I have to coordinate with my didactic experience. It’s a lot to assimilate initially, but you start making connections and it becomes clearer as time goes on. “My most challenging coursework to date was ‘Image Evaluation and Procedures’—just keeping all of the disease processes and pathologies straight was challenging. For those who can set aside a consistent study pattern and discipline themselves to maintain good study habits, however, it’s not that difficult. “I’m having a great time,” he continues. “I’m enjoying the clinical experience immensely. We’re in clinic three days each week this quarter and sometimes I come in four days because there’s so much enjoyment in doing the clinical rotations and performing interventional procedures, such as angiography, fluoro exams, myelograms, and more.” As Hawkins nears the midpoint in Loma Linda University’s pioneer program, he says he wants to continue working with the radiologist group at Valley Health System—where he started clinical rotation as an x-ray student in 1988. “I see a real need for the radiologist assistant,” he says. “And I’m proud to be in the first class in the nation that will complete the RA program.” — MR |
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