Many radiology practices throughout the country are understaffed and overworked. But, it is not just the attending radiologist that can suffer the consequences of decreased time and increasing workload, it is also the radiology resident. Due to the increased burdens of radiologists, radiology residents may have decreased time to attend conferences, increased service obligations, less availability to perform procedures, and increased psychological stresses of having to get the daily work completed. One potential solution for the hospital based radiology practice to improve these conditions is to hire physician extenders. So, I am going to briefly discuss the types of physician extenders, how they can be utilized in practice, and finally how physician extenders can be used to improve the residency program.
Types of Physician Extenders
There are multiple excellent articles describing the roles of physician extenders. I will list a few of these articles including in Applied Radiology called Physician Extenders: Which one is right for you? , an ACR article called Registered Radiology Assistant/Radiologist Practitioner Assistant, and a sirweb article called: Position Statement: The Role of Physician Assistants in Interventional Radiology. I highly recommend reading these articles to get the nitty gritty details of each type of radiology physician extender. But to summarize I am going to list the different types and describe each briefly. These include Physician Assistants, Nurse Practitioners, Radiology Practitioner Assistants, and Registered Radiology Assistants. According to the sirweb article, only Physician Assistants and Nurse Practitioners can “order tests, write prescriptions, make diagnoses, and get reimbursed for services performed”. On the other hand, all of these physician extenders including the Radiology Practitioner Assistants and Registered Radiology Assistants can perform procedures. So, for a practice that needs more than just procedural help (most practices), Radiology Practitioner Assistants and Registered Radiology Assistants may not be the correct fit.
How Can The Physician Extender Be Utilized?
As I have perused the literature and forums on this topic, I have found that the responsibilities of the Physician Extender to be pretty varied. (1) Most commonly, they tend to work with interventional radiology and help to perform procedures such as Paracentesis, Thoracentesis, and Catheter Placements. But, they can certainly be involved in more complex procedures such as Nephrostomy tube placement and so on.
In addition to procedures in many practices, they also take responsibility for preliminarily approving patients for cases, taking patient histories, and getting consents for procedures. And, Nurse Practitioners and Physician Assistants can write orders before and after procedures as well as be involved in preliminary dictations. In some academic practices, they can even help out with data collection in research studies. So, their practice responsibilities can be very useful to many different types of academic practices.
Are Physician Extenders Helpful For a Residency Program?
Fear not radiology residents. Physician extenders are not here to take over the world!!! For most radiology residencies, the ability of the physician extender to perform such varied work, allows the radiology resident and staff to focus on other more important needed learning issues. These physician extenders are independent but not independent enough to run a department for themselves, so they will never take over the radiologist’s job.
At the same time, imagine you are responsible for getting consents during the daytime for all the PICC lines and for the first time the practice has introduced a physician extender to the practice. Now you can share in the responsibility of obtaining consents. They can write notes on the floors and talk to family members. These are also activities that will allow you and your attendings to concentrate on some of the more advanced work in the department.
In addition, some physician extenders have lots of procedure experience and are excellent teachers. You may have a physician extender who can teach you how to do a PICC line or Portacath when the attending is not directly available. Or, the physician extender can possibly perform procedures such as a paracentesis and allow the attending and the resident to take care over other more complicated cases simultaneously.
Although I am not an interventional radiologist, my experiences with physician extenders have also been extremely positive. When I was a resident, the practice hired a nurse practitioner and he helped to organize what we called “tube rounds”. It was a time in the morning when we would decide if we needed to pull catheter tubes, keep them in, or recommend other interventions. I learned a lot from both the physician running the “tube rounds” and the nurse practitioner who became adept at taking great clinical histories and understood the patients he followed very well. He also became friendly with many of the clinicians such as the surgeons and GI doctors. It was a net positive for the medical team, my learning experience, and I’m sure he brought in more business for the hospital as well.
Physician Extenders Can Be A Radiologist’s And Residency Program’s Best Friend
In today’s demanding environment with the need to increase efficiencies, a physician extender can be the right fit for an academic department. The ability of the extender to do procedures, teach, and consult can be a major benefit for the busy attendings on staff and the residents in the department. Not only can it increase department productivity, but it can significant increase morale of the attendings and residents alike. It is a decision that needs to be weighed carefully, but for many departments and residency programs, the physician extender brings significant long term benefits.