Physician Assistants and Radiology

Imagine the efficiency of working with a medically and surgically educated assistant who can provide a wide range of procedures at your direction and discretion. Hiring a PA is like gaining an extra pair of eyes and hands, and more hours in the week for research, difficult cases, or other interests.

Physician assistants provide medical and surgical care with physician supervision. Their medical education, versatility, and commitment to personalized care help practices to function more smoothly. They offer physicians increased revenues and improved patient satisfaction levels along with more flexible, forgiving work schedules.

Although physician assistants originally were envisioned as a primary care profession, at least a few PAs have practiced with radiologists since the profession's earliest days. In recent years that number has begun to increase as radiologists have realized the excellent skills and value PAs bring to their practices. As of January 2007, there were more than 63,000 physician assistants in clinical practice, with a small number working in radiology. PAs are licensed providers, nationally certified, and are recognized as covered providers by Medicare and most private insurance plans.

PA EDUCATION AND CREDENTIALS

Physician assistants are trained in intensive education programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). PA programs are offered at medical schools, colleges and universities, and teaching hospitals. The average program is 26 months long. The rigorous curriculum consists of classroom and laboratory instruction in the basic medical and behavioral sciences (such as anatomy, pathophysiology, pharmacology, clinical medicine, and clinical diagnosis). The didactic year is followed by clinical rotations in internal medicine, family practice, general surgery and surgical subspecialties, obstetrics and gynecology, emergency medicine, psychiatry, and geriatrics. PA education promotes the development of practical skills in clinical problem solving and decision making. Physician assistant students complete on average more than 2,000 hours of supervised clinical practice prior to graduation.

All states, the District of Columbia, and Guam regulate PAs, usually through the board of medical examiners. After graduation, PAs are required to pass the national certifying exam before they can be licensed to practice. Only graduates of accredited programs may take the exam, which is developed by the National Board of Medical Examiners and administered by the National Commission on Certification of Physician Assistants (NCCPA). Practices and hospitals that are hiring or credentialing PAs should verify that they are graduates of physician assistant programs accredited by ARC-PA (or its predecessor organizations) and are NCCPA certified.

To maintain NCCPA certification - required by some states and many employers - PAs must complete 100 hours of continuing medical education every two years and take a recertification exam every six years.

All fifty states plus the District of Columbia permit delegated prescribing by PAs. The vast majority of those states include controlled substances as part of this authority. All PA educational programs have pharmacology courses. Nationally, 78 hours is the mean number of hours of formal classroom instruction in pharmacology. PAs are capable of administering and monitoring conscious sedation.

THE PA ROLE

PAs work in virtually every medical and surgical specialty and subspecialty. Radiology practices find that PAs who have worked in other specialty areas bring many useful skills to the overall operation of the radiology department.

Physician assistants work within the scope of their supervising physician, taking into account any specific limitations in state law. Because the supervising physician has a great deal of latitude in what he or she delegates to the PA, the PA's role can be very flexible to fit the needs of the practice. A number of PAs in radiology were interviewed to provide examples for this Issue Brief. Most worked in interventional radiology practices or departments. In addition to the case examples described below, the PAs performed fluoroscopies, initial interpretations on scans and X-rays, needle biopsies, angiography, insertion and removal of venous catheters, and dye injections. The following cases describe how physicians worked with PAs in three practices.

One group of 20 radiologists hired a PA to help out generally in the group and specifically to assist an interventional neuroradiologist who was setting up new programs. In addition to assisting the neuroradiologist, the PA focused on post-treatment rounds and consults. A positive experience with the first PA quickly led to the hiring of another PA to conduct histories and physicals, perform and assist with invasive procedures, and write discharge summaries. The physicians also wanted the PAs to perform fluoroscopies. Though it was within their scope of practice, the PAs were too busy with other duties. In that state, radiologists could delegate to the PAs anything within their scope except final interpretations on scans and X-rays.

In another state, an interventional radiology practice hired a PA who started out doing all the first assisting with one physician. Eventually, the practice added three physicians, a fellow, and two residents. Because the fellow and residents took over the first assisting, the PA was asked to take on a new role. She took over most of the communicating with referring physicians and performing case evaluations, including such things as determining if patients needed antibiotics, IV orders for hydration, and insulin management. She still performed some procedures, such as removing venous access catheters. Though the PA said she preferred first assisting to her new role, she admitted that her new duties contributed a lot toward keeping the department running smoothly.

Another PA working in interventional radiology at a major teaching hospital said he spent most of his time running the outpatient department. He performed histories and physicals and wrote lab orders. He assisted on some procedures and followed patients afterward. This particular practice had a high percentage of liver patients with biliary tubes. The PA provided patient education on dealing with the tubes. He assisted with placement and maintenance of tubes and removed 95% of the Hickman catheters. He also did a lot of coordination and consultation by phone with patients who needed help with their tubes and with family physicians who needed to know about caring for their patients' tubes.

STATE LAW ISSUES

The PA scope of practice and the physician supervision requirements are defined in each state's physician assistant practice law and regulations. Usually, the scope of practice is quite broad, granting the supervising physician most of the say in what is delegated. Radiologists who wish to employ PAs should also check the radiologic technology laws and state ionizing radiation safety laws to see if they would prohibit PAs from taking X-rays or performing any other radiological procedures. For example, in New York State, the PA practice act does not restrict PAs, but the radiologic technology law does not allow PAs to take X-rays. Information about such restrictions may be available from the AAPA or the state PA chapter, the state medical board, or a state radiologic technician association or regulatory board. Many laws and regulations also are available on the Internet.

REIMBURSEMENT

Medicare covers medical services provided by PAs at 85 percent of the physician fee schedule. Medicare generally allows PAs to deliver the same services that physicians provide (within the PA's scope of practice as determined by state law) using the same Current Procedural Terminology (CPT) codes. Payment is made to the practice.

Medicare follows PA regulations in each state regarding the degree of physician supervision required. Under Medicare's guidelines, the physician supervisor need not be physically present with the PA when a service is being performed unless specifically required by state law or by facility policy.

Private insurers generally follow Medicare's lead on reimbursement policy. There may be some requirements that physicians provide the final read on scans and X-rays.

COST-EFFECTIVENESS AND EXCELLENCE IN PRACTICE

Studies show that PAs, practicing as part of a supervising physician's team, provide high quality health care. A 1994 federal study of state practice environments reported, "Within their areas of competency, and with appropriate training and supervision, these practitioners may provide medical care similar in quality to that of physicians at less cost." An AMA Socioeconomic Monitoring System survey of approximately 4,000 practices found that employing PAs improved productivity.

Studies of patients have shown a high level of satisfaction with care provided by PAs. In its 1994 report, the federal Advisory Group on Physician Assistants and the Workforce concluded that published research since the profession began has consistently found a high level of patient acceptance. A large 1995-96 Kaiser study evaluating patient satisfaction with PAs, nurse practitioners, certified nurse-midwives, and physicians in a managed care setting concluded that "patient satisfaction with interpersonal care appears to depend on communication style and not on type of provider."

RESOURCES FROM THE AAPA

The American Academy of Physician Assistants offers numerous resources to assist a practice or institution in effectively employing PAs. Publications such as Hiring a Physician Assistant, Physician Assistant Third-Party Coverage, and Physician Assistants and Hospital Practice, may be ordered by calling 800/708-7581. Other information is available on the AAPA's Web site, www.aapa.org or by calling the AAPA at 703/836-2272.

Issue Brief: Physician Assistants and Radiology
2/08

 

 

Last Revised: 2/20/07