radiologic technologists would have to limit their 'regular' work schedule to part time at least, to allow for clinical training and studying and some may need financial loans to cover tuition fees. Since only half of RAs are currently working as RAs, many radiologic technologists are not willing to take the risk. It seems obvious that both Medicare and Medicaid could potentially save millions of dollars and
therefore it would be in their interest to recognise the role of the RA (100% reimbursement versus. 85% reimbursement = savings for the insurance companies). However, historically when additional healthcare providers, such as nurse practitioners and physician assistants, have been added to the system, Medicare and Medicaid costs increase, since these groups have a tendency to order additional tests such as blood tests and imaging procedures. So this is another hurdle faced by RAs, that of trying to make non-medical legislators understand that staff in radiology generally do not order examinations or make more work. Instead, they carry out what has been requested by others, if deemed appropriate of course. Recognising RAs as suitable healthcare providers would simply improve efficiency of the radiologist and provide him/her additional time to interpret images. Perhaps fear of litigation is a factor behind the reluctance to recognise RAs. In 2012, $3.6 billion was
awarded against medical malpractice. Medical malpractice lawsuits are relatively common in the United States and are under the authority of the individual states6
. Several states have enacted a cap on damages.
According to the American Medical Association, more than 61% of physicians older than 55 years have been sued at least once. General surgeons and obstetrics/gynaecology specialty physicians are sued most frequently7
. Radiologists fall near the middle range in types of physicians commonly sued. However, were
litigation to be brought against an RA's practice, it would be the radiologist who was named in the case since they are the supervisor at all times. To date, I am not aware of any litigious situations that have involved an RA but RAs do typically have liability insurance above what a radiologic technologist would carry, which is purchased by the radiologist group employing them. My liability insurance costs $175 per year whereas my radiologist's insurance costs about $10,000 per year. I could also purchase additional malpractice insurance separate from my radiologist's should I choose for about $900 per year, although, arguably, this would be of value only if the radiologists I worked for refused to cover me. Medical malpractice insurance costs and claims vary a lot by state. My state (Indiana) is a relatively inexpensive state compared to most, due to its tort reform imposing a $1.25 million cap on medical lawsuits. I feel fortunate to have worked seven years doing what I enjoy as a radiologist assistant but when I think about the future of my career and other radiologist assistants I have more questions than answers. What will the job outlook be five years from now? Will federal legislation pass, allowing us to work to our fullest potential? Will advanced practice, such as the radiologist assistant role, become an option for greater numbers of radiologic technologists? Certainly to improve the chance of widespread adoption, it is vital that members of the profession raise the profile of such roles by belonging to national organisations, increasing their research and publication output, and by presenting at national and international congresses. Some noteworthy topics of RA publication to date include: patient satisfaction with RAs8 radiology practice9,10
, paediatric barium imaging11 , and infection control in line insertions12
, the value of an RA to a . These papers
span radiologic technologist journals, radiologists' journals, and management publications. Additionally in -57-
2014, in conjunction with the ASRT, we began journal club conference calls every other month with RAs and radiologic technologists. During these calls we discuss and critique publications, discuss current practice, and network with others in the profession. There are currently 192,000 nurse practitioners and 100,000 physician assistants in the United States. Both of these mid level providers waited nearly 20 years for federal recognition and reimbursement, but now both these professions are strongly utilised in healthcare. RAs and their radiologists can learn lessons from the experiences of these two groups, which may help expedite acceptance of the RA role. I believe RAs have the same potential to become a vital and valued part of the radiology service, but this will not be realised until legislation is passed, forcing the big insurers such as Medicare and Medicaid to recognise us.
References 1.
2. 3. 4. 5.
6. 7. 8. 9.
American Society of Radiologic T echnologists. The Radiologist Assistant: Improving Patient Care While Providing
Workforce Solutions. Consensus Statements from the Advanced Practice Advisory Panel, March 9-10, 2002. Washington, DC. American Society of Radiologic T
echnologists.
Sunshine J, Meghea C. How Could the Radiologist Shortage have Eased? American Journal of Roentgenology 187 (5) 1160-1165.
American Registry of Radiologic T Available at https://www
American Registry of Radiologic T 2014. Available at https://www
American College of Radiology T , 2006:
echnologists. Registered Radiologist Assistant Entry-Level Clinical Activities. 2010.
.arrt.org/pdfs/RRA/RRA-Entry-Level-Clinical-Activities-2014-rack-Changes.pdf.
echnologists. Registered Radiologist Assistant Entry Level Clinical Activities: July .arrt.or/pdfs/RRA/RRA-Entry-Level-Clinical-Activities.pdf.
. 2014. Available online at: http://www Advocacy/Fed%20Relations/MedicareAccesstoRadiologyCareAct.
Bal B. An Introduction to Medical Malpractice in the United States, Clinical Orthopedics, 2009;467 (2), 339-347. Kane C. Medical Liability Claim Frequency: A 2007-2008 Snapshot of Physicians. 2010. American Medical Association. Sanders V
. Patient Satisfaction with Radiologist Assistants, Radiologic T
Ludwig R, Ferrara T Radiology
10. Napel R, Sanders V 22-7.
T echnology , 2008, 5(2), 115-8. , Wright D. Radiologist Assistant: best fit for medical imaging. Radiology Management, 2014, 36 (2),
11. Odgren M. Pediatric Upper Gastrointestinal Studies, Radiologic T 12. Petree C, Wright D, Sanders V
, 2012, 83 (6) 532-40. echnology , 2014, 85,(5)523-43. , Killion J. Reducing bloodstream infections during catheter insertion, Radiologic echnology , 2014, 85 (6): 599-608. . What is your Radiologist Assistant student worth to you? Journal of American College of .acr .org/~/media/ACR/Documents/PDF/
ABOUT THE AUTHOR Cindy Petree works as a Radiologist Assistant in Indianapolis, IN for Radiology of Indiana. She has previously served as Vice President for the Indiana Society of Radiologic Technologists, and for the American Society of Radiologic Technologists as a Radiologist Assistant Chapter delegate. She also helps grade RA examinations for the American Registry of Radiologic Technologists.
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