Neiman Health Policy Institute finds 18% increase in radiology employed non-physician providers

A new Harvey L. Neiman Health Policy Institute study found that between 2017 and 2019 the number of non-physician providers (NPPs, which includes nurse practitioners and physician assistants) employed by radiology-only practices increased 18%. This increase was associated with more NPPs employed per practice, as well as an 11% increase in the number of practices employing them. 

This Journal of the American College of Radiology study was based on Centers for Medicare and Medicaid Services (CMS) databases of doctors and clinicians who participated in Medicare.[1] Radiology practices were defined as practices in which all affiliated physicians were radiologists. Two-thirds of U.S. radiologists currently practice in radiology-only practices.

The study found that radiology practices were more likely to employ NPPs when they employed more than 50 radiologists, were urban located, had above average interventional radiology specialization, and employed more earlier-career radiologists. 

“As radiology practice and professional society leaders seek to better understand and react to apparent trends in NPPs, our findings about their evolving use within the specialty could inform these efforts," explained senior author Richard Duszak, Jr., MD, professor and vice chair for health policy and practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Neiman HPI affiliate senior research fellow.

“Given how NPP scope of practice is largely defined by state laws and regulations, our observation of substantial variation in radiology practices’ use of NPPs across state lines was not surprising,” said first author Stefan Santavicca, senior data analyst in the Department of Radiology and Imaging Sciences at Emory University School of Medicine. Specifically, he said the share of practices with NPPs in 2019 was 15% overall but was 17% for urban practices and 7% for rural practices. 

The increase in the share of urban practices with NPPs increased from 10% to 17% between 2017 and 2019, but over the same period Santavicca said it increased from 5% to 7% for rural practices. “Given reduced local access to both diagnostic and interventional radiologists in rural counties across the U.S., we found it interesting that urban, rather than rural, radiology practices were much more likely to employ NPPs to meet their clinical service needs,” he explained.