ACR has concerns about nonphysician scope creep in radiology
The American College of Radiology has growing concern that expanding the scope of practice for nonphysicians, specifically nurse practitioners and physician assistants, could undermine patient safety and diagnostic accuracy in medical imaging. Efforts to expand the scope of practice for these lesser-trained clinicians are increasing as the growing shortage of physicians becomes more pronounced, especially in rural areas.
ACR is not alone in its concerns. The broader medical community, including the American Medical Association, has voiced opposition to what it calls “scope creep,” when nonphysician providers take on responsibilities traditionally handled by physicians, without the equivalent training.
"We love our clinician colleagues, our nurse practitioners and physician assistants. However, we strongly feel they should be part of the physician led team because of the difference in education. A lot of people don't realize what they don't know. It's just the fact of the matter—look at the numbers of the years of education, and education does matter," Alan Matsumoto, MD, chairman of the ACR Board of Chancellors and professor of radiology at the University of Virginia, explained in an interview with Radiology Business.
He emphasized that ACR supports team-based care, but warns against allowing nonphysician providers to operate independently in areas requiring deep clinical expertise, like radiology. Physicians undergo a rigorous training pathway with four years of medical school with around 6,000 clinical hours, followed by years of residency. In contrast, nurse practitioners may complete as few as 500 to 1,500 hours of clinical training, while PAs average about 2,000 hours. Despite this gap, many NPs and PAs are being granted authority to practice autonomously, even in specialties like radiology.
Shortages prompt policymakers to tap less-trained clinicians
In December, the Centers for Disease Control and Prevention asked for public comments on expanding its B Reader Program, which trains and certifies nonradiology physicians to examine chest radiographs of workers partaking in federal health surveillance programs. Needing more than the 184 U.S. physicians across 35 states who were certified as B Readers, the CDC explored expanding this to include nonphysicians as readers.
Legislative efforts at the state level have also caught the attention of ACR. In Oklahoma, two bills, H.B. 2298 and H.B. 2584, sought to expand independent practice and prescribing rights for NPs and PAs. Though initially vetoed by Gov. Kevin Stitt, the legislature overrode the vetoes, sparking concern among radiologists. The lawmakers argued there is a greater need for more access to healthcare, especially in rural and remote parts of the state.
“These bills passed despite advocacy from the Oklahoma Radiological Society, the ACR, and even the American Society of Radiologic Technologists,” Matsumoto noted. “This gives them licenses to practice independently and have prescriptive power. That raises our concern."
Hattiesburg Clinic study found NPs did not lower costs
Using the example of primary care physicians who refer complex cases to specialists because they understand their limits, he said this is not always the case with nonphysician providers. In the case of imaging, nonradiologists are not trained to synthesizing scans, labs, and clinical context; so, they order more tests, do more physician consults and can misdiagnose patients or not fully understand how to best manage them.
Matsumoto cited data from the Hattiesburg Clinic in Mississippi, where a decade-long evaluation showed that NP-led care resulted in higher costs and worse outcomes. Patients treated by NPs had more lab tests, imaging and specialty consults ordered, yet patients ended up sicker and visited the emergency department more frequently than those managed by physicians. Similar studies in emergency departments found similar results, he said.
"They found the cost of care actually went up because of NPs. So there's evidence to say that NPs don't necessarily cut costs or improve the care when they're not working as part of a dyad with a physician. We want to do what's best for patients and we want to ensure that they're well cared for," Matsumoto said.
As debates over workforce shortages and access to care continue, the ACR is urging legislators and regulators to prioritize evidence-based policymaking and preserve the integrity of physician-led diagnostic care.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]