APC Imaging: An Opportunity for Better Interaction with Ordering Clinicians?

The following post was contributed by Melissa Chen, MD

Danny R. Hughes, PhD, research director and senior research fellow of the Neiman Health Policy Institute, recently guest moderated the February ACR Resident and Fellow Journal Club session and discussed his article published in JAMA Internal Medicine titled, “A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office Based Evaluation and Management Visits.”

Advanced Practice Clinicians (APCs) often referred to as “physician extenders” include Nurse Practitioners and Physician Assistants. The article discussion took a pro-con framework, based on the question, “Are the expanding roles of APCs beneficial to radiology?”

On the con side, it was discussed that increased imaging volume by APCs in a primary care setting could dilute the value of imaging, particularly with inappropriate imaging. Additionally, it was discussed that APCs in the IR setting could potentially take away from the training of residents and fellows as they may be performing the procedures independently.

Fellow Stuart Cohen, started the discussion of the pros. He suggested that the increasing number of APCs in the clinic setting was an opportunity for radiologists to demonstrate their value by protocolling the appropriate exam with the help of ACR appropriateness criteria and functioning as the consultant in the care of the patient. In particular, Clinical Decision Support could be the key tool enabling radiologists to deliver cost-effective and quality imaging care to the patient. He argued that APCs may be a great face for radiology with proper supervision.

Joining via Twitter, resident Amy Patel and fellow Sumir Patel suggested that educating APCs about radiology appropriateness criteria prior to their clinical practice will lay the groundwork for better imaging utilization. Furthermore, radiologists need to take the lead, to make themselves more available, and educate APCs, with the help of Clinical Decision Support, to break the bad habits APCs may have picked up from physicians.

To further support the pro side of the debate, resident McKinley Glover pointed out that the increased imaging utilization could lead to overall decreased downstream health care costs, a potential area for further investigation. He also played devil’s advocate suggesting that perhaps primary care clinicians are under-ordering imaging studies, and APCs may be appropriately ordering a larger number of imaging studies.

Dr. McGinty concluded that Dr. Hughes’ work and article highlight the importance that radiologists collaborate with the health care team, and the key role Clinical Decision Support can play in preserving the value of radiology and radiologists.

The ACR Resident and Fellow Journal Club occurs bi-monthly, and we hope to continue debate of future topics that affect radiology and radiation oncology.

Information about future journal clubs can be found here.

Discussions can also be followed on twitter via @ACRRFS and #RadRes.

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