The professional titles are similar but that is where the similarity ends. Physician assistants (PAs) and radiology practitioner assistants (RPAs) have significantly different training and responsibilities in the field of radiology. While either practitioner may be an asset to a radiology practice, each provides distinctly different services. It is important to recognize the scopes of practice and limitations of both of these professionals in order to utilize their expertise to the fullest extent.
PHYSICIAN ASSISTANTS
Physician assistants are health care professionals who practice medicine with physician supervision. Educated as medical generalists, they work with physicians in virtually any specialty, including radiology and its subspecialties. PAs are licensed in every state, are nationally certified by a single body, and are recognized as covered providers by Medicare and most private payers.
The profession began more than thirty years ago, when physicians at Duke University recognized the need for a health professional trained in the medical model who would work with physician supervision to extend patient access to care. The founders, led by Dr. Eugene A. Stead, Jr., then chairman of Duke's department of medicine, envisioned a medical school-type curriculum, geared toward primary care and focused to provide the appropriate education in an intense and uniquely designed curriculum. The profession has retained this commitment to the medical educational model and to team practice with physician supervision.
In recent years radiologists have realized the excellent skills and value PAs bring to their practices. Some PAs move easily from surgical practices into interventional radiology. In many cases, PAs who work with radiologists were radiologic technologists before they became PAs.
PA Education
Physician assistants are trained in intensive education programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The programs are offered at medical schools, colleges and universities, and teaching hospitals. As of October 2002 there were 134 accredited physician assistant educational programs throughout the country, averaging 26 months in length. PA students bring with them to PA school a wide variety of medical backgrounds, including but not limited to radiologic technology, nursing, respiratory therapy, physical therapy, and paramedic training.
The rigorous PA program curriculum consists of classroom and laboratory instruction in the basic medical and behavioral sciences, including anatomy, pathophysiology, pharmacology, microbiology, 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, pediatrics, and other elective rotations. PA education promotes the development of practical skills in clinical problem solving and decision making. Physician assistant students complete an average of more than 2,000 hours of supervised clinical practice prior to graduation. The number of students graduating from accredited programs is increasing each year. Four thousand new graduates are expected in 2002.
PA Regulation
All states, the District of Columbia, and Guam regulate PAs, usually through the board of medical examiners. After graduation, PAs must pass a 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). To maintain NCCPA certification, which is required by some states and many employers, PAs must complete 100 hours of continuing medical education every two years and take a re-certification exam every six years.
Physician assistants have delegated prescribing privileges in forty-seven states plus the District of Columbia. More than three-fourths of those states include controlled substances as part of this authority. The study of pharmacology is part of all PA programs. Nationally, 78 hours is the mean number of hours of formal classroom instruction in pharmacology.
PA Scope of Practice
PAs work within the scope of practice of their supervising physicians and within additional parameters defined by state law. Along with reviewing the PA practice act, radiologists who wish to employ PAs should check the radiologic technology laws and state ionizing radiation safety laws to see if they prohibit PAs from taking X-rays or performing any other radiologic procedures. Some states require PAs to have additional specific training in order to perform radiologic procedures. Assistance in determining the requirements is available from the AAPA.
Some of the common responsibilities of a physician assistant in radiology include performing histories and physical examinations; performing fluoroscopic tests and procedures, needle biopsies, and angiography; inserting and removing central and peripheral venous catheters; providing initial interpretations of studies, performing pre- and post-procedure evaluations and post-procedure follow-ups, and writing discharge summaries. PAs may administer conscious sedation, and they commonly provide first assist services in the operating or procedure room. They often serve as a point of contact between referring physicians and the radiologist. PAs may also write medical orders and interpret laboratory tests. Because the supervising physician delegates responsibilities to the physician assistant, the PA's role can be very flexible to fit the needs of the practice.
RADIOLOGY PRACTITIONER ASSISTANTS
Radiology practitioner assistants are radiologic technologists with additional education and responsibilities. State licensing laws do not distinguish between radiologic technologists and RPAs, except in New York. (In that state, radiology practitioner assistants are regulated as "specialist assistants" under a section of the medical practice act. When they practice there, they are called "specialist assistants" or "SAs.")
There are many certification exams available to radiologic technologists, covering numerous specialties within radiology. In addition, there is a specific certification exam available to RPAs. RPAs and radiologic technologists are not recognized providers for purposes of insurance reimbursement, but rather are covered as part of global fees or "incident to" the physician's services.
The radiology assistant concept was first conceived in the 1970s as a way of training radiologic technologists to be physician extenders in radiology. The University of Kentucky and Duke University offered advanced training programs for radiologic technologists. The graduates were typically called "radiology physician assistants." In the late 1970s when federal funding was cut, the programs closed. A small number of the graduates from the 1970s remain in practice as "radiology physician assistants," mostly in Kentucky and North Carolina. They are not eligible for the certification exam currently offered to radiology practitioner assistants.
In 1994, representatives from the Department of Defense (DOD) approached leaders at Weber State University in Ogden, Utah, asking that they create a radiology assistant program for the military. Before the program could get off the ground, federal budget cuts once again eliminated government support. Nevertheless, two years later Weber State introduced a two-year training program to interested radiologic technologists. Candidates must have a minimum of five years on-the-job experience and who are registered with the American Registry of Radiologic Technologists (ARRT), the certifying agency for radiologic technologists. The name "radiology practitioner assistant" was coined in 1997. Currently, Weber State University is the only educational institution in the United States to offer this program.
RPA Education
The goal of the RPA program is to prepare radiologic technologists to more fully participate in patient care and management within a radiology department. RPA coursework focuses on radiologic services. Courses center on the performance of a variety of imaging procedures and the evaluation of images to determine normal from abnormal pathology. Anatomy and physiology, proper patient placement, and radiological patient assessment are part of the core course requirements. Additional classes in clinical pathways, radiation biology, health physics, and primary radiologic medicine are offered. Students must also complete a clinical preceptorship in a radiology department.
The two-year program is accredited through the Northwest Accrediting Agency for Colleges and Universities and is designed to be completed through distance learning. Students attend intensive classes on campus twice a semester. Typically, students receive a bachelor of science degree upon completion of the program. Upon graduation, the Certification Board for Radiology Practitioner Assistants (CBRPA) offers a certification examination for RPAs. As of November 2001, the CBRPA had certified 45 RPAs. Fourteen new RPAs are expected to graduate and take the certification exam in 2002.
RPA Scope of Practice
Because the RPA is an extension of the radiologic technologist, RPAs must maintain their ARRT certification, must maintain the continuing education requirements of the ARRT, and are licensed as radiologic technologists. The scope of practice of the radiology practitioner assistant is defined by the supervising radiologist. The RPAs' responsibilities include conducting radiologic patient assessments, participating in patient management, and separating normal from abnormal imaging exams. The majority of RPAs work in hospital radiology departments and imaging centers.
THE DISTINCTIONS
Despite the similarity in the titles, radiology practitioner assistants (RPAs) and physician assistants (PAs) are separate professions with distinctly different educational models and curricula.
Physician assistants are broadly educated as medical providers and are regulated in all states, typically by medical boards. They diagnose and treat patients, order tests, and prescribe medications, working with physicians in all medical and surgical specialties.
Radiology practitioner assistants are radiologic technologists with additional radiology training. They practice strictly within radiology, providing expanded patient management, performing more complex procedures than radiologic technologists. They do not diagnose, order tests or procedures, or prescribe medications. Radiology practitioner assistants practice under their radiologic technologist licenses, except in New York, where they are recognized as "specialist assistants" under the medical practice act.
While both professions practice with physician supervision, the scopes of practice are very different. Jane Van Valkenburg, PhD, RT, director of the Nuclear Medicine Technology Program at Weber State University, states, "The roles are completely different. Radiology practitioner assistants should not be confused with physician assistants. RPA education is an extension of the radiology technician."
Additional information about physician assistants is available on the American Academy of Physician Assistants Web site, www.aapa.org or by calling the AAPA at 703/836-2272.
PHYSICIAN ASSISTANTS
Physician assistants are health care professionals who practice medicine with physician supervision. Educated as medical generalists, they work with physicians in virtually any specialty, including radiology and its subspecialties. PAs are licensed in every state, are nationally certified by a single body, and are recognized as covered providers by Medicare and most private payers.
The profession began more than thirty years ago, when physicians at Duke University recognized the need for a health professional trained in the medical model who would work with physician supervision to extend patient access to care. The founders, led by Dr. Eugene A. Stead, Jr., then chairman of Duke's department of medicine, envisioned a medical school-type curriculum, geared toward primary care and focused to provide the appropriate education in an intense and uniquely designed curriculum. The profession has retained this commitment to the medical educational model and to team practice with physician supervision.
In recent years radiologists have realized the excellent skills and value PAs bring to their practices. Some PAs move easily from surgical practices into interventional radiology. In many cases, PAs who work with radiologists were radiologic technologists before they became PAs.
PA Education
Physician assistants are trained in intensive education programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The programs are offered at medical schools, colleges and universities, and teaching hospitals. As of October 2002 there were 134 accredited physician assistant educational programs throughout the country, averaging 26 months in length. PA students bring with them to PA school a wide variety of medical backgrounds, including but not limited to radiologic technology, nursing, respiratory therapy, physical therapy, and paramedic training.
The rigorous PA program curriculum consists of classroom and laboratory instruction in the basic medical and behavioral sciences, including anatomy, pathophysiology, pharmacology, microbiology, 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, pediatrics, and other elective rotations. PA education promotes the development of practical skills in clinical problem solving and decision making. Physician assistant students complete an average of more than 2,000 hours of supervised clinical practice prior to graduation. The number of students graduating from accredited programs is increasing each year. Four thousand new graduates are expected in 2002.
PA Regulation
All states, the District of Columbia, and Guam regulate PAs, usually through the board of medical examiners. After graduation, PAs must pass a 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). To maintain NCCPA certification, which is required by some states and many employers, PAs must complete 100 hours of continuing medical education every two years and take a re-certification exam every six years.
Physician assistants have delegated prescribing privileges in forty-seven states plus the District of Columbia. More than three-fourths of those states include controlled substances as part of this authority. The study of pharmacology is part of all PA programs. Nationally, 78 hours is the mean number of hours of formal classroom instruction in pharmacology.
PA Scope of Practice
PAs work within the scope of practice of their supervising physicians and within additional parameters defined by state law. Along with reviewing the PA practice act, radiologists who wish to employ PAs should check the radiologic technology laws and state ionizing radiation safety laws to see if they prohibit PAs from taking X-rays or performing any other radiologic procedures. Some states require PAs to have additional specific training in order to perform radiologic procedures. Assistance in determining the requirements is available from the AAPA.
Some of the common responsibilities of a physician assistant in radiology include performing histories and physical examinations; performing fluoroscopic tests and procedures, needle biopsies, and angiography; inserting and removing central and peripheral venous catheters; providing initial interpretations of studies, performing pre- and post-procedure evaluations and post-procedure follow-ups, and writing discharge summaries. PAs may administer conscious sedation, and they commonly provide first assist services in the operating or procedure room. They often serve as a point of contact between referring physicians and the radiologist. PAs may also write medical orders and interpret laboratory tests. Because the supervising physician delegates responsibilities to the physician assistant, the PA's role can be very flexible to fit the needs of the practice.
RADIOLOGY PRACTITIONER ASSISTANTS
Radiology practitioner assistants are radiologic technologists with additional education and responsibilities. State licensing laws do not distinguish between radiologic technologists and RPAs, except in New York. (In that state, radiology practitioner assistants are regulated as "specialist assistants" under a section of the medical practice act. When they practice there, they are called "specialist assistants" or "SAs.")
There are many certification exams available to radiologic technologists, covering numerous specialties within radiology. In addition, there is a specific certification exam available to RPAs. RPAs and radiologic technologists are not recognized providers for purposes of insurance reimbursement, but rather are covered as part of global fees or "incident to" the physician's services.
The radiology assistant concept was first conceived in the 1970s as a way of training radiologic technologists to be physician extenders in radiology. The University of Kentucky and Duke University offered advanced training programs for radiologic technologists. The graduates were typically called "radiology physician assistants." In the late 1970s when federal funding was cut, the programs closed. A small number of the graduates from the 1970s remain in practice as "radiology physician assistants," mostly in Kentucky and North Carolina. They are not eligible for the certification exam currently offered to radiology practitioner assistants.
In 1994, representatives from the Department of Defense (DOD) approached leaders at Weber State University in Ogden, Utah, asking that they create a radiology assistant program for the military. Before the program could get off the ground, federal budget cuts once again eliminated government support. Nevertheless, two years later Weber State introduced a two-year training program to interested radiologic technologists. Candidates must have a minimum of five years on-the-job experience and who are registered with the American Registry of Radiologic Technologists (ARRT), the certifying agency for radiologic technologists. The name "radiology practitioner assistant" was coined in 1997. Currently, Weber State University is the only educational institution in the United States to offer this program.
RPA Education
The goal of the RPA program is to prepare radiologic technologists to more fully participate in patient care and management within a radiology department. RPA coursework focuses on radiologic services. Courses center on the performance of a variety of imaging procedures and the evaluation of images to determine normal from abnormal pathology. Anatomy and physiology, proper patient placement, and radiological patient assessment are part of the core course requirements. Additional classes in clinical pathways, radiation biology, health physics, and primary radiologic medicine are offered. Students must also complete a clinical preceptorship in a radiology department.
The two-year program is accredited through the Northwest Accrediting Agency for Colleges and Universities and is designed to be completed through distance learning. Students attend intensive classes on campus twice a semester. Typically, students receive a bachelor of science degree upon completion of the program. Upon graduation, the Certification Board for Radiology Practitioner Assistants (CBRPA) offers a certification examination for RPAs. As of November 2001, the CBRPA had certified 45 RPAs. Fourteen new RPAs are expected to graduate and take the certification exam in 2002.
RPA Scope of Practice
Because the RPA is an extension of the radiologic technologist, RPAs must maintain their ARRT certification, must maintain the continuing education requirements of the ARRT, and are licensed as radiologic technologists. The scope of practice of the radiology practitioner assistant is defined by the supervising radiologist. The RPAs' responsibilities include conducting radiologic patient assessments, participating in patient management, and separating normal from abnormal imaging exams. The majority of RPAs work in hospital radiology departments and imaging centers.
THE DISTINCTIONS
Despite the similarity in the titles, radiology practitioner assistants (RPAs) and physician assistants (PAs) are separate professions with distinctly different educational models and curricula.
Physician assistants are broadly educated as medical providers and are regulated in all states, typically by medical boards. They diagnose and treat patients, order tests, and prescribe medications, working with physicians in all medical and surgical specialties.
Radiology practitioner assistants are radiologic technologists with additional radiology training. They practice strictly within radiology, providing expanded patient management, performing more complex procedures than radiologic technologists. They do not diagnose, order tests or procedures, or prescribe medications. Radiology practitioner assistants practice under their radiologic technologist licenses, except in New York, where they are recognized as "specialist assistants" under the medical practice act.
While both professions practice with physician supervision, the scopes of practice are very different. Jane Van Valkenburg, PhD, RT, director of the Nuclear Medicine Technology Program at Weber State University, states, "The roles are completely different. Radiology practitioner assistants should not be confused with physician assistants. RPA education is an extension of the radiology technician."
Additional information about physician assistants is available on the American Academy of Physician Assistants Web site, www.aapa.org or by calling the AAPA at 703/836-2272.
