9 June 2016

Should the VA Use APRNs to Supplement Radiologists?

On May 25, the Department of Veterans Affairs proposed to amend its “medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.” The proposal comes amid a new push by the VA to maximize its available resources and improve access to timely healthcare services for the nation’s veterans without increasing costs. Public perception of the VA has diminished in recent years, as heightened media coverage of a 2014 scandal has highlighted a growing number of cases in which veterans are denied access to care.

This latest proposal would allow advanced practice registered nurses (APRNs) to "Order, perform, supervise, and interpret laboratory and imaging studies" without the supervision of a physician. APRNs would also be required to complete additional training to work at the VA.

With the ACR and the radiology community as a whole to the proposed ruling, many policymakers and healthcare leaders are asking if there is a better way for healthcare organizations to use their resources more efficiently.

Radiology is undeniably among the most complex medical specialties in healthcare delivery. Radiologists devote years to honing the skills necessary for accurately interpreting thousands of images a day. Many pursue additional training to become highly specialized in a single modality. Currently, there are very limited resources available for APRNs to develop such skills.

With healthcare organizations across the US struggling to maximize the capabilities of their available resources, physician extenders such as APRNs are increasingly being relied upon to fill the inevitable gaps in physician coverage. However, given the complexity and nuance implicit in the practice of radiology, the chance for catastrophic error cannot simply be ignored.

There is, however, growing evidence that technology-based applications will one day be capable of systematically analyzing the massive quantities of unstructured data present in electronic health records. Many experts have suggested that such technology could also be used to analyze visual data such as that of an imaging study. Is this the Holy Grail of modern medicine?

The answer for the foreseeable future is no. There is growing demand for physicians and allied health providers who possess the skills and expertise to usher in a new era of outcomes-based healthcare delivery. However, greater emphasis on cost containment will inevitably result in reduced wages, leading to slowed growth of the healthcare provider market.

With demand for quality healthcare services exploding without bound, the industry will undoubtedly look elsewhere for safe and cost-effective means by which to extend the capacity of physicians. Whether the answer is to expand the scope of healthcare providers, or to employ advanced technology, one fact remains: our role as healthcare providers is to improve the lives of our patients.