Could ‘radiology extenders’ be the answer to the field’s budget, quality issues?

To reduce healthcare costs and improve radiologist job satisfaction, clinicians at Penn’s Perelman School of Medicine are proposing a new role akin to the physician’s assistant: a radiology extender.

The radiology extender, or RE, was born more out of necessity than anything else, Mitchell D. Schnall, MD, PhD, and colleagues wrote in the Journal of American College of Radiology, because Perelman’s radiology department comprises just 10 clinicians, 3 fellows and a handful of residents. For those experienced, board-certified radiologists, they said, busywork such as reading plain films can be unfulfilling and monotonous.

“[Research] suggests that routine and repetitive tasks often lead to feeling a lack of meaningfulness, achievement and responsibility, resulting in issues of inefficient resource allocation and employee dissatisfaction in the organization,” the authors wrote. “When these viewpoints were expressed repeatedly by our technicians and radiologists, we devised a solution.”

But a fix wasn’t easy, they said—especially taking into account their limited budget. While academic radiology centers have been relying on mergers and acquisitions, consolidations and buyouts, and teaching hospitals have turned to residents and fellows to “share the burden” of interpreting film for less money, the demand for radiology work is realistically outpacing those solutions.

That’s where the radiology extender steps in. Almost like physician’s extenders but unlike existing radiology assistant or radiology physician assistant roles, REs would be responsible for interpreting plain-film images, Schnall and co-authors wrote. An RE would ease radiologists’ daily loads while ensuring quality, since a board-certified physician would need to finalize any and all reports.

The researchers tested the new role at Perelman, where they trained an RE using one-on-one review, an online course for radiographers in the U.K. and conventional radiologic textbooks. The team calculated radiologists’ flow rates—the number of cases read per minute—both without and with an RE, who read either alongside the radiologist or separately from them.

“We suspect that improved flow rates of radiologists could lead to additional revenue from time gained by radiologists,” Schnall and colleagues said, noting that if an RE were to read an average of 99 cases per 8-hour day, they would free up an additional 85 minutes of radiologists’ time. “This extra time could be used by a radiologist to evaluate additional, presumably higher value cases if available.”

In their trial, the researchers found that a solo radiologist read at a mean 0.62 flow rate, but that that radiologist reviewing a case either alongside an RE or separately from them resulted in twice the speed, at a 1.33 flow rate.

Schnall et al. said the new role could also be a symbiotic relationship between a radiologist, whose job satisfaction generally improves when they feel they’re helping others do meaningful work, and an RE, who’s presented with a new opportunity for upward mobility and “provides an incentive to remain at the top of their game in an overcrowded field in which they are increasingly worked harder.”

“We believe that the RE role is an innovation that will result in a reorganization of work responsibility in the field of radiology,” the researchers wrote. “We envision that the RE role will become ubiquitous over time and will significantly impact the practice of radiology in the United States.”