Monday, February 4, 2019 (3 Comments) Posted by: Erin Cusack
Share|
The Texas Medical Board (TMB) recently proposed a new rule that could dramatically impact the practice of APRNs in Texas across all settings – from hospitals in urban areas to the most remote rural clinics.
The rule proposal says: §193.21.Delegation Related to Radiological Services...
(d) The following acts have been determined to be the practice of medicine under the authority of the Act, §157.001(b)(1), and cannot be delegated to a midlevel provider, certified radiological technologist (MRT and LMRT), or non-certified radiological technologist (NCT):
(1) the reading and interpretation of the radiological studies; and (2) rendering a diagnosis based on the radiological studies.
Nurse Practitioners and Clinical Nurse Specialists regularly use x-ray and other imaging for everything from mammograms to broken bones. Certified Registered Nurse Anesthetists use fluoroscopy for central line placement and other procedures. Certified Nurse Midwives use ultrasound to ensure the health of mother and baby during pregnancy. By adopting this rule, physicians on the TMB are prohibiting an essential part of APRN practice and forcing their competition to practice blindfolded.
While almost all APRNs would be affected, APRNs who own or work in small and micro businesses will no longer be able to provide certain treatments. Rural communities that do not have a physician to read and interpret these studies will have to seek care elsewhere.
TNP Members received a call to action on Friday. If you are a TNP member, be sure to check your email. If you didn’t receive it, feel free to email [email protected]. If you are not a TNP member and are interested in receiving these important updates that impact your profession, join TNP today.
Comments on Rule §193.21 can be emailed to [email protected] or mailed to Ms. Rita Chapin to P.O. Box 2018, Austin,Texas, 78768-2018. Comments are effectively due on February 22. Earliest date of adoption of this rule is February 24.
Why would someone need to drive 3hrs? Clearly they don’t have to take their xrays to a radiologist in person. A rural NP can certainly order imaging studies and then be read remotely. There is simply no reason for someone not formally trained, boarded and continually tested to read imaging cases with availability of remote interpretations. Again, I can only imagine how many subtle findings are missed by someone not formally trained to read these cases. Or even not so subtle findings misinterpreted. Mass treated as pneumonia, missed rib lesions, pathologic fractures missed on limb cases.
You have a dramatic misunderstanding of what happens in medicine and are missing the entire point of this rule. 1. The rule does not say a radiologist must read the xray simply a physician. So a Family practice physician who has minimal training in xray can read and interpret an Xray but an FNP cannot. If the regulation said only a radiologist can read and interpret a radiological study then I would agree. But it doesn't its simply an anti competitive measure to try to ensure physician primacy.
2. The road to hell is paved with good intentions. This is especially obvious in an acute care setting. Specifically:
Quote
The rule prohibits
(1) the reading and interpretation of the radiological studies; and (2) rendering a diagnosis based on the radiological studies.
The problem is with number 2. If I look at an xray and see a problem such as a pneumothorax, I can't act on it until its read by a physician. Even in an tertiary care hospital it regularly takes several hours to get reads on x rays. I can't imagine what its like in a tertiary hospital. For example, I'm asked to look at a KUB for feeding tube placement. I notice that not only is the feeding tube in the lung but there is a pneumothorax on the same side. I put in a chest tube on that side and get a CXR which shows resolution of the pneumothorax. Three hours later I get a call from radiology that there is a pneumothorax. Just sayin.
Specializes in Peds Urology,primary care, hem/onc.
10 minutes ago, core0 said:
You have a dramatic misunderstanding of what happens in medicine and are missing the entire point of this rule. 1. The rule does not say a radiologist must read the xray simply a physician. So a Family practice physician who has minimal training in xray can read and interpret an Xray but an FNP cannot. If the regulation said only a radiologist can read and interpret a radiological study then I would agree. But it doesn't its simply an anti competitive measure to try to ensure physician primacy.
2. The road to hell is paved with good intentions. This is especially obvious in an acute care setting. Specifically:
The problem is with number 2. If I look at an xray and see a problem such as a pneumothorax, I can't act on it until its read by a physician. Even in an tertiary care hospital it regularly takes several hours to get reads on x rays. I can't imagine what its like in a tertiary hospital. For example, I'm asked to look at a KUB for feeding tube placement. I notice that not only is the feeding tube in the lung but there is a pneumothorax on the same side. I put in a chest tube on that side and get a CXR which shows resolution of the pneumothorax. Three hours later I get a call from radiology that there is a pneumothorax. Just sayin.
I agree with this point here. I work in a clinic for voiding dysfunction in children. I order KUB's all the time to assess stool load and decide if the child needs bowel cleanouts etc. The patients go and get the Xrays and review them with me duirng the visit. With my years of experience, I know how to assess stool load on the KUB and give the family the treatment plan based on my interpretation of the Xray. In my busy hospital, it could be hours before one of my Radiologists has time to read a non- urgent KUB. I am not going to make the family wait that long for the treatment plan. Now I always f/u on the Radiologists interpretation of the films and be sure to read the report to make sure I did not miss something. It is within our scope of practice to interpret imaging like this (same goes with the example above to interpreter an NG tube, pneumothorax etc.). I also feel pretty comfortable looking at renal ultrasounds. Now when it comes to CTs or MRI's, no I do not feel comfortable and would rely on the Radiologists interpretation. The urologists I work with are the same way. They are completely comfortable with interpreting ultrasounds etc. but when it comes to the more complex imaging, they need the Radiologists interpretation as well. But to have a blanket law that says a NP can never make a treatment decision off an imaging study on their own is, in my opinion, ridiculous.
Why would someone need to drive 3hrs? Clearly they don’t have to take their xrays to a radiologist in person. A rural NP can certainly order imaging studies and then be read remotely. There is simply no reason for someone not formally trained, boarded and continually tested to read imaging cases with availability of remote interpretations. Again, I can only imagine how many subtle findings are missed by someone not formally trained to read these cases. Or even not so subtle findings misinterpreted. Mass treated as pneumonia, missed rib lesions, pathologic fractures missed on limb cases.
We take flat films at our small (MD and me) clinic. All films go out for radiologist read, even stats take time. According to this rule, I can't even make a no-brainer read, I would have to wait for the interpretation to come from radiology. And as said previously, I've had to make several calls to the radiologist to amend a read due to dumb errors. I'm not taking away from the value of the radiologist expertise, likewise, don't insult me either. This rule is insulting.
Anyone in medicine has to know their limitations. If you can't read a film because your green, then wait to get the read. How about requiring all films to be read by a radiologist. If that were the case, I'd have no argument. But after over 25 years under my belt, I've got more experience than many doctors. Be honest, this has nothing to do with skill.
core0
1,831 Posts
You have a dramatic misunderstanding of what happens in medicine and are missing the entire point of this rule.
1. The rule does not say a radiologist must read the xray simply a physician. So a Family practice physician who has minimal training in xray can read and interpret an Xray but an FNP cannot. If the regulation said only a radiologist can read and interpret a radiological study then I would agree. But it doesn't its simply an anti competitive measure to try to ensure physician primacy.
2. The road to hell is paved with good intentions. This is especially obvious in an acute care setting. Specifically:
The problem is with number 2. If I look at an xray and see a problem such as a pneumothorax, I can't act on it until its read by a physician. Even in an tertiary care hospital it regularly takes several hours to get reads on x rays. I can't imagine what its like in a tertiary hospital. For example, I'm asked to look at a KUB for feeding tube placement. I notice that not only is the feeding tube in the lung but there is a pneumothorax on the same side. I put in a chest tube on that side and get a CXR which shows resolution of the pneumothorax. Three hours later I get a call from radiology that there is a pneumothorax. Just sayin.