Imaging Service

Undermining the Argument for NPPs

If you think you’ve been seeing more non-physician practitioners (NPPs) reading medical imaging exams, you’re not alone. A new study in Current Problems in Diagnostic Radiology found that the rate of NPP interpretations went up almost 27% over four years. 

US radiologists have zealously guarded their position as the primary readers of imaging exams, even as allied health professionals like nurses and physician assistants clamor to extend their scope of practice (SOP) into image interpretation. The struggle often plays out in state legislatures, with each side pushing laws benefiting their positions.

How has this dynamic affected NPP interpretation rates? In the current study, researchers looked at NPP interpretations of 110 million imaging claims from 2016 to 2020. They also examined how NPP rates changed by geographic location, and whether state laws on NPP practice authority affected rates. Findings included:

  • The rate of NPP interpretation for imaging studies went from 2.6% to 3.3% in the study period – growth of 26.9%.
  • Metropolitan areas saw the highest growth rate in NPP interpretation, with growth of 31.3%, compared to micropolitan areas (18.8%), while rates in rural areas did not grow at a statistically significant rate.
  • Rates of NPP interpretation tended to grow more in states with less restrictive versus more restrictive practice-authority laws (45% vs. 16.6%).
  • NPP interpretation was focused on radiography/fluoroscopy (53%), ultrasound (24%), and CT and MRI (21%). 

The findings are particularly interesting because they run counter to one of the main arguments made by NPPs for expanding their scope of practice into imaging: to alleviate workforce shortages in rural areas. Instead, NPPs (like physicians themselves) tend to gravitate to urban areas – where their services may not be as needed. 

The study also raises questions about whether the training that NPPs receive is adequate for a highly subspecialized area like medical imaging, particularly given the study’s findings that advanced imaging like CT and MRI make up one in five exams being read by NPPs. 

The Takeaway    

The findings undermine one of the main arguments in favor of using non-physician practitioners – to address access-to-care issues. The question is whether the study has an impact on the ongoing turf battle between radiologists and NPPs over image interpretation playing out in state legislatures. 

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