Developing and implementing clinical services, including consultations, rounds, and clinic, is time-consuming, and for the interventional radiologist this means time away from the interventional laboratory. Using a team approach to providing clinical services is logical, and the midlevel provider is a perfect fit for an interventional radiology team. Midlevel providers can be grouped into two categories, advanced practice nurses (APNs) and physician's assistants (PAs). Under the umbrella of APN are several specialties including the nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse midwife, and certified nurse anesthetist. The midlevel providers that are particularly suited for interventional radiology are the NPs, CNSs, and PAs. This article discusses midlevel providers in-depth including skills, limitations, and expenses. KEYWORDS: Midlevel providers, interventional radiology, nonphysician extenders, nurse practitioners, physician assistantsObjectives: Upon completion of this article, the reader should (1) understand the necessary components of a clinical practice and the value of employing physician extenders or midlevel providers and (2) know the difference between subcategories of midlevel providers, including their scope of practice, usual duties, governing bodies, and relative costs. Accreditation: Tufts University School of Medicine (TUSM) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit: TUSM designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit TM . Physicians should only claim credit commensurate with the extent of their participation in the activity. The development of a clinical practice in inter-ventional radiology is imperative for survival in today's competitive environment. Referrals to interventional radiology will be lost to other specialties as they obtain the skills and credentials to perform percutaneous image-guided procedures that have historically been within the domain of the interventional radiologist-that is, unless the interventional radiologist is ready to provide a full range of clinical services that the primary care physician expects when making a referral to a specialist. To maintain a healthy referral base the interventional radiologist must provide complete periprocedural and comprehensive care. Developing and implementing clinical services, including consultations, rounds, and clinic, is time-consuming, and for the interventional radiologist this means time away from the interventional laboratory. Using a team approach to providing clinical services is logical and the midlevel provider is a perfect fit for an interventional radiology team. CHOOSING A MIDLEVEL PROVIDERMidlevel providers can be grouped into two categories, advanced practice nurses (APNs) and physician's
Interventional radiology interacts with all medical disciplines and historically has not had a patient base of its own. The specialty has depended upon referrals for procedures (often complex) and not referrals for the global management of the disease process or patient. Because of this, when referrers develop catheter-based skills, referrals to interventional radiology drop and competition for primary care physician referrals increase; a double strike. To compete, interventional radiology needs to offer clinical services to the primary care physician. One way to compete is by establishing particular disease surveillance programs. Below we discuss in detail the process of establishing surveillance clinics, which one worked for us, and the expected outcomes of these clinics. KEYWORDS: Interventional radiology, referrals, surveillance program, aneurysm screeningObjectives: Upon completion of this article, the reader should (1) understand the importance of direct patient referrals and learn methods to change referral patterns of primary care physicians and (2) gain knowledge on how to establish surveillance programs within their diagnostic and interventional practices and the importance of working closely with their non-interventional radiology partners in establishing the clinics. Accreditation: Tufts University School of Medicine (TUSM) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit: TUSM designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit TM . Physicians should only claim credit commensurate with the extent of their participation in the activity.For interventional radiology to prosper, it needs to compete with established traditional medical practices. Competing effectively should result in increasing referrals, performing more desirable vascular procedures, and establishing a patient base for future referrals and procedures. The bottom line? Growth. We have effectively competed and improved our referral base by establishing outreach programs in the form of specialty clinics. These are surveillance programs with office visits, which help us build a patient referral base geared toward a common disease entity. We have established two programs, which have been successful, and are working on a third outreach program. Our first program was an abdominal aortic aneurysm-screening clinic (discussed in detail below); the second, a carotid stenosis clinic (staffed by a stroke neurologist, neurosurgeon, and an interventional radiologist); and our third program, a peripheral arterial disease surveillance clinic for local podiatrists, is in development. They require little additional effort and have blended seamlessly into our existing office practice. 333Below is information on our first surveillance program: the Abdominal Aneurysm Clinic (AC). BACKGROUNDWe have been treating aortic aneurysms for more than 11 years; our early abdominal aortic aneurysms (AAA) were treated with homemade devices ma...
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