In July 2013, the president of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) Technologist Section put together a task force to examine the current graduate-level program for Nuclear Medicine Advanced Associate (NMAA) as a mid-level practitioner and determine whether that type of graduate education served all parties involved in nuclear medicine technology. The task force consisted of a variety of stakeholders in the profession, including practicing technologists, NMAAs, research technologists, educators, corporate representatives, and physicians. They determined that there are a variety of graduate-level programs for nuclear medicine technologists, including a master of business administration or master of health administration, as well as the NMAA field, but a lack of programs for technologists interested in a career in clinical research related to nuclear medicine and molecular imaging. In December 2013, the task force recommended that the executive board of the SNMMI support graduate-level education focused on nuclear medicine and molecular imaging at both the NMAA level and the clinical research level. This white paper focuses only on the NMAA and examines the history and current state of the NMAA but also the needed changes for the future success of this profession.
NMAA BACKGROUNDThe general climate of health care has been unpredictable for many years. Currently, medicine is undergoing a series of dramatic changes. The first of these is the projected shortage of as many as 35,000 physicians by 2020 (1). This health-care provider shortage is projected to affect imaging practice as well as clinical medicine. There are a decreasing number of nuclear medicine residencies, and many of the current nuclear medicine physicians are nearing or at retirement age. The lack of new nuclear physicians plus the age of the current group lead to a projected shortage. Other pressures are emerging as well, such as the expectation that to be efficient, physicians need to see more patients in less time. Additionally, the Affordable Care Act is bringing more people into the health-care system as well as changing the old fee-for-service payment model to new payment models, possibly requiring modification in delivery of services (2). Consequently, these issues will require us to change how we approach an imaging practice.In the clinical areas of medicine, this physician shortage is being met by the expansion of mid-level providers. Physician assistants, clinical nurse practitioners, and others are beginning to pick up a good deal of the clinical patient load. They see patients before the physician does, obtain the history from the patient, perform physical examinations, and form initial clinical impressions. These health-care providers are often permitted to write prescriptions and may provide other services that were formerly offered only by physicians. The opening of the "instant clinics" in many geographical and rural areas relies solely on the services of a clinical nurse practitioner or physician assistant. In...