The practitioner in nuclear medicine has increasing
responsibilities in many areas of medicine. Recently, proposed HCFA
rules would require that physicians be present whenever contrast or
radiopharmaceutical agents are injected. In the best of all
possible worlds, the physician would always be present when these
and other similar events are to occur. However, as we now find
ourselves particularly taxed with all the procedures that truly
require our attention, the time of the nuclear medicine physician
should be allocated so that he or she is most involved in the areas
of highest risk for a patient. And physicians should be allowed the
judgment to decide just which areas these are.
Medicine by legislation is virtually always a poor idea. There
are situations in which paramedical personnel may be able to
function in place of the physician. As telemedicine grows, the
relationship of the imaging physician and the patient is likely to
change. Already, one can find situations in which physicians
examine or consult with patients who are many miles away. Clinical
medicine uses current telemedicine techniques to enhance
productivity, lower costs, and deliver care to difficult-to-reach
areas. Medical imaging should be allowed the same opportunity to
provide services to the disadvantaged or rural populations.
There is a fear that, as time goes on, the number of practicing
nuclear physicians may decrease, and that this decrease will take
place in the face of an increased demand for our services. This
demand will in part arise from the age-shift of the American
population. It is well known that older patients require more
services of all types. Nuclear medicine physicians, in particular,
represent an aging group as well. As they retire, there will be a
shortage of these specialists. In order to maintain the quality of
practice, we must look at telemedicine as an alternative to on-site
practice. For this to occur, medical paraprofessionals must be
allowed to supervise certain procedures, such as the injection of
radiopharmaceuticals.
Throughout the medical field, the physician's assistant (PA) has
assumed an increasingly important role. For example, in many school
systems today, immediate or urgent health care is provided by PAs.
If we can entrust the health of our children to physician's
assistants, serious consideration should be given to creating a new
class of the health care worker for nuclear medicine, and perhaps
for the entire field of radiology. This new member of the
healthcare team would need special training and certification above
that commonly granted to technologists. Additional medical training
also should be required in how to deal with life threatening
situations, which rarely arise from radiopharmaceutical injection
or from an expansion of duties beyond imaging.
Many nuclear medicine and radiology facilities already require
their technologists to be certified in CPR and ACLS. Other
facilities provide specialized training in electrocardiographic
monitoring. We must very carefully study the issue of what type of
person is needed to extend physician services and what specialized
training they should be given. We should not rush into programs to
produce a new class of people without proper review and analysis.
However, neither should we postpone the appropriate discussions,
nor delay the development of training and certification programs
for these new workers.
As physicians, we must recognize the changing roles we play in
the health care community. The demand for access to quality
services is a major portion of health care reform. Regionalization
of health care may be one of the new facts of life. In order to
appropriately deliver services, we will need additional assistance.
The world of high-speed, computer-driven image processing is here.
However, the computer revolution is more about communication than
computers. In order to deliver global services and provide service
to under served areas, a combination of new technology and new
people are required. Now is as good time as ever to begin to look
for a new structure for the practice of medical imaging. With the
participation of all professional organizations, the future and the
quality of medicine in the imaging specialties can be assured.
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Dr. Henkin is Professor of Radiology and Director of Nuclear
Medicine at Loyola University Medical Center in Maywood, IL; he is
also a member of the editorial advisory board of this journal.