Go ahead and let teens read x-rays

Costs are spiraling out of control, access is declining, and our quality of care doesn’t match what other developed nations are delivering at half the cost.

In the search to reduce costs and bring our ever inflating health care budget under control, the powers that be (insurers, government, health policy wonks (and maybe a few doctors) have looked to individuals with less formal education to perform medical services that were once the sole purview of physicians.

The rationale is that physicians are immensely overqualified for some of the tasks they perform.  If you can use someone who was trained in half the time and for half the cost to perform a service, then the service should become cheaper and more widely available.

This is already happening in my specialty.  The American Association of Colleges of Nurses (AACN) and the American Nurses Association (ANA) tell me and my patients that virtually all of the services I perform can be done as well, or better, by a nurse practitioner.  And they have decades of sponsored studies to prove it.  Some are well controlled and widely applicable.  Others aren’t.  But they exist.

And primary care hasn’t been the only target for disruption.  CRNAs, whose training is half that of anesthesiologists, have been administering anesthesia independently for years.   Non-physicians have been performing sigmoidoscopy since the 1970s, and studies of nurses in the United Kingdom have shown they can perform upper endoscopy as safely and effectively as physicians.  And while not as essential to a person’s health as the previously mentioned examples, many types of non-physicians can administer botox and laser skin treatments.

But why should primary care, anesthesia, gastroenterology and dermatology have all the fun?  I wish to offer my own disruptive solution to the health care crisis.

Let non-physicians try their hand at radiology.

I propose a study where you take a couple of 18-19 year olds (high school graduates, of course) with an affinity toward science and put them through a 6 month “boot camp” where they are trained by radiologists to read knee films.  At the end of their “boot camp,” put them head to head with board certified radiologists in diagnosing things like fractures and osteoarthritis.

Teenagers would make a great initial test group.  Their vision is probably the best it’ll ever be, and they’re really used to sitting in a dark room staring at a computer screen.  They can be paid minimum wage, aren’t prone to forming unions, and because they’re not doctors, wouldn’t be fearful of malpractice suits or other disciplinary actions by credentialing boards (unless you count getting grounded by their parents).

I’d wager you could do some pretty convincing randomized controlled trials showing teenagers can be trained to read certain types of x-rays as effectively as radiologists.  Then we can do the same for other imaging tests with limited anatomy like shoulders, elbows … maybe even mammograms.

Of course, even if we do show equivalency (or superiority) in large scale studies, would I really want a teenager reading my knee films or my mother’s mammogram?  I guess if I came up with the idea and I’m suggesting other people do it, I’d have to be okay with having it for myself.  I’m sure most politicians who support expanding the roles of nurse practitioners and CRNAs would choose them over a physician if they or their loved one needed care.  You’d be nuts not to choose the thing that’s just as good but half the price.  Politicians aren’t nuts, are they?

So let’s go for it and train the new workforce of teenage radiologists.  It may make people a little nervous, but all we have to do is show them the equivalency data and the massive savings they’ll see on their medical bills, and they’ll soon be on board.  It sounds crazy, but no one ever said health care policy was rational.  Let’s add a little disruption.  My kid cousin needs a summer job and those x-rays aren’t going to read themselves.

Keegan Duchicela is a family physician who blogs at Primary Care Next.

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