The Radiology Assistant is a job title whose time has come, but the need for it may not be here anymore. Central to the tasks of this job category is the performance but not the interpretation of fluoroscopic procedures. However, the record of the past several years indicates a decline in such studies nationally, and an acceleration of that decline most recently. Thus, the increase in compensation demanded by Radiology Assistants by the mandate of their B.A. or M.A. degrees may not be justified by the paucity of the volume allotted to their enhanced responsibilities.

All of you know that Radiology is undergoing profound changes, at least with respect to the provision of personnel. The radiologist glut is upon us. At the same time a shortage of technologists has come to the fore as a major issue. One of the ways in which to respond to the decreased number of applicants per available position is to upgrade the status of the radiology technologists making them radiology assistants with expanded training and skills. This issue, controversial of course, was embraced several years ago by the American College of Radiology who, with the American Society of Radiology Technologists, has devised a curriculum for an enhancement of the technologist’s responsibilities. Training guidelines encompassing a range of characteristics under the rubric of upgrading the capabilities of the technologist have been devised, and now approximately 15–20 programs have been initiated to train radiology assistants. The American College of Radiology has felt compelled to address this issue because state governments by themselves were going to approve both the concept and the specifics of radiology assistants, education and certification. So now we have the official imprimatur of the radiology establishment fostering the development of this new job title and its new capabilities. I am here to offer a criticism of the concept. I will endeavor to do that with data derived from a range of sources to try to demonstrate that the radiology assistant position does not really enhance quality very much, but certainly increases the cost of care for radiologists and ultimately for society.

Let me state that I am not against radiology extenders. In fact, we have used interventional radiology PAs for the last several years and are very pleased with their performance. Moreover, at first, I was not hostile to the concept of the radiology assistant. In fact, I have devised a curriculum for radiology assistants, and this year will give several 90-min lectures to our first year class of radiology assistants matriculating in our adjacent school of allied health. I will continue to pursue this project with determination, if not with gusto, but also with the knowledge that the positions we are creating may have untoward consequences for the practice of medicine. I was not initially aware of these negative features because, like many other initiatives, the unintended results take a while to declare themselves.

Now, why are there radiology assistants? Why has this notion become popular? Of course, as I mentioned before, the overabundance of radiologists is becoming widespread in the U.S. We now have enough radiologists to do all the procedures that can be scheduled for them. But there is also a shortage of radiological technologists with a current 15.3 % vacancy rate which, by the way, is the worst among all healthcare workers. Moreover, the average age of technologists is leaning toward the geriatric, since half of the technologists are over 41. In 2010, it was estimated that there will be a need for 75,000 more technologists. Presently, the technologist’s position does not leave much room for advancement, and many consider it to be a career dead end.

Also, we have noticed the growth of non-physician advanced practice positions in other specialties. For instance, nurse practitioners and, especially nurse anesthetists, have shown that even without an MD degree they can take on much responsibility.

The adoption of the concept of the RAs was the subject of a consensus paper approved by the ACR in 2002 in hopes of managing then current shortage of radiologists. The stated expectation was that RAs would make radiologists more efficient, but no further elaboration of what efficiency meant was included. It was also stated that the radiology assistant would not interpret images. The need to codify the responsibilities of RAs nationally was in part a response to an avid interest in some states, especially in Kentucky, Washington and Montana, for the establishment of the job category of R.A.s. Moreover, the impress of marketplace considerations portended that this title would become a reality whether the ACR would approve it or not. Nonetheless, many radiologists were concerned, particularly in view of the eventual prospect that the radiologist assistant would bring power unto himself like the nurse anesthetist and take away some of our responsibilities, business and income.