Don’t Be So Quick to Raise the White Flag on the Nuclear Medicine Advanced Associate as a Career Path

What is the true difference between a nuclear medicine technologist and a nuclear medicine advanced associate (NMAA)? There can be many answers to this question: a specialized advanced degree; a broader scope of practice; about $40,000 in debt; a long, uphill battle. It appears that many believe the future of the NMAA to be ill-fated and that if technologists truly want to increase their clinical knowledge and position, they should follow the route of a conventional physician assistant (PA). PAs can bill for services and are recognized by state legislators, physicians, and medical institutions. NMAAs cannot bill for services, must prove their worth to institutions (most of which do not have job descriptions or openings for NMAAs), and currently have no certification in states that require imaging professionals to obtain valid licenses. Make no mistake: this pathway is not easy, but as several practicing NMAAs can attest, it can definitely be successful. Having a conventional PA license would not prepare someone to act as a potential extender for the nuclear medicine physician. Though PAs have been used in diagnostic radiology, it is rare or impossible to find a PAwith clinical training in nuclear medicine. We do not see PAs in the interpretation room dictating ventilation–perfusion results or calculating therapy doses. The reason is multifold. To be a valuable resource in the nuclear medicine department, one must be trained as a physician extender in this specific modality. Current NMAAs have responsibilities such as making technical and clinical decisions, which requires a strong technical background; administering adjunctive medications, which requires knowledge not only of pharmacology but also of the specific imaging procedure and the physiologic response being assessed; evaluating patients and obtaining information specific for nuclear medicine procedures; and interpreting the preliminary results of molecular imaging procedures. Most of these duties are not taught in conventional PA classes. Even a seasoned nuclear medicine technologist who has completed a conventional PA program would not be prepared to function as a physician extender in nuclear medicine, as a large part of the NMAA’s role—image interpretation—is not addressed by current PA curriculums. As an example, 5 areas of study for an NMAA clinical internship might include pulmonary, endocrine, and skeletal medicine; therapeutic and PET imaging procedures; gastrointestinal, genitourinary, and neuroimaging procedures; cardiac imaging and stress testing; and administrative procedures and specialized modalities. The curriculum would have strict requirements for each of these areas. For a PA clinical internship, in contrast, the corresponding 5 areas might include emergency medicine and internal medicine procedures; pediatrics and surgery; primary care and obstetrics and gynecology; psychiatry and geriatrics; and critical care and elective courses. The NMAA program is not designed for advanced technical education but, rather, uses training methods similar to those for radiology residents. Students sit with physician preceptors to gain knowledge and interpretation skills for each type of molecular imaging; they interpret preliminary findings before their preceptor performs the final interpretation. This is how imaging professionals are trained, and the NMAA is no different. But beyond just image interpretation, NMAAs are also taught physical assessment. They perform physical examinations on patients just as a PA does, are instructed in pathophysiology to give a differential diagnosis just as a PA is, are skilled in pharmacology just as a PA is, and just as PAs must demonstrate a certain level of expertise in a specific area (e.g., surgery, gynecology, or geriatrics), NMAAs must demonstrate a certain level of expertise in the specific area of molecular imaging. Thus, training in the conventional PA curriculum would not prepare the physician extender to perform adequately in the nuclear medicine department. Technologists who would like to go into advanced practice in molecular imaging should consider several differences between PA and NMAA positions. The PA position is more clinically patient-based than the NMAA position, as evidenced by the clinical requirements of PA programs. However, because a degree of patient assessment is definitely necessary in molecular imaging, physical assessment training is mandatory for the NMAA even though its scope may be less than that for the PA. By Received Oct. 16, 2015; revision accepted Dec. 28, 2015. For correspondence or reprints contact: Vicki LaRue, National Jewish Health, 400 Jackson St., Denver, CO 80206. E-mail: laruev@njhealth.org Published online Jan. 14, 2016. COPYRIGHT © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc. DOI: 10.2967/jnmt.115.168302