My Boss Wants Me to Train Our MA’s to Take X-rays!

Fighting words or a major twinge of conscience? Is this a moral dilemma and you are concerned about patient care, or are you gatekeeping to protect your profession?

This problem or concern is not new. It just reoccurs often. Only 5 states and the District of Columbia do not have some type of licensure, certification, or registration regulations, and the regulated states usually provide a second level of limited training that provides technicians for limited practice.

Today’s shortage of radiographers is a double edge sword. Maybe in your area, if it’s in the city and near a training program, the shortage is not severe. Since the COVID pandemic, there have been staffing shortages in some modalities as patient loads have increased. I constantly hear and see advertisements that offer sign on bonuses and increased pay for radiographers and especially multi-modality technologists. Travel radiologic technologists have once again become a specialty at increased pay levels with benefits including housing and car allowances. The shortages seem to be more apparent in the rural areas where pay may not equal what can be earned in the larger facilities. And what is a rural area or a rural state? In the state of Texas, 75% of the 16,660 (Bureau of Labor Statistics -2020) certified radiographers live in the triangular land shape between San Antonio, Dallas, and Houston. Not exactly rural.

In a state that has regulations for radiologic technology, some form of limited permit is usually provided. There is wide variation in hours and content between the different limited permit state training requirements. This is usually attached to the types of x-rays a limited permit is allowed to perform. There are x-rays defined as dangerous and hazardous in some states and can only be performed by a fully credentialed radiographer. Some states regulate modalities that include radiation, making a differentiation between x-ray, radiation therapy, nuclear medicine, mammography, and/or CT. There are no consistencies between the states for how regulations are promulgated, with mammography being the outlier as it is governed by federal law. Some states allowed for grandfathering of the current workforce if they did not meet the new regulations or created hardship exemptions for physicians who took responsibility as “captain of the ship”.

These arguments for these regulatory exemptions are not new nor are they original. If you are or have been involved in any state regulatory efforts, you will have heard many of the arguments. Never was I so surprised when I heard one of our legislators testify in a debate from the floor of the House of Representatives that dentists should be excluded from the law because the radiation for dental x-rays was different and was not harmful. Of course, the speaker was a powerful legislator and, might I include, he was a dentist! In today’s healthcare world, many of our healthcare facilities are owned by or incorporated into healthcare systems that may be located in multiple states. They are governed by a central administration with policies that are applied across the system. Therefore, an idea can catch fire in one state and quickly spread through facilities in other states. 

One idea was submitted to the Tennessee Legislature January 31, 2023. TN Senate Bill, TN-SB-1191 removes licensure requirements for persons who practice radiologic technology and radiation therapy and instead requires such persons to be certified by the division of health-related boards; essentially terminating the Tennessee Radiologic Imaging and Radiation Therapy Boards of Examiners with no wind down period.

My colleague who had to face the question that is our headline “My boss wants me to train our MA’s to take x-rays” lives in a state without regulation for radiographers. Their counterpart (in a different state that has no law or regulation for radiographers) had already allowed medical assistants to take x-rays. The change came because they had open positions for radiographers and could not hire nor receive applicants for the open positions. It seems that radiographers in those areas were not interested in the work environment in the clinic or urgent care facility. 

We have to face the facts that some x-rays, such as extremities, can be taught to lesser trained healthcare personnel without fear of harm or exclusion. Individuals in healthcare want to do what is right for patient care. If not given a choice, it is much better to provide for better patient care. After all, that is why we are here. I have experienced this myself when implementing legislation in our state. One of the committees I interacted with had an RN as Chairperson. Her husband was a physician. They owned a large ranch in rural Texas. This was rural, literally, not figuratively. She asked me how she would get her ranch hands treated if there was no credentialed radiographer available at the clinic in the small town close to the ranch. The physician was not officed in the clinic, and it was operated by a Nurse practitioner. I had no answer for her. It was more than 50 miles to the closest healthcare facility where a credentialed radiographer might be (yes, might be) available. The answer was obvious that this would be a hardship location where training and supervision was required.

I can think of other scenarios where we have to face the facts regardless of protecting our profession. I am sure that you have your own stories. Share them in the comments section if you agree or disagree.