HealthDayNews — Nurse practitioners (NPs) and physician assistants (PAs) use more imaging compared with primary-care physicians, results of a study published in JAMA Internal Medicine indicate.

“Little is known about the use of diagnostic testing, such as medical imaging, by advanced practice clinicians (APCs), specifically, nurse practitioners and physician assistants,” noted Danny R. Hughes, PhD, of the Harvey L. Neiman Health Policy Institute in Reston, Va., and colleagues.

To compare the use of diagnostic imaging ordered by NPs and PAs compared with primary-care physicians following office-based encounters, the investigators obtained Medicare claims for a 5% sample of beneficiaries from 2010 to 2011.

NPs and PAs ordered imaging in 2.8% of episodes of care, compared with just 1.9% for physicians. ACPs were more likely to order imaging compared with physicians in adjusted estimates (odds ratio, 1.36 and 1.33, respectively), ordering 0.3% and 0.2% more images per episode of care, respectively.

For advanced imaging, increased imaging was seen in association with NPs and PAs for established patients (odds ratio, 1.28), ordering 0.1% more images, while for new patients there was no significant difference between APCs and PCPs.

“Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during evaluation and management office visits,” wrote the researchers.

“Expanding the use of APCs may alleviate PCP shortages.”


  1. Hughes DR et al. JAMA Internal Med. 2014; doi: 10.1001/jamainternmed.2014.6349