ACR Bulletin

Covering topics relevant to the practice of radiology

Shining a Light on Scope-of-Practice Battles

The government relations chair of the Wisconsin Radiological Society speaks about the importance of radiologist-led advocacy.
Jump to Article

Even if you don't have the time, interest or comfort level to directly meet with legislators, radiologists can have a huge influence by responding to calls to action and communicating their position electronically to the offices of lawmakers.

—Gregg A. Bogost, MD, FACR
November 23, 2022

Gregg A. Bogost, MD, FACR, government relations chair of the Wisconsin Radiological Society (WRS), recently shared insights into the WRS scope-of-practice advocacy success achieved during the 2022 legislative cycle. During his conversation with the ACR, Bogost shared how an American College of Radiology Association® (ACRA®) Scope of Practice Grant helped in Wisconsin’s scope fight. During the legislative session, the WRS was engaged in combating a well-funded effort by multiple non-physician provider groups to drastically expand the scope of practice in Wisconsin for advanced-practice nurses. Multiple state and national physician specialty groups advocated against the scope expansion legislation, which was ultimately vetoed by the governor. The ACR’s conversation with Bogost touched on this advocacy victory and the importance of radiologist-led advocacy.

Why and when did you get involved in advocacy?

As an eager young radiologist, I was asked to assist in defeating a harmful licensure bill at a time when cross-state turf battles were more of an issue. I found the entire political process to be an interesting new opportunity for professional diversification. The process brought new positive professional relationships and fun and interesting challenges, and it was professionally rewarding to be productive beyond the view box. I’ve been involved in advocacy ever since. Because most proposed legislative actions have an impact on patient care in one way or another, political advocacy is another route we can use to improve patient care while advancing our profession.

Why do you think it is important for other radiologists to be involved in advocacy?

Our expertise is badly needed to educate and guide our legislators. Our point of view is critically important for legislators to understand since they are generally unaware of the issues’ nuances and may not even know why a particular proposal is bad or good for patients.

The key point is that these various legislative issues can have profound impact on your practice’s success and the care you deliver. So having your voice heard is important, and it is very doable. Even if you don’t have the time, interest, or comfort level to directly meet with legislators, radiologists can have a huge influence by responding to calls to action and communicating their position electronically to the offices of lawmakers. We have received specific feedback over the years from legislators’ offices commenting on the volume of support coming from our doctors on issues we have been successful with.

Another way is to attend political fundraisers and try to get to know your legislators. A familiar face goes a long way the next time you need to communicate.

Keep in mind, the next legislative fight is not if, but when, so be ready. Being ready means building your internal structure and outside relationships ahead of time instead of being simply reactive.

What advice would you give to other state radiological chapters that are engaged in scope-of-practice battles?

My first piece of advice is if you don’t have one already, retain a lobbyist who is well-established and has good connections in your state capitol and experience in healthcare issues.
Next, it’s important to build relationships with other state and local medical organizations. This includes not only other physician groups, but other potentially impacted stakeholders, whether they are hospital systems, patients, and even in some cases, the insurance industry. Such coalitions are more powerful than a single specialty group’s voice and are proven to increase the chance of legislative success.

Regarding scope issues specifically, it’s important to emphasize the critical importance of the role we play at the top of the healthcare team, directing care for best outcomes at a lower cost, and not defaulting that care to lesser-trained providers. To help lawmakers understand that, it’s important to emphasize the differences in our education and training as radiologists compared to mid-level providers. Legislators are generally unaware of these nuances, which are obvious to us. Also, compared to other specialty physicians, we understand the overuse of imaging and subsequent increased costs resulting from lesser-trained mid-level providers practicing independently. These arguments resonated with our governor in his decision to veto the Advanced Practice Nurse Practitioner scope expansion.

How did the ACRA’s Scope of Practice Grant help WRS during its recent legislative fight?

The WRS was very grateful to the ACR for establishing this grant as it greatly impacted our advocacy efforts. This scope-of-practice fight took much more time, money, and effort than originally thought. The money the WRS received from this grant allowed our chapter to develop much more extensive and far-reaching coordination and collaboration with other stakeholders. We used it mostly for lobbying, but other chapters have used the funds to appeal directly to patients, voters, and legislators through social media and advertising that define the radiologists as the best-trained leaders of the necessary team approach. This type of funding was needed and will be needed again as we anticipate future battles with non-physician groups that are well-organized and well-funded and aren’t going away anytime soon.


Author Dillon Harp  ACR's senior state government relations specialist