Sharing the Workload With NPs and PAs May Be a Solution for Projected Shortage of Oncology Providers

Incorporating nurse practitioners and physician assistants into oncology practices appears to be an effective strategy for dealing with an impending shortage of oncologists and at the same time improving productivity and achieving both patient satisfaction and provider satisfaction, according to a recent study.¹

“Patients were aware when the care was provided by a non-physician practitioner (NPP) and were very satisfied with all aspects of the collaborative care they received. The integration of NPP into oncology practice offers a reliable means to address increased demand for oncology services without adding physicians,” wrote the authors.

Practices where the NPP worked with all practice physicians demonstrated significantly higher productivity than practices where the NPP worked exclusively with a specific physician or group of physicians. Interestingly, the practices that had a higher than average number of patient encounters per FTE (full-time equivalent) provider felt they could be even busier, while being less busy was associated with the subjective perception of being able to see fewer patients. “There is little observed correlation between the subjective perception of workload and the objective measure of work production,” the authors wrote.

In 2007, a study by the American Society of Clinical Oncology (ASCO) projected a shortage of about 4000 oncologists by the year 2020. The demand for oncologists is expected to increase by 48% by 2020, while at the same time the number of oncologists is expected to increase by 14%. Part of what will drive the need for more oncologists is an aging population (the number of people aged 65 and older is expected to double by 2030) and an 81% expected increase in the number of cancer survivors.

In 2009, ASCO initiated the first phase of the ASCO Study of Col - laborative Practices to identify practices that used NPPs. That study identified 226 community hospitals and hospitalbased practices from 43 states. The second phase of that study included 33 diverse practices with more in-depth assessment of experiences of physicians, NPPs, and patients in those practices, including levels of satisfaction. Approximately 40% of practices were from the Midwest, 30% from the East Coast, 20% from the West, and 10% from the South. The majority were physician owned (84%); 16% were hospital owned. The practices included in the in-depth surveys were mainly those where NPPs see patients independent of the physician, although the physician is usually present in the office.

Ninety-eight percent of patients were aware that an NPP was providing clinical services. Satisfaction measures showed that 92.5% of patients were extremely satisfied with the services they received at every study site. Although physician and NPP satisfaction varied at different sites, overall physician satisfaction score was 79.8% and overall NPP satisfaction score was 78.2%. There was no correlation between physician and NPP satisfaction scores.

Commenting on this study in a press release, ASCO President Michael P. Link, MD, stated: “In anticipation of the projected shortage, ASCO continues to seek solutions that will not only transform oncology care, but translate to a high level of excellence. This study shows that practices are extending oncology services by promoting a collaborative practice with nurse practitioners and physicians’ assistants. In pediatric oncology, nurse practitioners are already an integral part of our practice and are indispensable.”

Reference

1. Towle EL, et al. J Oncol Pract. 2011;7:278-282.