Nurse Practitioners, Physician Assistants Could Alleviate Projected Oncology Workforce Shortage ► NCI Cancer Bulletin for September 20, 2011 - National Cancer Institute

NCI Cancer Bulletin for September 20, 2011 - National Cancer Institute: Nurse Practitioners, Physician Assistants Could Alleviate Projected Oncology Workforce Shortage

The regular use of nurse practitioners and physician assistants in the care of patients with cancer may be a viable solution to the projected shortage of oncologists in the United States, a new study has found. Patients in practices that used this approach were "highly satisfied" with their care, and the oncologists, nurse practitioners, and physician assistants in these practices were also "highly satisfied" with the collaborative care arrangements, according to the study published September 15 in the Journal of Oncology Practice.

The study “shows that coordinated and integrated cancer care provided by both oncologists and nonphysician providers is a very successful model,” said Dr. Dean Bajorin, who co-chairs the American Society of Clinical Oncology’s (ASCO) Workforce Advisory Group.

The study was conducted under the auspices of ASCO's Study of Collaborative Practice Arrangements initiative. ASCO launched this effort in March 2009 in response to the organization’s earlier report that forecast a major shortage of oncologists by 2020.

The first part of the study was a national survey of 226 oncology practices to identify those that commonly use nonphysician practitioners (NPPs). The researchers then analyzed a subset of 31 practices of different sizes and from varied geographic locations, of which only 27 provided complete data. As was the case with the overall survey group, most of the practices in the study group were physician-owned private practices. (Practices at academic centers were excluded from the study group.)

In both groups, NPPs most commonly performed duties such as assisting patients during treatment visits, managing pain and symptoms, educating and counseling patients, and providing follow-up care for patients in remission. Nearly all of the patients knew they were seeing an NPP, the study showed.

The most common approach to collaborative care was what study leader Elaine Towle of Oncology Metrics and her colleagues called the incident-to-practice model (ITPM). In this model, NPPs see patients independent of the oncologists in their practice (although they discuss patients’ care plans prior to the visit with an oncologist), but the oncologists are in the office and available for consultation.

In 60 percent of the practices in the study group, the NPPs work with all of the physicians in the practice. This arrangement appeared to be more efficient—increasing the number of patients seen by nearly 20 percent—than those in which the NPPs worked only with specific physicians in the practice.

The ITPM also offers some practical advantages, the authors explained. “In the private practice setting, the ITPM allows practices to bill Medicare for NPP services as though they were rendered by the physician and to receive reimbursement at the full physician fee schedule.” If these visits were billed under the NPP’s provider number, they noted, reimbursement would be 85 percent of the physician fee schedule.

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