Use of NPs/PAs in the Oncology Setting

ARM Workforce Interest Group

Clese Erikson Senior Research Associate June 2, 2007

Oncology Workforce StudyFunded by the American Society of Clinical Oncology

Authors: Clese Erikson, M.P.Aff

Edward Salsberg, MPA

Gaetano Forte

Suanna Bruinooge

Michael Goldstein, MD

Survey Methodology• Survey sent to a random sample of 4,000

oncologists identified from the AMA Masterfile as having a primary or secondary specialty of:

Medical oncology Hematology/oncology Pediatric hematology/oncology Gynecologic oncology

• Initial mailing, thank you post-card, follow-up mailing to non-respondents

• 92-items, 19 related to use of NPs/PAs

• Results weighted using standard procedures

Overall Response Rate 42.5%

35% 38%43% 44% 47%

43% 41%

27%

50%

0%

10%

20%

30%

40%

50%

60%

Below 3

5

35-4

4 ye

ars

of a

ge

45-5

4 ye

ars

of a

ge

55-6

4 ye

ars

of a

ge 65 +

Male

Fem

ale

Non-M

embe

r

ASCO Mem

ber

Current professional activitiesN Percent

Active full-time in oncology 1280 77.6%

Active part-time in oncology 148 9.0%

Still in fellowship training as of 9/30/2005 6 0.4%

Active in medicine, but not oncology 98 5.9%

Inactive in medicine at the present time 38 2.3%

Retired from medicine 72 4.4%

Missing 9 0.5%

Total 1651 100%

SpecialtyN %

Medical oncology 317 22%

Hematology/oncology 800 55%

Pediatric hematology/oncology 158 11%

Gynecologic oncology 69 5%

None of the above 98 7%

Radiation oncology 20%

Surgical oncology 23%

Other 57%

Total Active Clinical Oncologists = 1,344

DemographicsRespondents Masterfile

Gender Female 26% 24%

Male 74% 76%

Age <35 5% 3%

35-44 27% 26%

45-54 38% 34%

55-64 23% 27%

65 and over 7% 10%

Medical Education

US MGs 76% 71%

IMGS 24% 29%

NPs/PAs likely to provide any of the following services to your patients?

TRADITIONAL ACTIVITIES• Provide patient education

and counseling • Manage patients during

treatment visits• Provide pain and symptom

management• Address emergent care• Provide follow-up care for

patients in remission• Provide non-cancer related

primary care for patients in active treatment

• Provide end of life/hospice care

• Perform research related activities

• Take night or weekend call• Conduct hospital rounds

ADVANCED ACTIVITIES• Assist with new patient

consults• Order routine chemotherapy• Perform invasive procedures

(eg, bone marrow, spinal tap)

Percent of Oncologists whose NPs/PAs ‘usually’ or ‘always’

Provide patient ed/counseling 61%

Provide pain and symptom mgmt 46%

Manage patients during visits 43%

F/U care for pts in remission 43%

Address emergent care 30%

Order routine chemotherapy 25%

Assist w/ new pt consults 23%

Provide end of life/hospice care 22%

Conduct hospital rounds 22%

Primary care for pts in active treatment 20%

Perform invasive procedures 19%

Perform research activities 13%

Take night or weekend call 7%

56% of oncologists work with NPs/PAs in some capacity

No44%

Traditional30%

Advanced26%

Use of NPs/PAs does not vary significantly by gender

40% 45%

0%10%20%

30%40%50%60%70%

80%90%

100%

Female Male

No

Traditional

Advanced

Likelihood of working with NPs/PAs decreases with age

0%

10%

20%

30%

40%

50%

60%

70%

<40 40 - 49 50 - 59 60 - 64 65 - 69

Advanced Traditional

72% of academics work with NPs/PAscompared to 46% of private practice oncologists

39%

32%28%

15%

32%

54%

0%

10%

20%

30%

40%

50%

60%

Advanced Traditional No

Pe

rce

nt

of

Ph

ys

icia

ns

Academic Private Practice

NP/PA contribution valued

70% 73%

66%

16%

31%

69%

92%87% 85%

19%

58%

88%

0%

20%

40%

60%

80%

100%

Increasesefficiency

More time oncomplex cases

Contributesprofessionalsatatisfaction

Increases myworkload

Participate inclinical

research

Improvesoverall patient

care

Per

cen

t A

gre

e

Traditional Advanced

Variation in productivity by reported level of NP/PA activity

58 52 51

109102 99

0

20

40

60

80

100

120

Advanced Traditional No Advanced Traditional No

Mea

n V

isit

s

Private PracticeAcademic Setting

Variation not statistically significant

Relationship breaks down when you look by gender and setting

Academic - F

Academic - M

Private - F

Private - M

40

50

60

70

80

90

100

110

120

No Traditional Advanced

Use of NPs/PAs

Me

an

To

tal

Vis

its

Options for Addressing Shortages (2006 Practitioner Survey) % Sig Potential

Increase Efficiency

Reduction of paperwork and regulations 61%

Improved IT such as EMRs 43%

Increase / extend oncology workforce

Increased use of NPs/PAs 36%

Train more clinical oncologists 34%

Increased use of oncology nurses and CNS 32%

Create incentives to delay retirement 28%

Increase use of related care providers

Hospice and palliative care providers 26%

Social workers, counselors and patient educators 24%

Hospitalists 20%

Pain and symptom management specialists 17%

Primary care providers to care for patients in remission 15%

Those who currently use NPs/PAs more likely to see increased use as a solution to oncologist shortages

Potential of increased use of NPs/PAs to address shortages

53%36% 27%

0%

20%

40%

60%

80%

100%

Advanced Traditional No

Use of NPs/PAs

No potential

Some potential

Significant potential

Supply Scenarios– Increased usage of NPs/PAs

• BASELINE - 56% currently use NPs/PAs but only 26% at advanced capacity

• MIN – 85% use NPs/PAs minimally (4% increase in visits per week for private practice; no increase academic)

• MAX– 85% use NPs/PAs for advanced activities (10% increase for both settings)

NP scenarios show potential to increase visit capacity by .4 million to 3.2 million visits

DEMAND

SUPPLY

Traditional

Advanced

35

40

45

50

55

60

2005 2010 2015 2020

To

tal

An

nu

al

Vis

its

(i

n m

illio

ns

)

Results from Survey of Physicians Under 50

Only 44% of physicians under 50 work with NPs/PAs

Do you regularly work with an NP/PA?

Yes44%

No56%

Percent work with NP/PA varies by specialty category

54% 54%

46% 44%41% 38%

0%

10%

20%

30%

40%

50%

60%

PedsSubsp

Ob/Gyn Surgical PrimaryCare

FacilityBased

Medical

Primary Care – FP, GP, IM, and PedsMedical, Surgical, and Facility Based – Physician Characteristics and Distribution Categories

Clear differences of opinion regarding benefits of using NPs/PAs among those who work with them and those who don’t

80% 76%62%

52%38% 42%

19%33%

0%10%20%30%40%50%60%70%80%90%

IMPROVESPRACTICE

EFFICIENCY

ALLOWS MDSTO FOCUS ON

MORECOMPLEX PTS

IMPROVESOVERALL

PATIENT CARE

COULD BEEXPANDED INMY PRACTICE

Per

cen

t A

gre

e U

se o

f N

Ps/

PA

s

Work with NPs/PAs Do not work with NPs/PAs

Conclusions• Oncologists that work with NPs/PAs consistently agree that this improves efficiency and quality without increasing their workload

• Inconclusive that use of NPs/PAs actually improves visit capacity

• Increased use of NPs/PAs could have potential to help address shortages but other solutions will be needed

• Those who do not work with NPs/PAs are less inclined to see the value of their contribution