By Jennifer Hinkel, NCCN eBulletin Editor-in-Chief, and Megan Martin, Communications Manager
A pilot study of a new productivity tool developed by the National Comprehensive Cancer Network (NCCN) Best Practices Committee was presented at the ASCO Annual Meeting on May 30, 2009, in Orlando, Florida. The tool was developed to help describe and measure how nurse practitioners (NPs) and physician assistants (PAs) work in academic oncology clinics and the number of new and follow-up patients they see in the outpatient setting.
Recent projections, including an ASCO study on the oncology workforce published in 2007, suggest that a shortage of oncology physicians may loom on the horizon. The ASCO study projects that by the year 2020 there will be a shortage of between 2,350 and 3,800 oncologists, a problem that will be magnified by a 48 percent increase in the overall demand for oncology visits.1
NPs and PAs in the oncology workforce have the potential to mitigate this shortage, but their productivity is challenging to measure for a number of reasons. These reasons include variations in state regulations related to the level of independent practice (for instance, these providers can prescribe in some states, but not in others), differences in how PA/NPs are integrated into a practice and how their services are billed, and variations in practice models and how PA/NPs are paired or grouped to work with physicians or independently.
“In many cases, mid-level providers do not bill for their services separate from the physician making it difficult to assess their productivity in an oncology setting,” says author F. Marc Stewart, MD, Fred Hutchinson Cancer Research Center. “We developed this tool in an attempt to facilitate staffing and workforce projections, especially in the face of future physician shortages.”
The study analyzed eligible responses from 176 PA/NPs providers from 15 of the 21 NCCN Member Institution cancer centers. The online survey included questions on work characteristics, allocation of time and labor, and productivity. Productivity was defined by the study authors as the average number of new or follow-up patients seen per half-day clinic. In addition, the survey asked questions with the intent to identify any significant differences between NP and PA productivity within a variety of oncologic specialties including Medical Oncology/Solid Tumor, Hematologic Malignancies/Bone Marrow Transplant, and Surgical Oncology.
Of the groups surveyed, the highest reported productivity was observed for Surgical Oncology specialists, who saw a mean of 8.7 patients per clinic (with a standard deviation of 3.5). This finding may be related to the structure of surgical oncology practice, where brief pre- and post- operative visits may account for a large percentage of these mid-levels’ clinic time, thus allowing for a larger volume of patients to be seen by PA/NPs.
Specialists in Hematologic Malignancies/Bone Marrow Transplant saw a mean of 6.1 patients per clinic (with a standard deviation of 2.7). Among Medical Oncology specialists, NPs reported seeing more follow-up patients per clinic than PAs reported (7.2 compared to 5.5, p=0.04).
In most cases, productivity was unrelated to factors such as seniority (years of experience as a PA/NP). However, more experienced providers in the Hematologic Malignancies/Bone Marrow Transplant specialty saw more new patients per clinic (rs=0.46, p=0.03).
The authors plan to repeat the survey using a broader sample and in conjunction with an existing oncology physician productivity tool developed by NCCN to better determine the direct impact of mid-level providers on overall clinical productivity. With further refinement, this tool will provide greater insight into PA/NP productivity and may help guide operational decisions in oncology clinics.
The authors include Jennifer M. Hinkel, MSc, National Comprehensive Cancer Network; F. Marc Stewart, MD, Fred Hutchinson Cancer Research Center; Jonathan L. Vandergrift, MS, National Comprehensive Cancer Network; Sara J. Perkel, National Comprehensive Cancer Network; Marcy B. Waldinger, MHSA, University of Michigan Comprehensive Cancer Center; and William Levy, Fred Hutchinson Cancer Research Center.
If you would like to receive a copy of the poster as presented at ASCO, please send an e-mail requesting this to Jennifer Hinkel.
1 Forecasting the Supply of and Demand for Oncologists: A Report to the American Society of Clinical Oncology (ASCO) from the AAMC Center for Workforce Studies: Center for Workforce Studies; 2007.