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Tool shows promise for measuring productivity of mid-level oncology providers


A pilot study of a new productivity tool developed by the National Comprehensive Cancer Network (NCCN) shows potential in measuring the impact of mid-level oncology providers in outpatient oncology settings. Refining productivity metrics for this group can help inform workforce projections given reports of a looming shortage of oncologists. The results will be presented at the ASCO Annual Meeting on May 30, 2009 in Orlando, Florida.


ORLANDO, FL — Mid-level providers have the potential to mitigate the impending workforce shortage of oncologists; however, their impact on clinical practice and productivity has been challenging to measure. A metric and tool developed by the National Comprehensive Cancer Network (NCCN) shows promise in the ability to quantify the productivity of mid-level oncology providers, physician assistants (PAs) and nurse practitioners (NPs), in outpatient oncology settings. The results of a pilot study evaluating this tool will be presented at the 2009 American Society for Clinical Oncology (ASCO) Annual Meeting on May 30, 2009.

“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 mid-level providers from 15 of the 21 NCCN Member Institutions. The online survey included questions on work characteristics, allocation of time and labor, and productivity. Productivity was defined by the 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.

“We found that the tool was a useful instrument in gauging the impact of mid-levels, and that NPs and PAs do seem to have a measurable effect on the number of patients seen in the participating academic outpatient oncology clinics,” says lead author Jennifer Hinkel, MSc, Manager, Business Insights at NCCN.

The authors noted that, as expected, NPs and PAs in the surgical oncology specialty saw more patients than mid-levels in other specialties. Brief pre- and post- operative visits may account for a large percentage of these mid-levels’ clinic time allowing for a larger volume of patients to be seen.

In the majority of the data collected, there was no significant difference between the number of patients NPs and PAs saw within each specialty except in the medical oncology specialty, where NPs reported seeing significantly more follow-up patients than PAs.

“This variation may be due to different practice patterns or the use of PAs for more procedure-oriented tasks rather than for outpatient clinic visits,” says Hinkel.

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.

Recent data from the American Society of Clinical Oncology’s Workforce Study published in 2007 has shown 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.

Additional authors include 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.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center
    Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan-Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Cancer Institute
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Comprehensive Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital