With Todd Pickard, MMSc, PA-C, DFAAPA, Director of Physician Assistant Practice at MD Anderson Cancer Center and Chair of ASCO's Workforce Advisory Group
By Sarah DiGiulio
The numbers of advanced practice providers involved in oncology is quickly growing. The number of U.S. oncology practices who've reported employing advanced practice providers has jumped from 52 percent in 2014 to 81 percent in 2017, according to ASCO's annual Practice Census Survey (J Oncol Pract 2018;14:e412-e420).
To better understand the role and scope that these advanced practice providers—including nurse practitioners and physician assistants—play in cancer care, several major health groups collaboratively conducted and published a survey to identify such providers. The data was published in the Journal of Oncology Practice (2018;14:e518-e532).
"There has been a great deal of interest in the role of advanced practice providers in oncology, but a limited understanding of how many advanced practice providers practice in this area, what services they provide, what influences their practice, and how they are compensated," survey co-author Todd Pickard, MMSc, PA-C, DFAAPA, Director of Physician Assistant Practice at The University of Texas MD Anderson Cancer Center and Chair of ASCO's Workforce Advisory Group that worked on the survey, shared with Oncology Times.
The collaboration included ASCO, the American Academy of Physician Assistants (AAPA), the Association of Physician Assistants in Oncology (APAO), the Advanced Practitioner Society for Hematology and Oncology (APSHO), and the Oncology Nursing Society.
"There has been a well-published disconnect between demand for oncology services and the supply of providers available to meet this growing demand," Pickard said. "One of the solutions to close this gap between supply and demand is the addition of advanced practice providers as oncology providers and integration into the care team.
"Oncology practices have real-world needs to respond to their communities and advanced practice providers have been a valuable resource to meet these needs. It simply makes sense that this growth has occurred and will likely continue," he added.
The analysis identified 5,350 advanced practice providers currently working in oncology, though the paper notes there could be as many as 7,000. The data also includes information about the demographics of those providers, as well as the roles they play and challenges they face.
According to the paper, it is the first detailed examination of advanced practice providers in oncology. Pickard further explained what the new data revealed.
1. What findings stood out to you?
"Several items stand out: 1) It is still very difficult to get a true 'census' of advanced practice providers in oncology due to limitations in how they are accounted for in the health care system. Many times their contributions are hidden in co-managed work and billing data that is attributed to our physician colleagues.
"2) Advanced practice provider practice in oncology is heavily influenced by physician preferences rather than patient care demands or standardization of the advanced practice provider role.
"3) Advanced practice providers in oncology have unique educational needs to ensure that they are fully prepared to provide the complex care of the oncology patient. ASCO, APSHO, APAO, and AAPA have worked to create in-person meetings, web-based learning, and other medical knowledge tools to meet these needs.
"4) There has been a very rapid growth and wide acceptance of the advanced practice provider in oncology since 2014."
2. How is the increasing presence of advanced practice providers in oncology care changing how care is delivered?
"The growing presence of advanced practice providers in oncology has created several opportunities for increasing patient access to care, quality of care, coordination of care, new services for cancer survivors, and safer care. When you have a fully integrated care team of physicians, advanced practice providers, nurses, pharmacists, social workers, and business/office staff, the team is positioned and resourced to provide the entire spectrum of care for oncology patients.
"This care is incredibly complex and relies on the knowledge, skills, and engagement of the entire team. Advanced practice providers fit perfectly into the area of need.
"They are flexible providers that can move quickly to fill in needed coverage of clinical appointments, perform procedures, educate patients, supervise chemotherapy treatments, manage symptoms, coordinate care across the health care system, and provide survivorship care."
3. What are the implications of these findings and what's most important for practicing oncologists and all cancer care providers to know about this research?
"This is great news for oncology physicians. They have the opportunity to work with advanced practice providers who can become critically important and valuable members of the team that improve the care for patients with cancer. Advanced practice providers have a proven track record in oncology and this enables physicians to understand and embrace [their] role in oncology.
"Advanced practice providers have a critical role in the delivery of oncology care that brings value, quality, and safety to those we serve. Advanced practice providers are focused on team-based care that is perfectly suited to the complex care of the patient with cancer."