Jason Astrin, PA-C, MBA, DFAAPA
Advanced practice providers (APPS) are playing anincreasingly important role in oncology care. The need for services is increasing, but there are not enough oncologists entering the profession. A deficit of 1487 oncologists is projected by 2025.1
In addition, oncologists are seeing more patients with comorbidities, requiring more physician time. And, although patient outcomes have improved thanks to the efficacy of new treatments, patients stay in the healthcare system longer. Additionally, the aging population and increased access to care have intensified the demand for services. Because of all these factors combined, the burden on oncologists is becoming unmanageable, leading many practices to turn to APPs (Table. Figure2,3
Table. Advanced Practice Providers in Oncology Practice2,3
When to Add an App
The decision to hire an APP often occurs soon after a practice realizes its providers are overbooked. As the average number of days until first appointment gets longer and patients are referred to competitors, practices react by hiring an APP.
However, this snap decision often leads to disappointment, as an APP typically cannot instantaneously bridge the provider gap. A better business response is to anticipate growing patient volumes as well as an aging workforce and factor those into succession planning. It is sometimes possible to replace a retiring physician with 1 or 2 APPs. By preplanning 4 or 5 years ahead, practices can anticipate when another provider will be needed, allowing ample time to find and on-board the right person.
Figure. Apps in Oncology Practice3
Using the Right Staffing Model
Across The US Oncology Network, 2 APP healthcare delivery models are most prevalent: independent visit and shared visit. While both are collaborative, the most popular is the independent visit model. Under this, APPs manage their own clinic, spending most of their time on follow-up care. Interaction with supervising physicians occurs as needed, such as when a change in treatment plan is required. Often, a patient will see the APP between physician visits. Ideally, APPs have their own nursing support, their own offices, and dedicated exam rooms. This staffing model provides a high degree of independence and job satisfaction. Essentially, APPs run their clinics simultaneously and independently, but there is oversight, support, and collaboration from oncologists.
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