Supply and demand for oncology specialists is expected to become even more unbalanced in the US market over the next 10 years, particularly as the new health reform legislation creates more uncertainty for the reimbursement of the high cost biologic treatments now coming on stream. Several survey are documenting the shortage and suggesting that the only practical solution is to empower physician assistants and nurse practitioners to help fill the gap.
Recent studies by the National Comprehensive Cancer Network [NCCN] and the American Society of Clinical Oncology (ASCO) predict a large workforce shortage among oncology physicians. According to ASCO, while the number of oncologists is expected to increase 20 percent by 2020, patient demand is expected to grow by 48 percent. According to Practical Clinical Exchange, an organization that provides educational opportunities to meet the needs of nurse practitioners (NPs) and physician assistants (PAs), NPs and PAs may be the answer to this upcoming shortage.
The ASCO study results showed that physicians who work with NPs or PAs in their practice saw 10 percent more patients per week. This was true with NPs or PAs who performed advanced patient care activities—defined as assisting with new patient consults, ordering routine chemotherapy, or performing invasive procedures. With only 56 percent of clinical oncologists working with NPs and PAs, the potential to expand capacity simply by adding an NP or PA to the mix is great.
According to Practical Clinical Exchange, the roles of NPs and PAs may be underutilized in oncology practice. Researcher Maura Polansky, MS, PA-C, and colleagues write in the November issue of the Journal of Oncology Practice that ASCO may be understating the current roles of these clinicians. Polansky found that PAs were writing chemotherapy orders and prescriptions, as well as performing invasive procedures at a much higher rate than reported by ASCO. Additionally, they found that oncology PAs participated in clinical trials at a rate four times as high as reported by ASCO.
Polansky also pointed out that to effectively increase the use of NPs and PAs in oncology, more of these clinicians should be attracted to work in oncology. Considering the limited exposure to oncology in their formal training, oncology continuing education and training opportunities tailored to these clinicians is essential for NPs and PAs to perform advanced patient care activities, fully practice to their potential, and best improve the efficiency of oncology practices.
The survey is also useful in documenting the importance of physician assistance in enhancing the role of drug therapy and assuring appropriate use. Incorporating this emerging stakeholder in advocacy work linked to oncology product launches is important but must be handled with discretion – oncologists remain the essential front line in what can only be described as an increasingly complex treatment environment, where the choices facing clinicians and patients are many.
For more information on this survey, please visit the American Society of Clinical Oncology.