Blog Post

Can advanced practitioners increase medical oncologist capacity?

By Ashley Riley

November 16, 2016

    Many cancer programs struggle to maximize capacity in the medical oncology clinic. With looming shortages, there is a finite supply of medical oncologists, and they can only see so many patients in a day. Some cancer programs have attempted to increase clinic capacity by employing advanced practitioners (APs) in the clinic, but many struggle to ensure top-of-license practice.

    We surveyed nearly 100 medical oncology clinics about their use of advanced practitioners. Keep reading to find out what they told us.

    Most medical oncology clinics hire APs; NPs more common than PAs

    The majority of medical oncology clinics (80%) employ at least 0.5 FTE advanced practitioner. Respondents are more likely to employ nurse practitioners (NPs) than physician assistants (PAs) (75% vs 28%). NPs are also employed in higher quantities than PAs. Clinics with NPs employ a median of 2.0 NPs, while clinics with PAs employ a median of 1.0 PAs.

    Employing advanced practitioners associated with higher volumes

    Medical oncology clinics that employ APs see almost three times as many patients per day than clinics without APs. While this could be explained by the fact that these institutions are larger and have more oncologists, the data also shows that clinics with APs have a higher median number of daily patients per oncologist.

    Median daily patients per oncologist for clinics that employ and do not employ APs

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    Furthermore, there is a linear relationship between the number of APs per oncologist and oncologist capacity. Clinics in the lowest quartile of APs per oncologist (less than 0.3 APs/oncologist) have the lowest median number of daily patients per oncologist, while clinics in the top quartile of APs per oncologist (greater or equal to 0.6 APs/oncologist) have the highest median number of daily patients per oncologist.

    Median daily patients per oncologist by number of APs per oncologist
    By quartile of APs per oncologist

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    This data suggests that having advanced practitioners allows oncologists to see more patients in a given day. However, due to the cross-sectional nature of the survey, we can’t definitively conclude that this is a cause and effect relationship.

    Capacity also linked with AP independence

    Only 5% of medical oncology clinics use APs exclusively as independent providers, but 56% say their APs serve as both physician extenders and independent providers. 0.Nearly 40% of respondents say APs primarily serve as physician extenders—suggesting real opportunity to improve top-of-license practice in those clinics.

    Scope of AP role in the medical oncology clinic
    Percentage of medical oncology clinics

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    In fact, clinics that leverage APs exclusively as independent providers have a higher median number of daily patients overall and per oncologist than those that use them as both independent providers and physician extenders and those that use them just as physician extenders.

    Median daily patients per oncologist by scope of AP role in the clinic

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    This data demonstrates that it is not just having APs that can increase clinic capacity, but also how you use them. To maximize capacity, it is critical that cancer programs use APs at the top of their license in the medical oncology clinic.

    Keep your eye out for our next blog to find out what specific responsibilities APs take on in the clinic.

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