Oncology Rounds

How your peers are using APPs—and what you can do to keep them on your team

by Jacob Dingle and Deirdre Saulet

It's no secret that advanced practice providers (APPs) are high-value staffing resources, especially in medical oncology where they can help expand access, improve symptom management, or make up for physician shortages. And while we've been talking about top-of-license practice for decades, many programs struggle to do so due to avoidable time sinks, lack of insight into the APP role, or challenges related to organizational culture and physician buy in.

More organizations using APPs at top of license—but still room to improve

According to our 2018 Trending Now in Cancer Care Survey, the vast majority—81%—of cancer programs employ at least one APP. However, APPs are only as valuable as the ways in which they are leveraged.

Credit should be given here—the top two tasks being performed by APPs are symptom management and follow-up patient visits in the outpatient clinic, which are top-of-license activities. And, compared to 2017, the percent of organizations using APPs in this way has increased slightly. Furthermore, some non-top-of-license tasks, such as dictating patient notes, have fallen 6% over that same time period.

However, there's still room to improve. Half of our respondents told us that APPs still regularly spend time dictating patient notes, which takes them away from other higher-value tasks. And only 29% report that APPs regularly perform other top-of-license tasks, like routine medical procedures.

APPs want to practice at top of license—and aren't afraid to leave if they aren't allowed to

Although it seems as if cancer programs have made gains in using APPs at top of license, leaders can't lose sight of this goal as it's critical to retaining these valuable staff members. In fact, we found that 20% of programs experienced over 11% of APP turnover across 2017-2018—and the third-most commonly reported reason for APP turnover is "too many bureaucratic tasks." Right behind it, with 15% of organizations reporting this as a reason APPs left, is "lack of professional fulfillment." While we don't know the exact reasons APPs expressed this sentiment, we feel confident a good percentage of it results from APPs feeling under-utilized and not practicing to the full extent of their training and licensure.

Setting your APPs up for success

Given this data, it is crucial for cancer program leaders to create the platform for APPs to focus on high-value tasks. The following steps can help ensure top-of-license practice for your APPs, lessen turnover, and maximize their contributions:

  1. Use collaborative practice agreements (CPAs) to encourage upfront discussion between physicians and APPs about expectations and productivity measures. Additionally, CPAs establish protocols for routine communication and common procedures, as well as help solve conflicts and answer questions about APP scope of practice.

  2. Engage physician champions to start leveraging APPs and demonstrate the benefits to their colleagues. Use your greatest APP advocates to communicate with their peers about the efficiencies gained through thoughtful division of tasks. You can similarly prove the top-of- license ability of APPs by standardizing training through residency programs that bake in a variety of cases and practice styles.

  3. Use your APPs to kickstart—or expand—new programs. Find opportunities for APPs to spearhead initiatives that are high-value for the cancer program and align with individual's interests. For example, having APPs help build survivorship, palliative care, or lung screening programs gives them the ability to practice at top-of-license while delivering value to the organization at large.
 

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