Abstract
PURPOSE: A workforce study by the Association of American Medical Colleges (AAMC) predicted a shortage of 2,350 to 3,800 oncologists, or 9.5 to 15 million visits, by 2020. Proposed solutions included use of physician assistants (PAs) and nurse practitioners (NPs). Although 56% of the oncologists reported working with PAs/NPs, the AAMC did not survey PAs or NPs. This article uses additional data to examine the role of PAs/NPs in the oncology workforce. MATERIALS AND METHODS: American Academy of Physician Assistant (AAPA) census data and a study of PAs in oncology were used to examine these workforce issues. RESULTS: The AAMC reported oncologists working with PAs/NPs had increased productivity compared with physicians who did not, primarily when the PAs/NPs performed advanced roles or worked in private practice. Visits handled by PAs/NPs themselves were not reported. According to the AAPA, PAs in the outpatient setting saw an average of 62.4 patients per week (inpatient PAs saw 62.2 patients per week), supporting the AAMC report that 70% to 92% of oncologists experienced increased efficiency with PAs/NPs. Whereas the AAMC reported that 46.4% of oncologists used PAs/NPs in advanced roles, Ross et al reported that more than 70% of PAs wrote chemotherapy orders (most requiring physician co-signature); more than 80% wrote prescriptions, including for controlled substances; and more than half performed invasive procedures. The AAMC reported that 13% of PAs/NPs performed research activities, and the AAPA reported that 60.5% of medical oncology PAs participated in clinical trials. CONCLUSION: The AAMC workforce study inadequately examined the role of PAs/NPs in oncology. Given the available data in PA literature, the contribution of PAs/NPs to the workforce was substantially underestimated. In examining workforce issues, understanding opportunities for increasing collaborative practice requires the input of PAs/NPs.