Results of the ASCO Study of Collaborative Practice Arrangements

Abstract

Purpose: ASCO projects a shortfall of oncologists in the next decade. The study was designed to address the workforce shortage by exploring collaborative oncology practice models that include nonphysician practitioners (NPPs).

Methods: ASCO contracted with Oncology Metrics, a division of Altos Solutions, to conduct a national survey of NPP integration and identify collaborative practice models and services provided by NPPs, as the first phase of the ASCO Study of Collaborative Practice Arrangements. Results of the national survey were used to identify practices for the next phase, in which selected practices participated in a more detailed data survey and satisfaction surveys. Focus groups or interviews were conducted with NPPs to collect additional subjective information to inform the project.

Results: The incident-to practice model was the predominant model. Satisfaction was universally high for patients and generally high for physicians and NPPs. In virtually all cases (98%), patients recognized they were seeing an NPP rather than a physician. Practices in which the NPP worked with all practice physicians showed significantly higher productivity than those practices in which the NPP worked exclusively with a specific physician or group of physicians.

Conclusion: The use of NPPs in oncology practices increases productivity for the practice and provides high physician and NPP satisfaction. Patients were aware when care was provided by an NPP and were very satisfied with all aspects of the collaborative care that they received. The integration of nonphysician practitioners into oncology practice offers a reliable means to address increased demand for oncology services without adding physicians.

Figure 1.

Services provided by nonphysician practitioners. bx, biopsy.

Figure 2.

Training for new nonphysician practitioners (NPPs).

Figure 3.

Perception of workload among physicians and nonphysician practitioners (NPPs).

Figure 4.

Perception of workload and patient encounters per full-time equivalent (FTE) provider. Each circle represents a practice; their size and color indicate practice productivity based on the number of patient encounters per FTE provider in the reporting period. The smaller red circles indicate below average productivity; blue is average; and the larger gold circles indicate greater than average productivity. The horizontal axis reflects the nonphysician provider (NPP) perception of workload and the vertical axis the physician perception. Circles in the upper right quadrant represent sites where both physicians and NPPs think they could see more patients. Circles in the lower left quadrant represent sites where both the physicians and the NPPs think they are seeing too many patients.

Figure 5.

Collaborative style and total patient encounters per full-time equivalent provider.