Understanding the Role of Advanced Practice Providers in Oncology in the United States

Abstract

Purpose: Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. Methods: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. Results: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/ oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/ gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. Conclusion: We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

Table 1

Survey Results

Table 1

Survey Results (cont.)

Table 1

Survey Results (cont.)

Figure 1

Distribution of percent time spent on patient care tasks. For each task and type of advanced practice provider, a box plot is displayed with medians, 25th percentiles, and 75th percentiles indicated by the boxes. Outliers are shown as individual points. NP = nurse practitioner; PA = physician assistant.

Figure 2

Types of direct patient care services reported by physician assistants (PAs) and nurse practitioners (NPs). Numbers to the right of the bars represent the percentages of each type of care reported for PAs and for NPs. Respondents were not limited in the number of services they could select.

Table 2

Results of Linear Regression Models of Compensation

Table 2

Results of Linear Regression Models of Compensation (cont.)

Appendix A.

Cancer Centers Included in Group 3 of the Study

Appendix B.

Oncology Care Model Practices Included in Group 3 of the Study