Advanced Practice Providers (APPs) in Hematology: Work Practices, Interactions with Physicians, and Opportunities for Collaboration within the American Society of Hematology (ASH)

Abstract

Background: Advanced Practice Providers (APPs) - Nurse Practitioners (NPs) and Physician Assistants (PAs) - play a critical role in hematology practice. APPs receive variable specialty-specific training, practice in a variety of environments, and interact in variable ways with their physician colleagues and professional societies. Evidence suggests that hematologists in community practice that work with APPs frequently may have lower rates of burnout than colleagues who do not. However, little is known about APPs in hematology regarding scope of practice, challenges and opportunities in APP-physician interactions, and potential involvement and desire for involvement with the American Society of Hematology (ASH) specifically. In 2021, ASH convened a Task Force to examine hematology-specific aspects of APP practice and further inform ASH's policies and programs related to APPs in hematology. Methods: The ASH Hematology Task Force, in collaboration with researchers at the GW Mullan Institute for Health Workforce Equity, conducted a series of focus groups with APPs and collaborating physicians practicing in hematology-oncology in the United States. Participants were recruited via email, and focus groups were conducted from April through June 2022. Questions focused on education/training in hematology, practice experience (scope and degree of independence in practice), interactions with physician colleagues, and specific interactions with ASH. Thematic analysis was performed using Dedoose, a qualitative analysis software. Results: 49 APPs and 7 physicians participated in 9 focus groups. Participants primarily practiced in academic settings, and represented a mix of classical/benign hematology, malignant hematology, and oncology. APPs reported receiving relatively extensive on-the-job training in their clinical focus areas, with most sites creating their own training programs due to limited availability of outside resources. While most APPs reported feeling trusted and respected by physician colleagues, some also reported current or past experience working with physicians who minimized APP contributions. Many reported limited career advancement opportunities. Although APPs reported attending other professional conferences for APPs in hematology-oncology and finding them valuable, barriers to attending the ASH annual meeting were identified including: the requirement for physician sponsorship to attend, the need to provide clinical coverage for physicians attending, and a perceived lack of focus on clinical care. APPs and physicians strongly support increased APP programming at ASH annual meetings and support APPs becoming ASH members and serving on ASH committees. APPs/physicians also support ASH's involvement in the creation of hematology training resources for APPs and "best practice" guidelines for APP-physician collaboration in hematology. APPs and physicians feel hematology will benefit from improved APP-physician collaboration as APPs take on more responsibility due to hematology-oncology workforce shortages and increases in the hematology-oncology patient population over time. Conclusions: APPs in hematology practice in a variety of clinical areas/roles and most feel that they work in a collaborative environment with physicians. APPs expressed interest in future interactions with ASH in multiple domains. The ASH APP Task Force plans to use the themes identified in these focus groups to develop two national surveys, one of APPs and one of physicians. These results will inform the Task Force's final recommendations to ASH regarding APPs in hematology.