Oncology Physician Assistants Research Articles

Asian representation in the United States (US) oncology workforce.

152 Background: The American Society of Clinical Oncology (ASCO) started the Diversity in Oncology initiative in 2017. Minority representation in the US oncology physician workforce was the subject of a recent series of ASCO State of the Oncology Workforce in America snapshots (1). However, Asian minority representation was not mentioned in any of these reports. Our objective was to determine the proportion of Asian workforce in various oncology specialties inclusive of physician and non-physician practitioners as well as physician trainees. Methods: We searched the web for publicly available data on Asian representation among US oncology adult (A) and pediatric (P) practitioners and trainees. Major data sources included the 2020 US Census, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and professional societies. Practitioners included hematologists/oncologists (H/O), gynecologic oncologists (GYNO), radiation oncologists (RADO), surgical oncologists (SURGO), hematopathologists (HP), oncology nurse practitioners (ONP), oncology physician assistants (OPA), and oncology nurses (ON). Trainees included fellows (F) and residents (R). For reference, we obtained similar data on US population, medical students (MS), adult internal medicine residents (AIMR), gynecology residents (GYNR), pediatric residents (PR), pathology residents (PATHR), surgery residents (SURGR), nurses (RN), nurse practitioners (NP), and physician assistants (PA). For a snapshot of the oncology workforce, data from 2020-2022 were used. Whenever available, we obtained serial data for trainees over the years. Results: A snapshot of the proportions of Asians based on their professions is shown (Table). While Asians comprise only 6.2% of the US population, between 14.7% to 32.1% of physician practitioners in various oncology subspecialties are Asian. Moreover, between 17.9% to 35.3% of oncology physician trainees and 26.7% of medical students are Asian and these proportions have remained stable from 2005 to 2022. Data are unavailable for HP, SURGO, and non-physician practitioners except for OPA (7.0%) and RN (7.2%). Conclusions: Asians comprise a large segment of the US oncology workforce. While only 1 in 20 people in the US are Asians, between 1 in 3 and 1 in 5 oncology physician practitioners and trainees are Asians. Data are limited for non-physician practitioners. Asian minority representation should be highlighted and considered as an example of success in diversity. 1. JCO Oncol Pract 2020-2022. Snapshot of Asian representation among oncology trainees and practitioners in the US. Trainees 2022 A-H/O-F 35.3% AIMR 35.9% 2022 P-H/O-F 20.0% PR 22.0% 2022 RADO-R 26.4% MS 26.7% 2022 GYNO-F 17.9% GYNR 14.9% 2022 HP-F 20.0% PATHR 26.6% 2022 SURGO-F 21.2% SURGR 19.2% Practitioners 2021 A-H/O 32.1% OPA 7.0% 2021 P-H/O 20.4% RN 7.2% 2021 RADO 25.9% HP/SURGO/ONP/ON NA 2020 GYNO 14.7% US Census 6.2%

AI-assisted clinical summary and treatment planning for cancer care: A comparative study of human vs. AI-based approaches.

1523 Background: Understanding a patient's clinical narrative, timeline, and history is critical for accurate treatment decision-making. However, reviewing and summarizing complex records is time-consuming and error-prone. Recent advancements in artificial intelligence (AI), specifically large language models (LLM), offer paths to improve quality and efficiency. Methods: A study was conducted on 50 breast cancer cases from an academic medical institution, utilizing all medical records—clinic, pathology, and radiology reports—up until the point of the initial treatment decision. All cases were processed using three different approaches: AI-assisted; full-AI; and human-only. In the AI-assisted method, two oncology physician assistants (PAs) revised AI-generated summaries to create clinical summaries. The full-AI method had AI independently produce clinical summaries, while the human-only method had the PAs compile summaries without AI. Eight board-certified international oncology specialists blindly evaluated summaries for faithfulness, completeness, and succinctness using a 3-point scale, ranked their preferences, and tried to predict which summaries were full-AI. Rankings were assessed using a Friedman test followed by a Wilcoxon signed-rank test, and full-AI prediction was assessed using a two-sided one-sample binomial test. After summarization, a distinct AI system with access to clinical guidelines provided treatment plans. These plans were then evaluated by a board-certified oncologist with access to the original treatment decision. Results: The study found specialists favored AI-assisted, followed by full-AI, and then human-only summaries, with average ranks of 1.73, 1.93, 2.34 respectively (lower is better, p<0.001). The difference between full-AI and AI-assisted was not significant (p=0.11). Evaluation scores (mean±95%CI, higher is better) showed AI-assisted, full-AI, and human-only scored 2.35±0.13, 2.14±0.14, 2.17±0.14 for faithfulness; 2.28±0.12, 2.01±0.12, 1.93±0.14 for completeness; and 2.33±0.12, 2.21±0.12, 1.99±0.13 for succinctness. The average summarization time was 19.71, 1.17, 26.03 minutes. Full-AI identification accuracy was 0.28 (not different from chance 0.33, p=0.46). With AI-assisted summaries, the treatment plans were accurate in 45 cases (90%) and partially accurate in 5 cases (10%). In the 5 partially accurate cases, the system was accurate with the provided input data, but there were inaccuracies with the input data, including incorrect formats or missing data. Conclusions: Incorporating LLMs into the creation of medical summaries has shown improvements in both quality and efficiency, achieving up to 22.2x speed up with full-AI, indicating that AI-assisted summarization tools can potentially enhance care quality. AI-assisted summaries yield accurate treatment plans when the input data is accurate.

Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology.

Moral distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. This study was initiated to explore associations between MD, burnout, and the organizational climate (OC) for oncology physician assistants (PAs). A national survey of oncology PAs was conducted to explore the associations between MD, OC, and burnout. The Nurse Practitioner-Primary Care OC Questionnaire was revised for oncology PAs to assess OC for PA practice. MD and burnout were assessed using the Measure of MD-Healthcare Professionals (MMD-HP) and the Maslach Burnout Inventory. One hundred forty-six oncology PAs are included in the analysis. PAs were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical oncology (73%), with mean age 41.0 years. The mean MMD-HP score for oncology PAs was 71.5 and there was no difference in MD scores on the basis of oncology subspecialty, practice setting, practice type, or hours worked per week. PAs currently considering leaving their position because of MD had significantly higher mean scores on the MMD-HP compared with those not considering leaving their position (108.2 v 64.8; P = .001). PAs with burnout also had significantly higher mean scores for MD compared with PAs without burnout (97.6 v 54.3; P < .001). A negative relationship between OC for PA practice and MD was only found for the PA-administration relations subscale, whereas all subscales were negatively associated with burnout. This study demonstrates that the risk of professional burnout increases significantly with increasing levels of MD. Additional research exploring the relationship between MD and burnout is needed.

Clinical care in hepatocellular carcinoma: A mixed methods assessment of experiences and challenges of oncology professionals.

Healthcare providers (HCPs) may face numerous dilemmas in optimally screening, diagnosing, and treating patients with, and/or at risk for, hepatocellular carcinoma (HCC). This study aimed to achieve a greater understanding of the challenges in HCC care which in turn could delineate HCP educational opportunities within this oncologic sub-specialty. A mixed-methods approach was used to identify practice gaps and clinical barriers experienced by US-based medical oncologists, hepatologists, oncology physician assistants, oncology nurse practitioners, and interventional radiologists involved in HCC care. The qualitative (semi-structured interview) and quantitative (survey) data collection approaches were deployed sequentially with findings subsequently triangulated. A total of 214 HCPs participated in this study. Analysis revealed challenges related to screening and diagnosing HCC, specifically in applying appropriate screening guidelines, and the optimal use and decisions related to diagnostic imaging and biopsy. Issues related to treatment selection included the application of existing HCC guidelines in treatment decision-making, weighing risk/benefit ratios of various antineoplastics regimens (i.e., tyrosine kinase inhibitors-TKIs, immunotherapy agents, chemotherapy), sequencing therapies, potential toxicity management, and optimally educating patients about their HCC. These findings highlight the educational needs of those involved in HCC care and provide a starting point for clinicians to both reflect on their practice and identify opportunities to enhance communication within the HCC team and between provider and patient. There is an opportunity to optimize continuing professional development interventions that address the identified gaps in clinical practice specifically related to teamwork and interdisciplinary communication.

Association of Organizational Context, Collaborative Practice Models, and Burnout Among Physician Assistants in Oncology.

Despite an increase in the number of physician assistants (PAs) in the oncology workforce, their potential to meet anticipated demand for oncology services may be hindered by high rates of burnout. The aim of this study was to examine the association between organizational context (OC) and burnout among oncology PAs to better understand factors associated with burnout. A national survey of oncology PAs was conducted to explore relationships between burnout and the OC in which the PA practiced. The Areas of Worklife Survey (AWS) assessed OC by examining six key workplace qualities (workload, control, reward, community, fairness, and values). Burnout was assessed using the Maslach Burnout Inventory. PAs demonstrating burnout scored significantly lower across all domains of the AWS than those without burnout (P < .001 for each AWS subscale). The median score for each domain of the AWS and burnout (No v Yes) were as follows: workload (3.33 v 2.67), control (3.67 v 3.00), reward (4.00 v 3.67), community (4.00 v 3.67), fairness (3.33 v 2.67), and values (4.00 v 3.33). Multivariable analysis found that mismatches between the PA and their work environment in workload (odds ratio [OR] = 1.99; 95% CI, 1.32 to 3.02; P = .001), reward (OR = 1.89, 95% CI, 1.18 to 3.02; P = .008), and values (OR = 2.25; 95% CI, 1.31 to 3.88; P = .003) were more likely to report burnout. Differences in burnout in the context of workload were not explained by patient volume, practice structure, or professional autonomy. Workload, reward, and values were associated with greater odds of burnout, with workload being the most common mismatch in job fit. Sustainable workloads and consistency in rewards (financial, institutional, and social) for oncology PAs should be an employer's focus to help mitigate their risk of burnout.

Oncology Advanced Practice Providers Chemotherapeutic Prescribing Practices

Background:Physician Assistants (PA) and Nurse Practitioners (NP), referred to as Advanced Practice Providers (APPs), are an integral part of cancer care today in community oncology (ONC) and academic institutions across the country. It has been shown, a team approach using APPs can extend the ONC workforce (PMID: 25009939). The need for ONC services will increase with the rise in cancer incidence and prevalence. As the rise continues, studies have shown ONC services will dramatically increase due to the predicted shortages of oncologists. Increasing the use of APPs is a viable solution to this shortage (PMID: 21037868). PAs and NPs have validated their value by safely prescribing chemotherapy (CT) as they provide cancer care. This value has been key for both patient and physician colleagues. The Association of Physician Assistants in Oncology (APAO) pursued research to better understand CT prescribing practices of ONC PAs. The focus was on whether or not PAs were allowed to prescribe CT drugs in their day to day practice.Methods:A survey was used to collect data. The survey focused on APPs scope of practice to include prescribing CT independently (IND) or were there restrictions by the state or organizations they are employed by. For those allowed to prescribe CT, further questions regarding training programs and time periods to demonstrate competency were asked. The survey also viewed physician and employer attitudes towards APPs prescribing CT. The survey was sent in January 2021 to 1307 APAO members via email with a 30-day collection period. Eleven percent were returned (N=149).Results:Respondents (R) were PAs, 95%, NPs, 3% and other 1%. The majority of R worked in Hematology/Medical ONC, 87%, with fewer in Surgical ONC 6%, Radiation ONC 1%, other 6%. R came from 34 states with the largest number representing Texas, 13%, New York 12%, Pennsylvania, 8%, North Carolina,7%, Massachusetts 6% and Florida 5%. Most of the R had been in ONC for 1-8 years (y) (59%), followed by 9-16 y (21%), 17-24 y (16%), and 25+ y (3%). The survey was divided into two arms, those who could IND sign CT orders and those who could not IND sign CT orders. The survey demonstrated 44% of the R were able to IND sign CT orders and 56 % of the R could not. With regard to work setting, 60% of R in this arm worked in academic ONC centers and 35% worked in community ONC centers. Also in this arm, 23% were only allowed to sign existing CT plans that did not require modification and 77% were not. The majority of R could sign existing CT orders (89%) and fewer could initiate and sign new CT orders (35%). Most R were able to prescribe intravenous and oral medication (98%), while fewer could prescribe intrathecal 34%) and clinical trial medications (49%).Of the R in the second arm, 74% worked at academic ONC centers and 19% worked at community ONC practices. When asked if their state medical board prohibited prescribing CT, the majority (77%) reported this was not the case, then if their institution/facilities prohibited prescribing CT, the majority (69%) reported this was true. To explore physician/employer attitudes, a question was posed to ask the APP if their physicians believe that limiting CT to physicians is a safety measure. Responses were mixed, 36% reporting this is true, 33% reporting this was false and 31% as unsure. Next, the APPs were asked if their physicians believed experienced APPs should be allowed to prescribe CT. Again, responses were mixed, 44% agreeing, while 11% disagreeing. Finally, 44% were unsure. When asked if their employer believed limiting CT to physicians is an important safety measure, 47% of the R reported this is true, 19% R reported this is false and 34% were unsure. When asked if their employer believed experienced APPs should be allowed to prescribe CT, 30% of the R reported this is true, 20% R report this is false and 49% were unsure.Conclusion:CT prescribing privileges, are not universal for APPs and the reason for inconsistencies in prescribing CT is not clear. This survey provided insight to the wide range of prescribing practices throughout the US based on ONC settings, geographic regions, and experience of the APP. As APPs are valued team members in extending the ONC workforce, and prescribing CT is a common practice in cancer care which APPs participate in. This would seem worthy of further research to understand the reasons why such discrepancies exist. DisclosuresDiaz Duque: Morphosys: Speakers Bureau; Hutchinson Pharmaceuticals: Research Funding; Incyte: Consultancy; Astra Zeneca: Research Funding; Epizyme: Consultancy; ADCT: Consultancy.

Changes in Burnout Among Oncology Physician Assistants Between 2015 and 2019.

Burnout has significant implications for the individual provider, the oncology workforce, and the quality of care for patients with cancer. The primary aim of this study was to explore temporal changes in burnout among physician assistants (PAs) in oncology in 2019 compared with 2015. Oncology PAs were surveyed to assess for burnout using the Maslach Burnout Inventory according to the same cross-sectional design of the study performed in 2015. Comparison between oncology PAs in 2015 and 2019 in the prevalence of burnout and personal and professional characteristics was performed. Two hundred thirty-four participants completed the full-length survey. The participants in 2015 and 2019 were similar in age (41.8 v 40.3 years), sex (88.8% v 86.3% female), number of years as a PA in oncology (9.6 v 10), and percentage involved in academic practice (55.2% v 59.2%). There was a significant increase in burnout in 2019 compared with 2015 with 48.7% of PAs reporting at least one symptom of burnout compared with 34.8% (odds ratio for burnout, 2019 v 2015 = 1.92 [95% CI, 1.40 to 2.65], P < 0.001). The odds of burnout remained higher in 2019 compared with 2015 when adjusted for age, sex, relationship status, practice setting, subspecialty, practice type, and hours worked. Factors associated with burnout in both 2015 and 2019 include the percentage of time spent on patient care, collaborative physician relationship, number of hours worked, and satisfaction with compensation. No new factors associated with burnout emerged in 2019 that were not identified in 2015. The rate of burnout of oncology PAs has significantly increased. Burnout in oncology PAs is multifactorial, and the increase cannot be easily explained. Additional research is needed to better define the drivers of PA burnout.

Moral distress, organizational climate, and the risk of burnout among oncology physician assistants.

11018 Background: Moral Distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care and has been associated with burnout. Advances have been made in our understanding of burnout in the oncology (Onc) workforce but our understanding of MD remains limited. This study was initiated to explore associations between moral distress, burnout, and the organizational climate (OC) for Onc Physician Assistants (PAs). Methods: A national survey of onc PAs was conducted in 2020. MD and Burnout were assessed with the Maslach Burnout Inventory and the Measure of MD – Healthcare Professionals (MMD-HP). To assess OC, the Nurse Practitioner Primary Care OC Questionnaire (NP-PCOCQ) was revised for Onc PAs and assessed professional visibility (PV), administrative relations (AR), physician relations (PR), and professional autonomy and support (PAS). A robust Poisson regression model was used to estimate risk ratios (RR) for burnout associated with MD and OC variables. Results: Respondents who completed the survey included 146 Onc PAs that were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical Onc (73%). Mean MMD-HP score was 71.5 and burnout was reported by 39.7% of PAs. MMD-HP scores did not differ based on specialty, practice setting or practice type. PCOCQ subscale scores were lower for PAs with burnout vs. without burnout (p=0.003 to p &lt; 0.001). Increasing levels of MD were associated with increased levels of emotional exhaustion (p&lt;0.001), depersonalization (p&lt;0.001) and a higher overall rate of burnout. For Low, Medium and High MMD, burnout rates were 10%, 44% and 66% respectively (p&lt;0.001). Risk of burnout was associated with increasing levels of MD, which remained when adjusted for the PCOCQ subscales. An interaction model with the PCOCQ subscales and the association between burnout and MD was not significant. Conclusions: Higher levels of MD and unfavorable organizational climate are associated with Onc PA burnout. The relationship between MD and burnout does not appear to be moderated by organizational climate. Additional research is needed to identify potential moderators of the MD/Burnout relationship. Risk Ratio estimate for Burnout.[Table: see text]

Burnout among oncology physician assistants (PAs) from 2015 to 2019.

11009 Background: Changes in the demand and delivery of healthcare have led to a significant increase in employment of PAs in Oncology (Onc). These changes may also increase PAs risk of burnout, a syndrome characterized by a high level of emotional exhaustion (EE) and/or depersonalization (DP). This study was initiated to explore temporal changes in burnout &amp; the PA workforce. Methods: Using the same methods from 2015, a national survey of Onc PAs was conducted in 2019. Survey items (n = 74) examined personal and professional characteristics, collaborative practice (CP), team structure, organizational context (OC), and burnout. OC was assessed using Areas of Worklife Survey (AWS) domains: workload, control, reward, community, fairness, &amp; values. Low AWS domain score indicated a workplace mismatch (WM). Burnout was assessed with the Maslach Burnout Inventory. Change in burnout was examined with repeated measures logistic regression. Results: 234 out of 917 PAs (25.5%) completed the full survey. Respondents were mostly female (86%), married/partnered (78%), in Med Onc (71%), and practicing in the outpatient setting (67%). Burnout increased from 34.8% in 2015 to 48.7% in 2019 [odds ratio for burnout, 2019 vs 2015 = 1.92 (95%CI 1.40-2.65), p &lt; .001]. Adjustment for workforce variables did not explain the increase in burnout. Among 2019 respondents, increased hours worked (p = .003), sub-specialty (P = .018), less time (%) spent on direct patient care (p = .007), practicing below full extent of education and training (p = .048), dissatisfaction with CP (p &lt; .001), and perceptions of poor collaborative physician leadership (p &lt; .001) were associated with higher rates of burnout. No difference in burnout was seen for personal or team characteristics, practice setting, years in onc, or # of patient visits. AWS scores were lower for PAs with burnout vs. without burnout (p &lt; .001). PAs with a WM had a higher rate of burnout for each AWS domain (p &lt; .001); most common WMs were fairness (44%) and workload (43%). Conclusions: The rate of burnout for Onc PAs has significantly increased and is now at levels of nearly 50%. Burnout in Onc PAs related to WM in workload is common, significant, &amp; not explained by patient volume alone. The causes of burnout are multifactorial and additional research is needed in this at risk group. [Table: see text]

The Growing Role for Nurse Practitioners &amp; Physician Assistants in Oncology

The Growing Role for Nurse Practitioners &amp; Physician Assistants in Oncology

National Study of Burnout and Career Satisfaction Among Physician Assistants in Oncology: Implications for Team-Based Care.

A high rate of burnout has been reported in oncology physicians. Physician assistants (PAs) may also face similar risks of burnout. We sought to measure the personal and professional characteristics associated with burnout and career satisfaction and the potential impact on the oncology PA workforce. A national survey of PAs in oncology was completed by using the Maslach Burnout Inventory from September 2015 to January 2016. In all, 855 PAs were contacted and 250 submitted complete surveys (response rate, 29.2%). Respondents were representative of PAs in oncology with a mean age of 41.8 years, females (88.8%), academic practice (55.2%), urban location (61.2%), outpatient (74.4%), medical oncology (75.2%), worked 41 to 50 hours per week (52.8%), and had a mean of 9.6 years as a PA in oncology. Burnout was reported in 34.8% of PAs, 30.4% reported high emotional exhaustion, 17.6% reported high depersonalization, and 19.6% reported a low sense of personal accomplishment. In multivariable analysis, age, time spent on indirect patient care, oncology subspecialty, and relationship with collaborating physician were factors associated with burnout. Career and specialty satisfaction was high (86.4% and 88.8%, respectively). In the next 2 years, only 3.6% of PAs plan to pursue a different career or specialty and only 2.0% plan to retire. Despite high career and specialty satisfaction, burnout is reported in one third of PAs in oncology. Further exploration of the relationship between PAs and collaborating physicians may provide insight on methods to decrease burnout. Negligible short-term attrition of the current oncology PA workforce is anticipated.

Provider characteristics and their association with burnout and career satisfaction among physician assistants in oncology.

6521Background: About 45% of oncologists report burnout (BO) despite high career/specialty satisfaction (CS/SS). Little is known about BO and CS/SS among Physician Assistants (PAs) in oncology (onc...

An interactive web-based module to teach physician assistants about venous thromboembolism

Objective Questions about venous thromboembolism (VTE) management result in a high number of cardiovascular consults at one large teaching hospital. However, many of these consults are deemed “inappropriate” by the receiving consultants. This combination presented an opportunity to examine the effi cacy of interprofessional education through an interactive web-based module to teach physician assistants (PAs) about VTE management.Methods and results A web-based module and survey with interactive cases encompassing key VTE management decisions was distributed to 41 inpatient oncology PAs. Usability, satisfaction, and effi cacy were evaluated using knowledge and Likert-scale items. Participating PAs improved their VTE knowledge with a pre-module assessment score of 31.7% correct and post-module score of 63.3% (P =0.0016). There was an increase in self-reported comfort for managing VTE (mean 3.92 vs 3.07; P= 0.004) and calling cardiovascular consults (4.08 vs 2.50; P< 0.0001). The PAs would highly recommend the module and use it in their practice with 76.9% of them ranking it as their most preferred learning method.Conclusion A brief, interactive web-based module increased knowledge and comfort level with VTE management among PAs. This module design can serve as a template for a wide range of cardiovascular learning tools.

How do non-physician clinicians respond to advanced cancer patients’ negative expressions of emotions?

Patients with advanced cancer often experience negative emotion; clinicians' empathic responses can alleviate patient distress. Much is known about how physicians respond to patient emotion; less is known about non-physician clinicians. Given that oncology care is increasingly provided by an interdisciplinary team, it is important to know more about how patients with advanced cancer express emotions to non-physician clinicians (NPCs) and how NPCs respond to those empathic opportunities. We audio recorded conversations between non-physician clinicians and patients with advanced cancer. We analyzed 45 conversations between patients and oncology physician assistants, nurse practitioners, and nurse clinicians in which patients or their loved ones expressed at least one negative emotion to the NPC (i.e., an empathic opportunity). Empathic opportunities were coded three ways: type of emotion (anger, sadness, or fear), severity of emotion (least, moderate, or most severe), and NPC response to emotion (not empathic, on-topic medical response, and empathic response). We identified 103 empathic opportunities presented to 25 different NPCs during 45 visits. Approximately half of the empathic opportunities contained anger (53%), followed by sadness (25%) and fear (21%). The majority of emotions expressed were moderately severe (73%), followed by most severe (16%), and least severe (12%). The severity of emotions presented was not found to be statistically different between types of NPCs. NPCs responded to empathic opportunities with empathic statements 30% of the time. Additionally, 40% of the time, NPCs responded to empathic opportunities with on-topic, medical explanations and 30% of the responses were not empathic. Patients expressed emotional concerns to NPCs typically in the form of anger; most emotions were moderately severe, with no statistical differences among types of NPC. On average, NPCs responded to patient emotion with empathic language only 30% of the time. A better understanding of NPC-patient interactions can contribute to improved communication training for NPCs and, ultimately, to higher quality patient care in cancer.

Communicating with Cancer Patients: What Areas do Physician Assistants Find Most Challenging?

Physician assistants (PAs) and other midlevel practitioners have been taking on increasing clinical roles in oncology settings. Little is known about the communication needs and skills of oncology PAs. PAs working in oncology (n = 301) completed an online survey that included questions about their perceived skill and difficulty on several key communication tasks. Overall, PAs rated these communication tasks as "somewhat" to "moderately" difficult and their skill level in these areas as "average" to "good." Areas of most perceived difficulty were intervening with angry patients or those in denial and breaking bad news. Highest perceived skills were in communicating with patients from cultures and religions different than your own and telling patient he/she has cancer or disease has progressed, and the lowest perceived skills were in discussing do not resuscitate orders. There are areas in which enhancement of communication skills may be needed, and educational opportunities should be developed for PAs working in oncology.

Understanding the Role of Physician Assistants in Oncology

To understand the deployment of physician assistants (PAs) in oncology. A recent analysis of the oncology workforce in the United States commissioned by ASCO predicted a significant shortage of providers by 2020. A descriptive study was undertaken using a Web-based questionnaire survey. Invited participants, including all PAs listed in the national PA database (n = 855) and all PAs at The University of Texas M. D. Anderson Cancer Center (Houston, TX; n = 159), were mailed letters directing them to the Web-based survey. The study produced a 30% response rate. A total of 186 PAs worked in medical oncology (the population of interest). Of the respondents, 80% were women, mean age was 36 years, average time employed as a PA was 9.5 years (6.5 years in oncology), 55% had obtained a master's degree, four had completed a postgraduate oncology program, 91% reported that direct mentorship by a supervising physician was very important in obtaining oncology-based knowledge, and 61% reported that becoming fully competent in the practice of oncology required 1 to 2 years. The majority of PAs (78.5%) worked 33 to 50 hours per week, and 56% of those reported working 41 to 50 hours per week. Three fourths (77%) wrote chemotherapy orders, most requiring physician co-signature, and 69% prescribed schedule III to V controlled substances. Additional data were gathered regarding clinical duties, research, and teaching. Oncology PAs are used in multiple medical settings, and many assume high-level responsibilities. Future research addressing function and factors that limit use of PAs may allow for improved organizational efficiency and enhancement in the delivery of health care.

Physician Assistant Perspective on the ASCO Workforce Study Regarding the Use of Physician Assistants and Nurse Practitioners.

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. American Academy of Physician Assistant (AAPA) census data and a study of PAs in oncology were used to examine these workforce issues. 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. 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.

Understanding the role of physician assistants in oncology

17509 Background: Recent analysis of US oncology work force commissioned by ASCO predicts a significant shortage of providers by 2020. One proposed option to ease this burden is increased utilizati...

Physician Assistants in Oncology

To the Editor: We would like to comment on the efforts of the American Society of Clinical Oncology (ASCO) in identifying the challenges and demands of treating patients with cancer, and in naming physician assistants (PA) and nurse practitioners (NP) as part of the solution.1 At the same time, we are disappointed with two articles published in the May 2007 issue of the Journal of Oncology Practice (JOP), which slight the PA profession. The first article, written by Dr Yu, describes how NPs will have an increased role in the oncology workforce, yet the role of the PA is noticeably omitted.2 In the second article, a biased communication, Dr Cohen expresses his concerns over PAs in oncology.3 We cannot ignore that the section heading for the article by Dr Yu is the “Voice of ASCO.” I can only hope that Dr Yu will follow his current report with a discussion of the role of PAs in oncology. Certainly, an article dedicated to describing the positive impact that PAs can have in caring for patients with cancer is warranted. Or does ASCO not have a voice for PAs? I do not believe this is the case. A liaison to ASCO was created in conjunction with the American Academy of Physician Assistants (AAPA) to represent PAs in oncology at ASCO events. In addition, a new educational symposium made its debut at the ASCO Annual Meeting in 2006. In conjunction with the AAPA, ASCO, and Oncology Nursing Society, the symposium addressed challenges that NPs and PAs face when evaluating patients. Dr Cohen's letter deserves attention as well. PAs are educated, motivated, and caring health care providers. The University of Texas M.D. Anderson Cancer Center (MDACC) employs over 160 PAs and relies on their skills, knowledge, and expertise to ensure the highest quality of care. The office of Physician Assistant Programs at MDACC developed a PA journal club, a PA continuing education lecture series, and a postgraduate PA program in oncology. In gastrointestinal medical oncology at MDACC, PAs have had a significant impact on oncology research, publishing original research articles and giving presentations at international oncology meetings.4–10 Other departments at MDACC have equally successful PAs. We admire Dr Cohen's engagement with his patients. We also suggest that a PA might allow him to work part-time in his practice or see more patients as a full-time clinician. Dr Erikson et al reported that oncologists who work with NPs or PAs have higher weekly visit rates, and productivity is highest when NPs or PAs are used for advanced activities.1 In addition, PAs provide quality care when working in non–primary care settings. For example, PAs and NPs working in specialty HIV clinics had performance ratings similar to or better than physician ratings for eight quality measures.11 PAs should not diminish the role of the patient-physician relationship in oncology, but rather provide high patient satisfaction, increased revenue, and more forgiving work schedules for their supervising physicians.

Physician Assistants in Oncology: Answering the Needs of Oncologists and Patients

s: Abstracts from the APAP 2003 Education Forum—Phoenix, Arizona October 22-26, 2003: Student Poster Submissions: PDF Only