Role of Advanced Nurse Practitioners and Physician Assistants in Washington State

Purpose: In response to the looming oncology manpower shortage, the Washington State Medical Oncology Society (Vancouver, WA) surveyed medical oncology practices in Washington regarding employment patterns for advanced nurse practitioners (ANPs) and physician assistants (PAs) in oncology. Methods: Funded by a 2008 ASCO State Affiliate Grant and using Surveymonkey. com as a platform, practices were queried regarding practice demographics, employment patterns, and functions of ANPs and PAs. Results: Of the total queried, 25 practices (50%) responded, representing the spectrum of single-specialty (n = 8), multispecialty (n =7), hospital-based (n= 6), and academic practices (n =4). Sixty-eight percent of practices employed ANPs and/or PAs. Compared with PAs, ANPs were more likely to work independent of supervision (64% v 0%), perform follow-up in the outpatient setting (93% v 77%), evaluate patients in infusion centers (71% v 62%), and provide genetic counseling (42% v 0%). PAs were more likely to see hospitalized patients (62% v 42%) and supervise infusion centers (15% v 7%). New patient consultations were performed with similar frequency (PAs,29% and ANPs, 31%). ANPs were more likely to review research eligibility (25% v 15%), obtain informed consent (33% v 15%), and monitor compliance (13% v 8%). Conclusion: Washington practices have embraced advanced practitioners. Given the diversity of practice patterns, practices can learn from one another how to maximize ANP/NP roles. Practices need to promote practice-based educational opportunities to attract ANPs/PAs to medical oncology.