First Large-Scale Survey of APPs in Oncology Shows Growing Role for Nurse Practitioners and Physician Assistants

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Advanced practice providers (APPs) have increasingly become integral members of the oncology care delivery team, according to the first large-scale study of nurse practitioners (NPs) and physician assistants (PAs) in oncology. The study was conducted collaboratively by ASCO, the American Academy of PAs (AAPA), the Association of Physician Assistants in Oncology (APAO), the Advanced Practitioner Society for Hematology and Oncology (APSHO), and the Oncology Nursing Society (ONS). It was simultaneously published in the Journal of Oncology Practice,1 the Journal of the Advanced Practitioner in Oncology,2 the Clinical Journal of Oncology Nursing,3 and the Journal of the American Academy of Physician Assistants.4

“Nurse practitioners and physician assistants are critical health-care providers in the delivery of quality cancer care,” said ONS Chief Executive Officer Brenda Nevidjon, MSN, RN, FAAN. “This survey is the first step toward better understanding their roles, needs, and challenges in today’s oncology care environment.”

According to data from ASCO’s annual Practice Census, the number of oncology practices in the United States who have reported employing APPs has grown dramatically—from 52% in 2014 to 81% in 2017. However, despite this rapid growth, little systematic research has been done on the total number of these professionals in oncology and their specific roles and responsibilities on the care team.

“As the number of individuals with cancer and cancer survivors in the United States continues to grow, APPs have become increasingly important to ensuring patient access to high-quality cancer care,” said ASCO President Monica M. Bertagnolli, MD, FASCO. “This new study provides an important benchmark to understanding their critical role on the cancer care delivery team.”

Collaborative Effort

To address the lack of data, ASCO, AAPA, APAO, APSHO, and ONS undertook a collaborative effort to identify the number of APPs currently working in oncology. The analysis identified 5,350 oncology APPs (and it is believed there could be as many as 7,000) practicing in the United States. The organizations also conducted a survey of APPs in oncology that asked questions about the demographics of their workforce in oncology. The results of those efforts were published in the study, which provides the first detailed examination of APPs in oncology.

“APPs play a pivotal role in providing high-quality collaborative care for people with cancer,” said President of the APSHO Board of Directors, Pamela Hallquist Viale, RN, MS, CNS, ANP. “APSHO is thrilled to work with our interdisciplinary colleagues on this important research into the nature of our work.”

“This study is yet another affirmation of the value that APPs bring to the table, specifically in a specialty like oncology, where collaboration leads to stronger health-care teams and better patient care,” said AAPA President and Chair of the Board of Directors, Jonathan E. Sobel, PA-C, DMSc, MBA, DFAAPA, FAPACVS.

Closer Look at APP Role

The study results suggest that oncology practices with APPs routinely rely on them for direct patient care, with APPs spending an average of 85% of their time providing patient counseling; prescribing and managing treatments; and handling follow-up patient visits. Nearly all APPs (92.5%) who provide direct patient care reported conducting independent patient visits. APPs who practice in independent models (where they typically see patients alone but work with a care team to address the most critical care decisions) report the highest level of professional satisfaction. However, the majority of APPs in oncology (90%) are satisfied or very satisfied with their position and their collaborative practice with oncologists (80% NPs, 76% PAs).

The study found that APPs in oncology earn an average of between $113,000 to $115,000 per year—about $10,000 higher than those not working in the oncology sphere. Compensation is highest among practitioners working in Western states, academic practices, and larger practices (those with more than 25 physicians). Compensation also increases with annual hours worked. Male APPs earn about 7% more than female APPs, even after adjusting for other factors, including years of experience and hours worked. Approximately two-thirds of APPs said they are either satisfied or very satisfied with their compensation. ■


1. Bruinooge SS, et al: J Oncol Pract. August 22, 2018 (early release online).

2. Bruinooge SS, et al: J Adv Pract Oncol 9:1-15, 2018.

3. Bruinooge SS, et al: Oncol Nurs Forum 45:1-16, 2018 (early release online).

4. Bruinooge SS, et al: J Am Acad Physician Assist (publication forthcoming).