Advanced practice providers in priv. prac. radiation oncology

[TomatoMan]

What experiences have others had with incorporating a PA/NP into their group? I apologize if this has already been discussed on this forum...I tried to search for similar threads and was not able to find any. As you would likely surmise by my posting this, our group is considering such an addition. I've spoken to a few colleagues in other groups who have done so and they reported positive experiences with it. For those who have used them, what have you asked them to do and just as importantly what have you found they are not adept at doing? Finally, as someone who routinely reads all the 1-star reviews on Amazon before purchasing, has anyone had a negative overall experience with incorporating APPs and why? Thanks!

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[Mandelin Rain]

Positive. Care coordination. Toxicity management on treatment. Survivorship. Follow ups in 90 day global. Now, they can supervise the clinic without any fear if HOPPS. Etc...

Never have allowed to contour or approve images or anything that is specific to technical aspects of rad onc training.

 

[BobbyHeenan]

Positive. Care coordination. Toxicity management on treatment. Survivorship. Follow ups in 90 day global. Now, they can supervise the clinic without any fear if HOPPS. Etc...

Never have allowed to contour or approve images or anything that is specific to technical aspects of rad onc training.

Same here. One of my partners is very busy and he uses one to basically keep his volume up without having to hire another doc.

Never any contouring or plan eval or films.

But assessing for +/- fluids on a head neck, going over to hospital to see a consult and do the H and P note and prep patient for the formal consult, toxicity checks, < 90 day routine follow ups, and even longer term follow ups (yearly breast) he uses our NP for. If you get a lot of inpatient consults is where the biggest help is IMO.

In terms of cost...the NP can bill for some things, but our NP's billing revenue only covers about 30-50% of their salary if I remember correctly.

Downside: in general, I think the NP orders more tests/referrals than the MD (this seems to be not isolated to rad onc), so there is a negative there. Other negative is they don't know how to tease out the radiology reads like we do - for instance a s/p lung SBRT we rad oncs kind of "know" the way the lung looks and know that the "worsening consolidation/tumor" typically isn't tumor, just evolving scar/post radiation change. So let's say you see your lung radiosurgery patient at 3 months post radiation and scan looks good. You schedule NP follow up in 3-4 months with a new scan...and scan says that but you'd know not to freak out...they don't know that. If you're using your NP for longer term follow ups, things like that can be problematic.

I personally have serious control issues and want to be aware of EVERYTHING going on in my patients (this is more my own neuroticism than me being some perfect rad onc or vilifying those that use NPs), so I'm having a harder time integrating the NP into my practice (and really don't much at all), but I'm getting busy enough to the point where I really need one because the volume isn't enough to warrant another full time doc but I'd like some extra help. I have worked with our groups NP but don't integrate her much into my practice yet.

 

[Mandelin Rain]

There's definitely a learning curve for how much responsibility you feel comfortable delegating. Breast and prostate follow ups are not hard though. Start with those and let your comfort level increase from there pending the talent of the NP. If they can't handle them, you need a different NP.

Main downside to me is that it's hard to keep them engaged. They basically become rad onc residents without the treatment planning, Can't sign off on anything. Can't really make any treatment calls. It's kind of a scut job. You have to sell it to young moms (ideally) or near retirees (less optimal). Come after dropoff, leave before pickup. No nights. No weekends. Not super intense.

 

[deleted941485]

After the supervision reqs changed We started posting them up at a far flung satellite. doc comes in once a week. Or at least that’s what the admin overlords have decided

 

[TomatoMan]

Thanks for all the insightful replies. It seems like most had positive experiences, but we'll need to be careful about who we hire and keeping them engaged.

Also, I wonder if anyone has analyzed whether the extra time/capacity (and downstream revenue) created for physicians being freed up to see more consults is enough to make up for the fact that the APP's billing revenue only covers less than half of their salary. My instinct is that it likely would.

 

[Mandelin Rain]

Also, I wonder if anyone has analyzed whether the extra time/capacity (and downstream revenue) created for physicians being freed up to see more consults is enough to make up for the fact that the APP's billing revenue only covers less than half of their salary. My instinct is that it likely would.

Anecdotally, it certainly does. They do all the stuff that reimburses poorly, leaving you more time to do all the high reimbursement stuff.