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Training, retaining APPs ‘of paramount importance’ to oncology workforce
Editor’s note: HemOnc Today’s regular columns for advanced practice providers (APPs) tackle common issues APPs face, discuss day-to-day practice and regulatory concerns, and share research advances. To contribute to this column, contact Alexandra Todak at stodak@healio.com.
Nurse practitioners and physician assistants are an increasing and integral part of the medical workforce in the United States.
Auerbach and colleagues detailed the relative increase of APPs compared with physicians in an article published in June in The New England Journal of Medicine.
This increasing reliance on APPs also seems to be apparent in oncology. In a study published in August in Journal of Oncology Practice, Bruinooge and colleagues estimated there are 5,000 to 7,000 APPs in the specialty.
It is generally accepted that the physician workforce is not growing at a rate that will keep up with population needs, particularly in oncology. Even with APPs, it is unlikely that the current medical system will be able to meet the needs of the population without innovative adaptations.
In this setting, recruiting, training and retaining APPs should be of paramount importance.
Although practices, employers and hospitals should critically evaluate each of these aspects, the focus of this article will be the development of structured training for APPs in oncology.
I will address training of new-to-oncology APPs, continuing professional development, and career ladders or levels of practice based on APP experience.
Structured training
Many larger oncology practices are utilizing some form of structured postgraduate training for APPs new to oncology.
These vary from shorter training curricula (up to 3 months) to longer, formalized fellowships or residencies.
Regardless of what it is called and how long it is, all APPs new to oncology need to be trained into the field. Although not an absolute, it is likely that a formalized training curriculum with multiple preceptors is superior to informal on-the-job training by a single preceptor. It is also unlikely that there will ever be enough spots or incentive for oncology APPs en masse to complete formalized residencies or fellowships.
Developing a training curriculum does not need to be complex. Many programs are willing to share their curricula, and programs such as the ASCO University Advanced Practitioner Certificate program can make up the didactic portion.
In my experience, one of the difficulties with developing and implementing a formalized oncology-specific curriculum for APPs is the practice’s need for the APP to see patients and contribute clinically.
Many times, APPs are expected to carry a clinical load immediately. For APPs new to oncology, this is both unreasonable and shortsighted.
In an ideal situation, the need for an APP would be seen by strategic planning well in advance. The person could then be recruited carefully and hired in time to allow an adequate training period consistent with their experience in oncology. Once they have completed training, they will be a more productive, well-rounded, sound and happy provider than if they are rushed into practice.
Rewarding experience
Once an APP has completed a training curriculum, it is important that they have continued stimulation from and exposure to didactic materials.
In many cases, an APP-specific journal club or lecture is created. Although this is good, I think APPs want to be included in the lectures, rounds and tumor boards that their physician colleagues attend.
From personal experience, I found this to be the most valuable aspect of my training. Give them a chance to attend and participate, and I bet they will surprise you with their understanding and contribution. This will foster mutual trust and encourage continued progress.
As APPs gain oncology experience, it is in the practice’s and the APP’s interest to allow APPs to practice at the level of their knowledge and experience.
Again, speaking as an ideal and not from experience, a career ladder or tiered system will provide structure and allow this type of practice. For example, an inexperienced APP would primarily work in a shared-visit model. As they gain experience and reach specified benchmarks, they can be rewarded with advancement and a higher degree of autonomy.
Similar to the academic model for tenure, APPs might have a three- or four-tiered system with increasing autonomy and incentive. This is not to argue that APPs should practice with complete autonomy, but that experience and knowledge should be rewarded.
Finally, when recruiting, training and retaining APPs, include APPs in program development and leadership. The APPs in the trenches know better than anyone how to train and retain talented people. They will help avoid job satisfaction pitfalls, such as using APPs as scribes or in nursing roles. It is also helpful for the APPs to see the big picture and take responsibility for their own profession.
References:
Auerbach DI, et al. N Engl J Med. 2018;doi:10.1056/NEJMp1801869.
Bruinooge SS, et al. J Oncol Pract. 2018;doi:10.1200/JOP.18.00181.
For more information:
Mark Hyde, PhD, PA-C, is director of advanced practice at Huntsman Cancer Institute at The University of Utah. He can be reached at mark.hyde@hci.utah.edu.
Disclosure: Hyde reports no relevant financial disclosures.