University of Michigan, Ann Arbor; Karmanos Cancer Center; Wayne State University; Metropolitan Detroit Cancer Surveillance System, Detroit, MI; Keck School of Medicine, University of Southern California; Los Angeles County Cancer Surveillance Program, Los Angeles, CA.
J Oncol Pract. 2010 Nov;6(6):312-6. doi: 10.1200/JOP.2010.000039.
We sought to examine the employment of nurse practitioners (NPs) and physician assistants (PAs) in surgical, medical, and radiation oncology practices and to identify correlates of NP and PA employment.
We conducted a mailed survey of attending surgeons, medical oncologists, and radiation oncologists who cared for a population-based sample of women diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles, CA, and Detroit, MI. In addition to information about whether practices employed NPs and/or PAs, physician and practice characteristics were obtained. We estimated the likelihood of the employment of NPs and PAs with multivariable logistic regression.
Overall, 39.6% of physicians reported that NPs and PAs were employed in their practice, although there were significant differences across specialty: medical oncologists (56.3%), radiation oncologists (40.0%), and surgeons (28.7%; P < .01). The likelihood of NP and PA employment increased for medical oncologists (compared with surgeons; odds ratio [OR], 2.63; 95% CI, 1.73 to 3.99), physicians with 10 or fewer years in practice (OR, 1.94; 95% CI, 1.18 to 3.16), and practices with university affiliations (OR, 2.20; 95% CI, 1.44 to 3.37). Physicians with fewer than 25% of their patients diagnosed with breast cancer (OR, 0.48; 95% CI, 0.25 to 0.92) and practices with fewer than three physicians (OR, 0.14; 95% CI 0.09, to 0.24) were less likely to employ NPs and PAs.
NP and PA employment was higher with newer physicians and in more heavily resourced practices. Employment of NPs and PAs was relatively modest, which suggests an opportunity for physicians to employ these providers to alleviate workloads.
我们旨在考察护士从业者（NPs）和医师助理（PAs）在外科、内科和肿瘤放射科实践中的使用情况，并确定 NP 和 PA 就业的相关因素。
我们对 2005 年 6 月至 2007 年 2 月期间在加利福尼亚州洛杉矶和密歇根州底特律接受基于人群的乳腺癌诊断的女性的主治外科医生、内科肿瘤学家和放射肿瘤学家进行了邮寄调查。除了关于实践是否雇用 NPs 和/或 PAs 的信息外，还获得了医生和实践特征。我们使用多变量逻辑回归估计了 NP 和 PA 就业的可能性。
总体而言，39.6%的医生报告说他们的实践中雇用了 NPs 和 PAs，但在专业之间存在显著差异：内科肿瘤学家（56.3%）、放射肿瘤学家（40.0%）和外科医生（28.7%；P<.01）。与外科医生相比，内科肿瘤学家雇用 NP 和 PA 的可能性更高（优势比[OR]，2.63；95%可信区间，1.73 至 3.99），实践年限为 10 年或以下的医生（OR，1.94；95%可信区间，1.18 至 3.16），以及有大学附属关系的实践（OR，2.20；95%可信区间，1.44 至 3.37）。诊断为乳腺癌的患者少于 25%的医生（OR，0.48；95%可信区间，0.25 至 0.92）和少于 3 名医生的实践（OR，0.14；95%可信区间 0.09，至 0.24）雇用 NP 和 PA 的可能性较小。
较新的医生和资源更丰富的实践中 NP 和 PA 的雇用率更高。NP 和 PA 的雇用相对较少，这表明医生有机会雇用这些提供者来减轻工作量。
