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AP Care is Safe Care

APSHO's strategic plan revolves around support for the role of oncology advanced practitioners (APs) in the delivery of safe and quality care. The APSHO Board of Directors believes that the negative public perception generated by the American Medical Association’s (AMA) recent #StopScopeCreep campaign, and the disparaging and offensive social media posts that followed, jeopardize accessible, quality cancer care. The AMA narrative leads the public to believe that care provided by APs is not safe care, and that APs believe that “patient safety is a game.”

We find this unacceptable, antiquated rhetoric to be offensive and divisive. We must stand up for ourselves and our fellow APs in all practices. We know that oncology APs (nurse practitioners, physician assistants, pharmacists, and clinical nurse specialists) are an integral part of the oncology care team. APs practicing at the full scope of their license increase quality patient care and patient care capacity (Bruinooge et al., 2018; Ignoffo et al., 2016).

The patients we serve daily are faced with the stress and complexity of living with a cancer diagnosis and are best served by an interdisciplinary approach to care. The COVID-19 pandemic has added to this stress but has also emphasized the essential role of the AP in improving access to quality patient care. Divisive tactics, including propagating unfounded information, can only increase barriers to accessing health care. APSHO believes that efficient, safe, and accessible care delivery occurs when APs, physicians, and other health-care professionals work together to provide quality care tailored to the needs of the patient, with each clinician practicing at the top of their license, education, and clinical competence.

There is an abundance of scholarly research that demonstrates the safety of AP practice and favorably compares it to physician practice in many specialty areas outside of oncology (Johnson et al., 2019; Kurtzman & Barnow, 2017; Martin et al., 2020; McCleery et al., 2011; Patio et al., 2018; Rymer et al., 2018; Yang et al., 2018). A 2016 national study of Medicare beneficiaries noted that the cost of care provided by nurse practitioners was significantly lower than the cost of physician-provided care (Perloff et al., 2016).

In fact, the Centers for Medicare & Medicaid Services and many states demonstrated full confidence in and dependence on APs in improving access to safe and effective care during the COVID-19 pandemic by lifting outdated scope of practice restrictions (AANP, 2020; AAPA, 2020, American Pharmacists Association, 2020). We recently submitted a letter to CMS requesting that these changes be made permanent to continue this improved access to care. In contrast, the ”key research and resources” listed on AMA’s own #StopScopeCreep Campaign page are not published, independent, nor peer-reviewed research allowing for objective analysis.

APSHO’s Board of Directors has launched a campaign to provide robust and truthful information to the public. Our goal for this campaign is to be positive, informative, and respectful. We will be emphasizing collaboration, scope of practice, and the value APs bring to the oncology team. We will be posting data on the AP role and safe care to educate the public and combat campaigns of fear.

The #APCareSafeCare campaign has several components:

  1. Letter of rebuttal sent to the AMA
  2. Email sent to our membership on awareness of the AMA campaign
  3. Downloadable template letter developed for members to personalize and send to the AMA
  4. Social media campaign using #APCareSafeCare
  5. Letter sent to other oncology associations asking them to join us in promoting the value of oncology APs.
  6. Development of this web page to provide APSHO members data to form their own responses to attacks on our scope of practice.
 

What you can do:

  1. Follow APSHO on all social media links (Facebook, Instagram, LinkedIn, and Twitter)
  2. Repost posts/tweets on this topic adding your own personal touch
  3. Compose your own post/tweets and tag #APCareSafeCare and #APSHO (remember, we want to be positive and respectful). We've created images you can add to your social media posts, download them here:
  4. Educate your patients, friends, colleagues, students, staff, and anyone you come into contact with about the value of the AP role. You can use the multiple references and resources supplied here.
  5. Repost/tweet other oncology organizations who show their support of the AP role and tag #APCareSafeCare and #APSHO
  6. Send your own personal email to the AMA (using the APSHO template if you desire)
    1. Emails:
    2. Letters:
      Address: American Medical Association
      AMA Plaza 330 N. Wabash Ave., Suite 39300
      Chicago, IL 60611-5885

APs may download this 5 minute presentation and use it in live meetings, staff meetings, board meetings, society meetings, virtual meetings, churches, civic meetings, - wherever we need to get the message out. Thank you for spreading the word!

AP Care is Safe Care Presentation

Articles, Quotes, and Resources to Share

  • Comparing clinical practice patterns between APPs and physicians finding: “Our data suggest that APPs can provide high quality care in multiple clinical settings.”
  • Johnson D, Ouenes O, Letson D, de Belen E, Kubal T, Czarnecki C, Weems L, Box B, Paculdo D, Peabody J. A Direct Comparison of the Clinical Practice Patterns of Advanced Practice Providers and Doctors. Am J Med. 2019 Nov;132(11):e778-e785. doi: 10.1016/j.amjmed.2019.05.004. Epub 2019 May 28. PMID: 31145882.
  • https://europepmc.org/article/med/31145882

  • Newhouse and colleagues stated “once the issue of comparability between APRN care and that delivered by physicians is set aside in favor of an integrated team concept, disciplines can focus on…overarching goals such as developing patient-centered team care, reducing quality gaps, and educating an interprofessional workforce.”
  • Newhouse RP, Weiner JP, Stanik-Hutt J, et al. Policy implications for optimizing advanced practice registered nurse use nationally. Policy, politics & nursing practice. 2012 May;13(2):81–89.
  • https://journals.sagepub.com/doi/10.1177/1527154412456299

  • Newhouse et al concluded that the outcomes of care provided by APRNs in collaboration with specialist or primary care physicians are similar to, or in some cases better than, the outcomes of care provided by a physician alone.
  • Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nurse outcomes 1990- 2008: a systematic review. Nurs econ. 2011 Sep-Oct;29(5):230–250.
  • https://pubmed.ncbi.nlm.nih.gov/22372080/

  • A publication from the Robert Wood Johnson Foundation (RWJF) asserts that “health outcomes are comparable for patients treated by primary care NPs and MDs.”
  • Improving Patient Access to High-Quality Care: How to Fully Utilize the Skills, Knowledge, and Experience of Advanced Practice Registered Nurses: Robert Wood Johnson Foundation; June 2013 2013.
  • https://www.rwjf.org/en/library/research/2013/06/cnf-improving-patient-access-to-high-quality-care.html

  • The Institute of Medicine notes that a large body of evidence “does not support the conclusion that APRNs are less able than physicians to provide safe, effective, and efficient care.”
  • The future of nursing: Leading change, advancing health. Washington, DC: Institute of Medicine;2011.
  • https://www.ncbi.nlm.nih.gov/books/NBK209880/

  • “We need to stop thinking about APP recruitment and practice as a supportive role to physicians and plan around patient needs and the quality of care”. 
  • “True partnerships between APPs and physicians in which each functions independently but collaboratively within the same patient population result in great patient care and high levels of patient satisfaction.”
  • https://www.healio.com/news/hematology-oncology/20201110/apps-have-a-growing-role-in-the-oncology-workforce

  • Yen, et al notes that team-based care with APP billing independently can be a viable strategy to safely leverage the scare oncology workforce to increase access and safe cancer care delivery.
  • DOI: 10.1200/JOP.18.00277 Journal of Oncology Practice 14, no. 11 (November 01, 2018) e644-e652

  • Bruinooge, S., Pickard, T. A., Vogel, W., Hanley, A., Schenkel, C., Garrett-Mayer, E., . . . Williams, S. F. (2018). Understanding the Role of Advanced Practice Providers in Oncology in the United States. Journal of Oncology Practice, 14(9):e518-e532. DOI:
  • 10.1200/JOP.18.00181. 
  • https://ascopubs.org/doi/10.1200/JOP.18.00181

  • “The best and safest outcomes for patients are produced when health care is provided in coordinated networks that recognize and encourage the unique knowledge base and skills of all practitioners.”
  • Cairo, J., Muzi, M. A., Ficke, D., Ford-Pierce, S., Goetzke, K., Stumvoll, D., . . . Sanchez, F. A. (2018). Practice Model for Advanced Practice Providers in Oncology. Am Soc Clin Oncol Educ Book, 37, 40-43. doi:10.1200/edbk_175577. 
  • https://ascopubs.org/doi/pdf/10.1200/EDBK_175577

  • “When APPs work to the full extent of their training and licensure, there are improvements in patient and provider satisfaction as well as an overall positive impact on productivity and revenue.” 
  • https://ascopubs.org/doi/full/10.1200/EDBK_175577

  • Yang W, Williams JH, Hogan PF, et al. Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better insured population will result in shortage.
    J Oncol Pract. 2014;10:39-45. 
  • https://ascopubs.org/doi/pdf/10.1200/JOP.2013.001319

  • “Board Certified Oncology Pharmacists can assist in mitigation of the predicted shortages of oncologists by 2025.”
  • “Oncology care models utilizing a collaborative team approach with the oncologist, nurse practitioner, physician assistant and oncology pharmacist functioning at their highest scope of practice can improve efficiency of care as predicted shortages of oncologists loom ahead.”
  • Ignoffo, R., Knapp, K., Barnett, M., Barbour, S., D’Amato, S., Iacovelli, L., et al. (2016). Board-Certified Oncology Pharmacists: Their Potential Contribution to Reducing a Shortfall in Oncology Patient Visits. J Oncology Practice, 12(4):e359-68. doi: 10.1200/JOP.2015.008490. 
  • http://pdfs.semanticscholar.org/e685/d7fde078fbe463f1b552e82057535869b0be.pdf

  • Martin, K., Vogel, R., Nagler, R., Wyman, J., Raymond, N., et al. (2020). Mammography Screening Practices in Average-Risk Women Aged 40-49 Years in Primary Care: A Comparison of Physician and Nonphysician Providers in Minnesota. J Womens Health (Larchmt), 29(1):91-99. doi: 10.1089/jwh.2018.7436.
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6983752/

  • “Study notes that Advanced Practitioners more likely to recommend mammography to women at average risk of breast cancer.”
  • Martin, K., Vogel, R., Nagler, R., Wyman, J., Raymond, N., et al. (2020). Mammography Screening Practices in Average-Risk Women Aged 40-49 Years in Primary Care: A Comparison of Physician and Nonphysician Providers in Minnesota. J Womens Health (Larchmt), 29(1):91-99. doi: 10.1089/jwh.2018.7436. 
  • https://www.liebertpub.com/doi/pdf/10.1089/jwh.2018.7436

  • With delivery system changes and full utilization of advanced practitioners, the projected shortage of primary care physicians may be effectively mitigated
  • Zhang X, Lin D, Pforsich H, Lin VW. Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resour Health. 2020 Feb 6;18(1):8. doi: 10.1186/s12960-020-0448-3. PMID: 32029001; PMCID: PMC7006215.
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006215/

  • “Oncology Pharmacists are qualified to function as a frontline provider in oncology patient care and can reduce predicted shortages of available patient visits.”
  • Segal, E., Bates, J., Fleszar, S., Holle, L., Kennerly-Shah, J., et al. (2019). Demonstrating the value of the oncology pharmacist within the healthcare team. J Oncol Pharm Pract, 25(8):1945-1967. doi: 10.1177/1078155219859424. 
  • http://europepmc.org/article/MED/27006358#impact

Do you have a resource to add to the list? Send your recommendations to info@apsho.org.