title: Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants.
abstract: OBJECTIVE
  With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role.
  
  
  METHODS
  Review of the literature and personal perspective.
  
  
  CONCLUSIONS
  Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy.
authors.affiliation: Ambulatory Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. kelvinj@mskcc.org
authors.forename: J F
authors.initials: JF
authors.lastname: Kelvin
authors.forename: G J
authors.initials: GJ
authors.lastname: Moore-Higgs
authors.forename: K E
authors.initials: KE
authors.lastname: Maher
authors.forename: A K
authors.initials: AK
authors.lastname: Dubey
authors.forename: M M
authors.initials: MM
authors.lastname: Austin-Seymour
authors.forename: N R
authors.initials: NR
authors.lastname: Daly
authors.forename: N P
authors.initials: NP
authors.lastname: Mendenhall
authors.forename: E F
authors.initials: EF
authors.lastname: Kuehn
mesh_terms: D002568:Certification; D017408:Guidelines as Topic; D006801:Humans; D007396:Internship and Residency; D008004:Licensure; D009743:Nursing, Practical / Q000331:legislation & jurisprudence / Q000592:standards; D010823:Physician Assistants / Q000331:legislation & jurisprudence / Q000592:standards; D018787:Radiation Oncology / Q000331:legislation & jurisprudence / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D000078329:Workforce