title: Employment of nurse practitioners and physician assistants in breast cancer care.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.forename: John
authors.initials: J
authors.lastname: Graff
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz