title: Physician assistant and nurse practitioner utilization in radiation oncology within an academic medical center.
abstract: OBJECTIVE
  To assess the utilization of physician extenders working in radiation oncology in an academic medical center and to identify opportunities to improve their utilization.
  
  
  METHODS
  A workload analysis and patient flow analysis were conducted on physician extenders employed by the University of Michigan Health System Radiation Oncology Department in order to better understand their utilization and impact on patient flow.
  
  
  RESULTS
  Nearly half (46%) of physician extender time was spent performing indirect patient care. Physician extenders performed most (84.3%) of the first encounters for follow-up appointments; however, these patients were seen independently by physician assistants (PAs) and nurse practitioners (NPs) only 51% of the time. Physician extenders perceived their utilization within the department would be improved with well-defined position goals (80%), less clerical work (40%), more involvement in treatment planning (40%), more training (40%), and more involvement with new patient consults (20%). Physicians felt the utilization of physician extenders could be improved by providing more training (33%), increased physician extender involvement in treatment planning (22%), increased physician extender involvement in new patient consults (11%), and increased autonomy (11%).
  
  
  CONCLUSIONS
  This study highlights the importance of collecting data to allow for evaluation of PA and NP performance and utilization. We have highlighted a unique methodology for analyzing physician extender duties and workflow that could be employed by other organizations and medical practices, regardless of specialty, to examine PA and NP deployment and to identify opportunities to optimize their utilization.
authors.affiliation: Office of Clinical Affairs, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: mmoote@umich.edu.
authors.forename: Marc
authors.initials: M
authors.lastname: Moote
authors.affiliation: Industrial & Operations Engineering Program, University of Michigan, Ann Arbor, Michigan.
authors.forename: Richard
authors.initials: R
authors.lastname: Wetherhold
authors.affiliation: Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Karin
authors.initials: K
authors.lastname: Olson
authors.affiliation: Industrial & Operations Engineering Program, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rachel
authors.initials: R
authors.lastname: Froelich
authors.affiliation: Industrial & Operations Engineering Program, University of Michigan, Ann Arbor, Michigan.
authors.forename: Nadia
authors.initials: N
authors.lastname: Vedhapudi
authors.affiliation: Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lash
authors.affiliation: Program and Operations Analysis, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Sheri
authors.initials: S
authors.lastname: Moore
authors.affiliation: Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman