Survey provides insights into how oncologists are managing stress, value-based care and advanced practice providers

Thanks to improvements in early detection and treatment, the number of cancer survivors is expected to grow from 15.5 million in 2016 to more than 20 million by 2026.

That’s great news for patients. For hospital leaders, it means there will be a growing number of survivors requiring ongoing care in addition to a continual influx of new patients.

To address this increasing patient load and medical needs, health systems must attract and retain a strong network of oncologists. That can be challenging at a time when fewer new physicians are choosing to specialize in oncology. Further, about one in five participating oncologists said they are considering retiring early due to stress and burnout, according to the latest Oncology Insights report from Cardinal Health Specialty Solutions.

Published in late 2018, this report provides valuable insights that can help healthcare executives develop strategies to address the needs of oncologists. The research surveyed more than 160 oncologists from a mix of community and hospital-based practices on topics such as the transition to value-based care, the prevalence of physician burnout and the growing use of nurse practitioners and physician assistants – collectively known as Advanced Practice Providers – to manage workloads. Here are three key findings:

Growing confidence on MACRA compliance. Since its introduction in 2015, healthcare providers have debated the merits of the Medicare Access & CHIP Reauthorization Act. In our first Oncology Insights report in June 2017, just over half of participating oncologists said they expressed some confidence in their ability to meet the requirements while achieving financial success. Our latest research shows a significant shift over the past 18 months: 77 percent of participants felt some confidence in their ability to meet MACRA mandates while succeeding financially. In addition, just three percent of participants said they are exploring mergers with another entity as a strategy for meeting MACRA requirements, compared to 16 percent in June 2017.

Yet participating oncologists remain skeptical that MACRA will deliver the desired results for improving patient care or reducing costs. In our new report, less than 15 percent of participating oncologists are either “very” or “moderately” confident that MACRA will improve patient outcomes or lower the total cost of care. However, that is a slight improvement from the 2017 research that found less than 5 percent of participants believed MACRA would improve outcomes or reduce costs.

Significant concerns on stress. The phenomenon of physician burnout has received extensive attention in recent years, and our research indicates that oncologists are not immune. Nearly half of participating oncologists reported experiencing significant amounts of stress at work (46 percent) and half of the participants said they feel emotionally exhausted either sometimes or frequently. In addition, more than a third (35 percent) said they would need an additional seven or more hours a week to complete all of their clinical work. Key drivers of that stress include electronic health records (36 percent), changing reimbursement and payment models (33 percent) and interactions with payers (31 percent).

Increasing use of APPs. Like other medical disciplines, oncology practices are hiring APPs to make workloads more manageable. Three-quarters of oncologists (74 percent) said they already use APPs in their practices and 57 percent predict the number of employed APPs will increase over the next three years.

Responsibilities of APPs vary between practices. Nearly two-thirds of participating oncologists (62 percent) said APPs only evaluate and assess return patients, while 36 percent see both new and returning patients. In outlining roles, participants said APPs are either frequently or always involved in conducting patient education (83 percent), ordering of images and tests (69 percent) and making supportive care decisions (61 percent). About two-thirds (65 percent) of surveyed oncologists said APPs enable their practices to be more efficient with more manageable workloads. As demands on oncologists continue to grow, we may see hiring APPs used increasingly as a strategy to mitigate physician burnout.

Insights for Hospital Leaders
The research points to several recommendations for hospital leaders:

Work with oncology practices to establish best practices for MACRA reporting. While participating oncologists said they are more confident in their ability to meet reporting requirements while succeeding financially, they also report that changing reimbursement models are a major stressor. By working with physicians to establish best practices, health systems can help ensure the standards are met without stealing time from patient care.

Invest in recruitment. The shortage of oncologists is well documented, and the research indicates that a significant number of current oncologists may retire early due to stress. These factors make it essential to commit to ongoing recruitment efforts to ensure health systems can meet the growing demand. Similarly, identifying reasons for attrition is critical to diminish physicians leaving the work force due to preventable reasons.

Identify stressors through open dialogue. Stress triggers will vary across practices, regions and settings. By engaging oncologists in an ongoing discussion, hospital leaders can help identify early warning signs and mitigate stress factors to reduce the risk of burnout.

Create APP-friendly work environments. Our research shows that APPs will be in demand for the foreseeable future which suggests the hiring market will become more competitive. Health systems can gain an edge by creating a culture in which oncologists and APPs can thrive together. This can mean integrating APPs with in the team and providing opportunities for challenging assignments and enhancing continued educational opportunities.

To learn more about how oncologists view the changing state of oncology practices, download the full report at

Chadi Nabhan, MD, MBA, FACP is Vice President and Chief Medical Officer for Cardinal Health Specialty Solutions, a leading provider of solutions to help specialty pharmaceutical companies enhance product success and health care providers enable exceptional patient care. With more than 17 years of clinical practice experience, he brings broad real-world healthcare management expertise in a variety of settings, including community, hospital-based and academic centers, as well as significant experience with clinical research, quality metrics, benchmarking and managed care.

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