NP in rad onc

[Haybrant]

Anyone in a small practice 2-4 docs have an NP working with them? What's the best way to incorporate an NP into a rad onc clinic anyone have thoughts. not sure if it's been discussed here before. Thanks

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[BobbyHeenan]

Our group has one NP we use. As my wife likes to tell me often, I'm still bad at "micro managing" or "controlling" everything, so I haven't integrated the NP into my practice as much as some of my partner(s), but am thinking about it as I think if done right it can be a great way to manage a busy patient load when you're not quite busy enough to hire another doc but are having a harder time managing all the patients.

We (partners, really) use the NP to see those follow ups that usually don't require much (prostate 6 months out, breast follow ups), under treats that need triaged (ie that needy breast cancer patient on week two complaining of minor breast erythema and "needs to see the doc" all the time), and inpatient initial assessments. Or, if you are jammed in clinic and a patient calls in from home with a problem we can work them in by adjusting schedule with MD or NP.

I think how you integrate an NP or PA is very individualized to your practice structure and comfort level with what you let him/her do. Obviously, they can't do CT sims, etc, but follow up visits and helping the clinic run smoothly to get you more time to contour or whatever is where I see the biggest impacts. I'm not sure whether they can see weekly under treats and bill without the MD coming in behind him/her...we typically don't do that but other groups might.

I don't think our NP quite bills out enough to cover their own salary, but if you look at "big picture" practice impact my partners find her invaluable. Ours has been pro active about trying to spend extra time with patients and do some things like smoking cessation counseling, lung low dose CT screening discussions (ie your DCIS patient that has a 60 pk yr smoker), and end of life discussions which can take up time but are billable E and M codes which help a little.

 

[BobbyHeenan]

I too would be interested in how others integrate mid levels as well.

 

[RadOncDoc21]

I would hire a PA, they can also write prescriptions.

 

[medgator]

I would hire a PA, they can also write prescriptions.

I've heard until recently (at least in FL), they couldn't write narcotics, and they are restricted in terms of how much they can write now

 

[evilbooyaa]

I would hire a PA, they can also write prescriptions.

???

PA's and NPs can both write prescriptions. If they have a DEA, they can prescribe narcotics.

Assisting clinics with follow-ups/consults/OTV is the extent of their involvement. My experience with Rad Onc PA's has been limited, but I wouldn't expect them to go through a patient's treatment options, just more to confirm history and bring me a list of questions to answer. If I had one as an attending it would primarily be for follow-ups and simple OTVs that I could just walk into, say "everything going well?" and walk back out. But I'd probably not be willing to do that until I was at least a few years into established practice.

 

[medgator]

PA's and NPs can both write prescriptions. If they have a DEA, they can prescribe narcotics
.

Fyi, that's a state-level issue

12 states with limits on physician assistants' prescribing power

FL changed their laws recently for PA and NPs though

Nurse Practitioners And Physician Assistants Win Prescribing Authority Milestone

 

[evilbooyaa]

Fyi, that's a state-level issue

12 states with limits on physician assistants' prescribing power

FL changed their laws recently for PA and NPs though

Nurse Practitioners And Physician Assistants Win Prescribing Authority Milestone

Today I learned... good to know about the controlled substances. However, they can still prescribe non-controlled substances which is likely at least half, if not the majority of Rad Onc prescriptions, at least from my experience.

 

[medgator]

Today I learned... good to know about the controlled substances. However, they can still prescribe non-controlled substances which is likely at least half, if not the majority of Rad Onc prescriptions, at least from my experience.

I guess it depends on your patient mix, but I do end up writing a lot of narcotics, ativan (for some mask pts), along with the non controlled stuff like magic mouthwash, carafate etc.

One of my retired partners practiced in a time where she never wrote anything controlled and sent them back to med onc for that

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[RadOncDoc21]

???

PA's and NPs can both write prescriptions. If they have a DEA, they can prescribe narcotics.

What’s up with all of the question marks?

I guess in some states NP’s can also prescribe but in my state only PA’s can.

Besides, I still rather have a PA then an NP, especially with the OTV’s and all the behind the scenes issues. I rarely use them for follow ups unless I am in a bind. I guess they could also dictate notes but I rather do that myself or leave them for a resident to do. As a resident, you pretty much serve as a low-priced PA that can also do contours.

I guess if I really had a choice, I would choose having a resident, which is probably why there are so many new programs, while others are expanding.

 

[evilbooyaa]

What’s up with all of the question marks?

I guess in some states NP’s can also prescribe but in my state only PA’s can.

Besides, I still rather have a PA then an NP, especially with the OTV’s and all the behind the scenes issues. I rarely use them for follow ups unless I am in a bind. I guess they could also dictate notes but I rather do that myself or leave them for a resident to do. As a resident, you pretty much serve as a low-priced PA that can also do contours.

I guess if I really had a choice, I would choose having a resident, which is probably why there are so many new programs, while others are expanding.

Unless you're talking only about controlled substances, NP's and PA's can both prescribe all uncontrolled medications.

 

[RadOncDoc21]

Unless you're talking only about controlled substances, NP's and PA's can both prescribe all uncontrolled medications.

Yes, which is a big deal in oncology!