Purpose: With changes in reimbursement and a decrease in the number of resi
dents, there is a need to explore new ways of achieving high quality patien
t care in radiation oncology. One mechanism is the implementation of non-ph
ysician practitioner roles, such as the advanced practice nurse (APN) and p
hysician assistant (PA). This paper provides information for radiation onco
logists and nurses making decisions about: (1) whether or not APNs or PAs a
re 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 radiat
ion oncology include: definition of roles, regulation, prescriptive authori
ty, reimbursement, considerations in implementation of the role, educationa
l needs, and impact on resident training. A point of emphasis is that the n
on-physician practitioner is not a replacement or substitute for either a r
esident or a radiation oncologist. Instead, this role is a complementary on
e. The non-physician practitioner can assist in the diagnostic work-up of p
atients, manage symptoms, provide education to patients and families, and a
ssist them in coping. This support facilitates the physician's ability to f
ocus on the technical aspects of prescribing radiotherapy. (C) 1999 Elsevie
r Science Inc.