The decision to add a mid-level provider to an oncology practice requires careful consideration of several factors. First, the oncologist should research state regulations and reimbursement rules. Prescribing authority for mid-level providers varies across the United States, with some states allowing these providers to write prescriptions for all medications, including controlled substances, and others requiring a physician signature on prescriptions.

Once the decision has been made to bring on a mid-level provider, the oncologist must determine how that person will function within the practice. The issue of roles within a practice is one of the biggest problems with integrating mid-level providers, says Rebecca Hawkins, MSN, ANP, AOCN, of St. Mary Medical Center, Walla Walla, Washington, who worked as a clinical nurse specialist/nurse practitioner in an oncology practice for 13 years. In contrast, Steven Foltz, MS, PA-C, of St. Luke’s Hospital, Duluth, Minnesota, sees all new patients in the oncology practice where he has worked for 5 years.

Hawkins admits that some physicians aren’t comfortable with the model and it may not work for everyone. But the benefits, both she and Foltz think, make it a sound decision. “It can be successful,” says Hawkins, “if you have good forethought, planning, and excellent communication.”