The clinical tasks oncologists should no longer own
Industry Buzz
These tasks may not need expert oncologist skills but tend to go into [their] inbox due to the nature of inbox design, legal liabilities... As a consequence, oncologists end up spending their precious time on tasks which could otherwise have been carried out by others in the team with some training.
—Michael O. McKinney, MD
Research shows medical oncologists and hematologists received an average of 203 EHR messages per week, which is roughly the same inbox volume recorded in primary care.[] One physician study found that across 15,653 oncologists and more than 43 million ambulatory visits, message volume increased 19% between 2019 and 2022. Although more recent data isn't yet available, there's little reason to believe the burden has eased. During the study period, patient-initiated messages rose 34%, total EHR time increased 16.2%, and after-hours EHR work increased 12.1%.
Related: The EHR 'second shift' costs docs more than time: Try these expert-backed fixes to reduce inbox overload“Oncology care has become more complex. Patients have more access to their portals,” says Aditi P. Singh, MD, a medical oncologist at Penn Medicine’s Abramson Cancer Center. She explains that portal communication works for simple questions, but becomes difficult when cancer care requires nuanced discussion.[]
But should oncologists remain at the center of these tasks?
Michael O. McKinney, MD, a board-certified physician and medical advisor for Pure Frequencies, says, “Examples of tasks that tend to eat up the oncologist’s time are refills, typical lab review notifications, scheduling/coordination messages, and standard symptom check forms that are protocol-based."
These tasks may not need expert oncologist skills but tend to go into [their] inbox due to the nature of inbox design, legal liabilities... As a consequence, oncologists end up spending their precious time on tasks which could otherwise have been carried out by others in the team with some training.
—Michael O. McKinney, MD
Move prior authorization out of the oncology workflow
Oncologists need to document the diagnosis, treatment intent, previous therapies, and clinical rationale. But benefits checks, payer forms, portal uploads, status calls, and routine appeals belong with centralized authorization teams.
In a 2024 survey of more than 750 radiation oncologists, 80% reported reallocating staff time to prior authorization, while 64% had hired additional staff to manage it. An average of 73% of initially denied requests were eventually approved on appeal.[] The burden affects care. Howard M. Sandler, MD, FASTRO, chair of the ASTRO Board of Directors, says “Prior authorization policies are failing people with cancer, causing avoidable delays that are dangerous and, in too many cases, deadly.”[]
Where delegation ends and oncologist judgment begins
“Visits that involve routine toxicity checkups with the help of standardized grading systems, patients on maintenance therapy, and routine oral oncology refill requests can be handled by APPs or clinical pharmacists," Dr. McKinney suggests. "Surveillance visits that involve routine review of labs and imaging according to pre-defined criteria, monitoring of adherence, and handling of predictable side effects can also be handled by APPs or clinical pharmacists. The task at hand here is defining what is 'routine' and 'complex.'”
This approach is particularly relevant for oral anticancer therapies, where adherence, drug interactions, affordability, and toxicity often require repeated contact between visits.
Related: 4 workload realities oncologists under 40 are facing right nowHowever, as Dr. McKinney explains, “Among responsibilities that must stay with the oncologist are those such as diagnosis and discussion about staging, decision-making around treatments (including intent changes, systemic therapy line switches, or participation in clinical trials), complicated toxicity management when adjustment of doses or discontinuation of therapy is required. Prognostic, goals of care, and end-of-life conversations also cannot be delegated because of the necessity of using clinical judgment and knowledge of the course of the disease in the particular patient.”
Eric Winer, MD, director of the Yale Cancer Center and physician-in-chief of Smilow Cancer Hospital, describes the growth of work as causing a disconnection from the reason many physicians entered oncology. “There are just a lot of pieces of our jobs that don’t feel like they’re mission driven.”[]
Before redistributing inbox management, follow-up, and treatment-monitoring work, oncology practices need clear safeguards, protocols, and escalation criteria, according to Dr. McKinney. “Protocols specifying what constitutes normal vs abnormal results, [along with] escalation criteria for alarming signs or laboratory results, and procedures for situations in which input [...] from the APP or pharmacist are required," he explains.
"It is important to establish response-time expectations and expectations regarding documentation and types of messages that must be cosigned or cleared by the physician," he adds.