In 1965, Dr. Eugene Stead founded the first Physician Assistant (PA) Training Program at Duke University. Also in 1965, Dr. Henry Silver inaugurated a four-month postgraduate Pediatric Nurse Practitioner program at the University of Colorado for nurses. Soon after in 1969, Dr. Richard Smith developed a MEDEX training program at the University of Washington to place ex-military corpsmen into underserved rural areas as quickly as possible. Soon after, similar programs were begun in other states, and by 1971 over 50 PA educational programs had been established in colleges, universities, and medical centers across the country. Existing financial support from the government was expanded in 1971 with passage of the Comprehensive Health Manpower Act and continued in the 1980s in the form of categorical grants funded under authority of the Health Professions Educational Assistance Act. Currently there are 140 PA programs within the United States.
The medical establishment joined in early efforts to solidify the PA profession. In 1970 the American Medical Association (AMA) House of Delegates recommended that states be encouraged to amend medical practice acts to allow physicians to delegate tasks to qualified PAs. The following year the AMA took steps, through its Council on Medical Education, to recognize and accredit the rapidly growing number of PA training programs. The founders of the PA concept believed that the key to success was a close practice relationship with physicians. Physician Assistants should be trained by Physicians, work for Physicians, and be responsible to Physicians. Therefore, efforts to legally sanction PA practice were aimed at modifying existing laws to allow physicians to delegate a wide variety of medical tasks to PAs. PAs were not to be viewed as “super technicians” but rather as an assistant working as a team member with Physicians. They were to perform duties previously performed only by doctors that included history taking, physical examination, diagnosis, and patient management, augmenting the services provided.
A physician-dependent role afforded PAs a large amount of responsibility for patient care, yet did not diminish the ultimate authority of physicians. As members of the health care team, PAs provide valuable and flexible support for their supervising physicians in both office and hospital settings. The use of a Physician Assistant enables the physician’s practice to operate in a more efficient and cost effective manner. The legal basis for PA practice is built upon their physician supervision, a relatively unique arrangement among health care providers. To insure the competence of PAs, the AMA and the PA profession worked with the National Board of Medical Examiners to produce a national competency examination.
In 1975, an independent organization, the National Commission on Certification of Physician Assistants (NCCPA), was created to administer a national certification program that involves an entry-level examination (developed in conjunction with the National Board of Medical Examiners), as well as continuing medical education and on-going periodic re-examination.
As the first Physician Assistants entered practice in 1968, they began to organize their profession by establishing a national organization, the American Academy of Physician Assistants (AAPA). The AAPA serves the interests of graduate and student PAs in areas such as government affairs, public relations, and professional development, while its chapters work to advance the profession. A closely related national organization, the Association of Physician Assistant Programs (APAP), represents the interests of PA educational programs. Since the 1970s, health services researchers have focused attention on Physician Assistants observing their acceptance by physicians and patients, the content and quality of the health care provided, their cost effectiveness and productivity, and their willingness to settle in medically-underserved areas. The results of this research have been generally positive.
In little more than 40 years, the PA profession has grown and become well established. Currently there are more than 50,000 practicing Physician Assistants providing health care in the world. A favorable national climate, support from government policy makers and the medical establishment, plus creative planning on the part of early leaders were all key factors in the successful introduction and the growth of the Physician Assistant concept.
Physician Assistants improve access to medical care by expanding a physician’s practice base, which is especially important in medically underserved areas. The majority of PAs are employed in primary care specialties, such as family practice, pediatrics, and general medicine. PA practice settings are varied and are influenced by many forces in the medical marketplace, including but not limited to:
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