Roots: A Brief History of the Physician Assistant Profession
I'm by no means a history buff. Sure, I enjoy a good WWII novel or bio, but I'm not one to rattle off dates, memorize the order of U.S. presidents, or even easily recall notable events that occurred during my own lifetime. The other day I was talking to a relative about my family's roots and was intrigued by what he had to say. Looking back on our origins gives context to current circumstances. In a previous post, I took a look at the timeline of the nurse practitioner profession. Today, I'll take a quick look back at the physician assistant role.
The physician assistant profession has its roots in WWII. An insufficient number of physicians in the battlefield forced medical leaders to look for a way to meet the increasing need for medical care among soldiers in a timely manner. Two schools of medical training were developed as a result.
First, in 1940, Dr. Eugene Stead developed a medical school program educating physicians on a 3-year track at Emory University preparing them for practice in an accelerated timeframe. He also used medical students to help staff Emory's hospital in the face of the national physician shortage. Stead's program provided the foundation for the modern PA education.
Second, in 1943, the U.S. Surgeon General took a similar approach to fast tracking the education of medical professionals. He replaced some of the surgeons stationed at Army aid stations with Medical Administration Corps officers. These officers were essentially surgeon's assistants with roles very similar to that of physician assistants today.
Stead attempted to translate his fast track medical education to the nursing profession in the late 1950's ultimately establishing a master's level curriculum for nurses. The program, however, was rejected by the National League for Nursing (NLN) and denied accreditation. The NLN objected to the heavy involvement of physicians in the new training program.
Undeterred by his rejection from the nursing community, Stead developed a 'physician's assistant' program at Duke University for former military corpsmen. The program proved widely popular and enrolled its first class of students in 1965, the same year Loretta Ford established a pediatric nurse practitioner program at the University of Chicago. Initially, physician assistants were viewed as medical providers whose purpose was to provide care in rural and other medically underserved areas under physician supervision.
Over the course of the 1960's, physician assistants begin to train in a wider variety of specialties and settings. The passage of Medicare and Medicaid by the United States Congress in the face of already strapped healthcare resources further propagated the need for physician assistants. As a result, other institutions begin to model PA programs similar to the program at Duke.
The physician assistant profession established itself professionally in the 1970's gaining both structure and reputation. Professional journals for physician assistants, industry conferences, and the development of a certification exam contributed to the profession's growing credibility. Hospitals began to employ PAs at increasing rates.
Throughout the 1980's and 1990's the physician assistant role further grew and matured. Changes were made to certification requirements and professional standards were established. The profession continued to thrive with the number of PAs increasing from 9,432 in 1980 to 21,194 in 1990.
Today, physician assistants continue to maintain an integral role in healthcare. Recognizing the importance of PAs, states are awarding physician assistants greater autonomy increasing their influence in the healthcare system.
How have you seen the PA profession change over the course of your practice?
You Might Also Like: Timeline - History of the U.S. Healthcare System
A few comments:
-PAs and NPs were always closer and intertwined than either profession thought. DR. Silver the physician who co-founded the NP movement started the Child Health Associate at the Univ of Colorado Med School a year after he started the NP profession.
-The first year of the PA program at Duke was taught by what we would call APNs as there were no PAs to teach. The second year was an internship all in the hospital.
-A concept called "Medex" started whiich took medical corpsmen and placed them in a total immersion program with a physician for two years. They were only for family medicine.
-NPs were allowed to sit for the PA Boards for the first few years. Many NPs did in states where they had no legislation but PAs did. NY was one that was big. Many NPs were also "PAs" by passing the Boards.