The position of physician assistant (PA) arose as a response to a dramatic rethinking of America’s medical delivery system in the 1960s, when the general public saw a critical shortage of trained and qualified physicians. In conjunction with new nurse midwife (CNM) and nurse practitioner (NP) designations, PAs helped to meet an increased demand for quality health care access.
The first educational program for physician assistants was implemented in 1965 at Duke University in Durham, NC. Under the direction of Department of Medicine chairman Dr. Eugene Stead, this new academic curriculum was based in part on the practice of “fast-tracking” medical training for doctors during World War II. In fact, the very first students to enroll in Duke’s emergent PA program were 4 ex-Navy corpsmen. Historic military precedents to the modern American PAs include French officers de santé, German “barber surgeons,” and US “loblolly boys,” who assisted medical officers on Navy frigates.
In 1996, the biweekly, general-interest magazine Look brought the concept of the PA to national attention when it published a controversial feature article titled “More than a nurse; less than a doctor.” Detailing the experiences of the 4 retired Navy servicemen as they worked through Duke’s new PA program, this article hailed the coming of a “new career that promises better care to the sick.” However, the article also unintentionally undermined industry attempts to foster an acceptance of PAs among nurses. As a direct result of the growing acceptance of PAs among the general public, leaders in the medical community established the American Academy of Physician Assistants (AAPA) in 1968.
The American Medical Association gave its approval to the PA designation in 1969 and began an official process of accreditation in 1972. This process was aided by the newly formed Joint Review Committee for Educational Programs for the Assistant to Primary Care Physician (JRC-PA).The Montefiore Medical Center Postgraduate Surgical Physician Assistant program that was established in 1971 is often recognized as the first clinical postgraduate program. By 1973, the First Annual Conference on New Health Practitioners was held at Sheppard Air Force Base in Wichita Falls, TX. A successor to 4 previous PA conferences that were hosted by Duke, the event was open to NPs as well as PAs. It was later recognized as the first annual conference of the AAPA. This was also the year in which the first certifying examination was administered to PAs. The National Board of Medical Examiners (NBME) offered the exam to 880 aspiring “Assistants to the Primary Care Physician,” 10% of whom were graduates of various NP educational programs. The exam consisted of multiple-choice health care questions and a series of patient management problems that employed invisible ink technology to expose applicable patient information.
In 1974, the AAPA became a fully participating member of the JRC-PA, and the 2 organizations opened a joint national office in Washington, DC. Working with 12 other health organizations, the AAPA and JRC-PA collaborated to create the National Commission on Certification of Physician Assistants, a regulatory organization that provided eligibility and content oversight for the NBME’s PA examination to ensure the competency of certified PAs.
By 1978, the modern PA designation was largely established and accepted. Respected physician Eugene Schneller published a definitive book on the subject, titled The Physician’s Assistant: Innovation in the Medical Division of Labor, and the US Air Force began appointing PAs as commissioned officers. At the end of the decade, the US had over 9400 certified PAs and supported 42 fully accredited PA programs.
Today, there are more than 180 accredited PA programs in the US. The AAPA currently represents more than 84,000 certified PAs. Merritt Hawkins health care placement firm reports that the demand for PAs and NPs has grown more than 300% over the past 3 years.
- American Academy of Physician Assistants website. http://www.aapa.org/.
- Cawley JF, Cawthon E, Hooker RS. Origins of the physician movement in the United States. JAAPA. 2012:25(12):36-40,42. http://www.ncbi.nlm.nih.gov/pubmed/23600002.
- Establishing a Profession. Physician Assistant History Society website. http://www.pahx.org/period03.html.
- History of the ARC-PA: the PA profession. ARC-PA website. http://www.arc-pa.com/about/arc_history.html.
- Physician Associate Program: History of the profession. Yale School of Medicine website. http://medicine.yale.edu/pa/profession/history_profession.aspx.