What Is The Physician Assistant Profession?

History of the Physician Assistant Profession
The role of the physician assistant (PA) was created to help bridge the gap in medical care, especially in rural environments, which has been a concern of doctors for centuries. During periods of war non-physicians were used as a means to provide medical care to soldiers and in prisons. In 1965 Duke inaugurates the first “physician assistant educational program”, which consists of four Navy corpsmen. Later on, the first baccalaureate degree was approved for PAs, MEDDEX was started, the AAPA was formed, the PANCE was created, and JAAPA was formed. All of these factors shaped the PA profession into what it is today, and future advances will continue to improve the profession. It has been documented
that governments around the world have used “non-physicians” or “medical assistants” in the field to provide acute care at military bases and on warships since the 1600’s. One of the first trained “medical assistants” was Eddie Rogers. He was hired by a doctor named Charles Higgins to help in urology at the Cleveland Clinic. During World War II in the 1940’s the U.S Surgeon General created the role of the Battalion Surgeon’s Assistant. This was a Medical Administration Corps (MAC) officer that was assigned to Army battalion aid stations and replaced one of the two surgeons that were usually assigned. 1(para 1)
In the 1940’s in North Carolina, Dr. Amos Johnson hired “doctor’s assistant”, Buddy Treadwell, whom he personally trained to help him see patients in clinic. Treadwell was able to perform routine tasks in the clinic and run the practice when Dr. Johnson was out of office. Throughout the 1950’s and 1960’s there was an increasing shortage of general practitioners, due in part to the start of specialties and Congress enacts Medicare.8 Dr. Johnson utilized Treadwell to help with the increasing volume of patients and allow him time to spend outside the office. 2 (para 1) The relationship between Treadwell and Johnson is very similar to the current relationship between doctors and PAs.
In 1961, the president of the National Board of Medical Examiners, Charles Hudson, recommended an “extern for physicians”, another provider to “practice with a supervising physician to ‘not only handle technical procedures but also take some degree of medical responsibility.”8 (para 6) In 1965 Dr. Eugene Stead Jr. starts the first PA program at Duke University. The class consisted of four former Navy corpsmen and three of the four graduated on October 6, 1967. “Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II.” 3 (para 1) He used the relationship between Dr. Johnson and Treadwell as a model for the program. 4 (para 1-2) The goal of the program was to “fill a gap between the physician and the nurse.” 5 (para 8) He wanted PAs to be “capable of extending the arms and brains of the physician, so that he can care for more people.” 5 (para 15) With this mindset, Stead the PA educations “has maintained a medical school-type curriculum geared toward generalist training and condensed to provide education consistent with the PA role.” 9 (para 5)
In 1968, Duke PA students and alumni established the American Association of Physician’s Assistants (AAPA). The purpose of the organization was to “encourage its members to render honest, loyal, and efficient service to the medical profession and quality care to the public whom they serve.” 1 (para 2) Currently the AAPA advocates for the PA profession and is a source of reference for PAs and PA students in regards to current practices and laws. 3 (para 1)
In 1969, the MEDEX PA program is launched at the University of Washington, Seattle, WA by Dr. Richard Smith. The intent of the program was to send ex-corpsmen to rural areas of the Northwest to work in primary care practices. 6 (para 10) Smith liked the idea of “medical extenders”, hence the name MEDEX, as a way to extend physician services. While he was in Nigeria, he trained “dressers”, who were in charge of changing dressings. He continued to teach selected individuals so that they could care for patients with the common pathologies in the area. They only recruited ex-corpsmen with the intention of building on the knowledge learned in the military. The didactic phase was three months, then the students worked in family medicine under a preceptor for twelve months. 6
The 1970’s were about the structure of the profession. In 1971, “the Comprehensive Health Manpower Training Act (PL92-157) authorizes funding for physician assistant education and deployment.” 1 (para 3) Montefiore Medical Center in Bronx, NY creates the first postgraduate residency program for PAs in surgery. 1 (para 3) In 1972, a certifying exam is approved by the National Board of Medical Examiners and in 1973, the first certifying exam was administered to “Assistants to the Primary Care Physician.” Nurse practitioners made up 10% of the 880 candidates that took the exam that year. The exam consisted of “multiple-choice questions and patient management problems using latent image technology to expose pertinent information.” 1 (para 3) Also, the Association of Physician Assistant Programs (APAP) is created with the purpose of facilitating “communication and cooperation among PA educational programs.” 1 (para 3) These two events aided in standardizing the education of the profession.
The 1980’s are about national recognition of the profession.
In 1981, the Physician Assistant National Recertification Examination (PANRE) is created. If a PA failed the PANRE, then they are re-certified for two years, but they have to take the exam again, and pass, within that two-year period. In 1983, the Physician Assistant National Certifying Exam (PANCE) is remodeled and has three components. The components include: “a general knowledge core, and extended core in either surgery or primary care, and observational checklist clinical skills problems.” 1 (para 4) This allowed students to be tested on their ability to give a physical exam, which was the first of its kind. 1 (para 4) In 1988, “the first Journal of the American Academy of Physician Assistants (JAAPA) is published.” JAAPA is a peer-reviewed clinical journal that is published by AAPA. The journal is distributed every month and includes “clinical review articles, case reports, clinical departments, original research, and articles of professional interest to PAs.” 7 (para
1)
The 1990’s is all about growth and maturation in the PA profession. In 1992, The US Army and the US Coast Guard begin commissioning PAs. In 1996, the APAP publishes PACKRAT (PA Clinical Knowledge Rating and Assessment Tool). This tool allows students to assess themselves in their areas of strengths and weaknesses. Also in 1996, the military forms the Interservice Physician Assistant Program (IPAP), which is a combination of the different programs. In 1997, the PANCE is redesigned; the clinical skills problems (CSPs) and extended core components in primary care and surgery were eliminated due to cost. Also, the PANCE is offered both in the spring and fall and it becomes computer based.1 (para 5) In 2000, the practice of PAs is universally accepted in all states and territories in the U.S. The NCCPA launches a new web-based system for logging CME (continuing medical education). In 2001, the Central Application Service for Physician Assistants (CASPA) is created, allowing students to apply to as many participating programs as they want. In 2003, “the Canadian Medical Association recognizes the PA profession as a designated health profession, eligible for the CMA accreditation.” 1 (para 5)
In 2007, the first clinical doctorate degree (DScPA) is awarded to Army PAs who completed an18 month emergency department residency. In 2008, two postgraduate PA programs are accredited by the ARC-PA. In 2013, the PA profession became one of the most sought after providers according to Medicus Firm. In 2016, the PA program in Dublin is launched, expanding the profession at the international level. 1 (para 7)
The PA profession has grown tremendously since Dr. Stead launched the first program in 1965. The profession has transitioned from a position for corpsmen after war, to one of the most sought after careers currently. Various organizations have worked not only to standardize the profession, but also grow the profession. Throughout the years, the goal of the profession has not changed, we are still working to bridge the gap in medical care between doctors and their patients so the profession will continue to grow in size and scope.

References
1) "Timeline." Physician Assistant History Society.
2017 PHYSICIAN ASSISTANT HISTORY SOCIETY, 2017. Web. 20 June 2017. .

2) "Johnson, Amos N." Physician Assistant History Society. 2017 PHYSICIAN ASSISTANT HISTORY SOCIETY, 2017. Web. 20 June 2017. .

3) "History." AAPA. N.p., 2017. Web. 20 June 2017. .

4) "Stead, Jr., Eugene A." Physician Assistant History Society. N.p., 2017. Web. 23 June 2017.

5) Martin, Andrea. "Duke Physician Assistant Program: The birthplace of the physician assistant profession." Department of Community and Family Medicine in the Duke University School of Medicine. Duke University, 1 July 2016. Web. 23 June 2017. .

6) "MEDEX Northwest." MEDEX Founder Dr. Richard Smith: Multiply My Hands. MEDEX Northwest, n.d. Web. 23 June 2017. .

7) "JAAPA Advertising." AAPA. N.p., n.d. Web. 23 June 2017. .

8) CJF, CE, HRS. Origins of the physician assistant movement in the united states. JAAPA : official journal of the american academy of physician assistants. 2012;25(12):36-40.

9) WGLJ, DAM. Physician assistants as partners in physician-directed care. Southern medical journal.
1999;92(10):956-960.