Where Did PAs Come From? A Brief Look at Our Roots

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PA week is celebrated annually from October 6 (PA Day) through October 12. Why? Well, October 6 marks the anniversary of the graduation of the first PA program students from Duke University in 1967. Physician assistants have now been around nearly 50 years, however it took many years before that day in October of 1967 to develop what we know now as the profession.

 

During World War II, the father of the PA profession, Dr. Eugene Stead, developed a fast track three-year medical curriculum at Emory University to quickly educate physicians for military service.

 

While residents were sent off to care for the troops, he used medical students to help provide care at Emory University and Grady Hospital in Atlanta, an experience that provided the basis for a competency-based medical curriculum that would later be used to create the first PA program at Duke University.

 

Following World War II, there was a continued shortage of primary health care providers due to an increase in specialization of physicians. In 1957, Dr. Stead worked with a registered nurse, Thelma Ingles, to develop a master’s degree program for nurse clinicians. The idea was to produce highly trained nurses to address the shortage of primary care providers.

 

However, the program was refused accreditation by the National League for Nursing (NLN) due to the significant dependence of physicians in the training program and because Nurse Ingles did not have a baccalaureate degree in nursing.

 

This certainly seems unfair in our modern context - PAs can have a non-science bachelor's degree and who else at the time was going to educate someone to perform physician-level duties other than physicians? Luckily for all future PAs, the NLN was unfair and their decision to not sanction the nursing program led Dr. Stead to later develop the first PA program.

 

Other physicians and entities were also beginning to recognize the need for also additional medical providers. In 1959, the US Surgeon General identified a national shortage of medically trained personnel to provide basic medical services. The Trustee of the House of Delegates of the AMA, Dr. Charles Hudson, published a 1961 JAMA article calling for a “mid-level provider” role for former military corpsmen.

 

In 1963, Hu Myers, MD, proposed a four year degree-granting program to educate physician assistants (similar to the degree granting nursing program that he had helped establish) to the Alderson-Broaddus College Board of Trustees. The board turned him down.

 

In 1964, Dr. Stead announced his intention to develop a program for the “physician’s assistant” using former military corpsman. Duke University granted his proposal. The first PA program began in 1965, with four former Navy medical corpsmen who had prior medical training in the inaugural class. Three of these students graduated on October 6, 1967.

 

In 1969, Dr. Richard Smith initiated the MEDEX program, similar to the Duke PA program, to train mid-level providers at the University of Washington. The program was designed to train providers for rural primary care practices throughout the Northwest.

 

By 1970, there were more than 100 programs throughout the country that had been developed to train "physician’s assistants", but they varied widely in duration, depth of training and quality of instruction. The Board of Medicine of the National Academy of Sciences released a report categorizing physician's assistants as Type A, B or C.

 

Type A were more broadly trained in an academic institution across a full range of specialties for at least 2 years, Type B were intensely but more narrowly trained in a particular specialty, and Type C were more broadly trained but over a shorter period of time. Due to the shortage of primary care medical providers, national medical organizations overwhelmingly favored focusing on the Type A assistant, and the modern PA profession was born.

 

Over the years, AAPA was formed, NCCPA developed the national certifying exam, and state regulations began to make the PA profession more organized and consistent in its breadth of practice.

 

Several names, including physician’s assistant, physician’s associate, surgeon’s assistant, and MEDEX, have been used to describe what we now know as a physician assistant. These name changes occurred in response to a number of less rigorous training programs that began using the term “physician assistant” for their students and graduates.

 

Duke University and many of the 2-year programs changed the title for graduates to “Associate”. The "’s" was later omitted from the original name as it was felt to demonstrate dependence on the physician and understate the autonomy of PAs.

 

In the 1980s, the AAPA recommended that all graduates of AMA accredited programs refer to themselves as "physician assistant" to reduce confusion and allow for clear state legislation. 

 

And thus, the PA came to be. 


Aren’t you so glad that other people did all of the work for us? In my nearly 10 year career, I have rarely had to explain to a patient what a PA is or what I am capable of doing.

 

I am so grateful for those that came before me for making an impact on the public, demonstrating the proficiency of care that we can provide, and fighting for the privileges that we now have the fortune of being accustomed to. Getting into PA school may seem like an uphill battle, but we all owe a great deal to those who paved the way to even make the profession a possibility.

 

Next time, we will take a look at what should be every student's first and most important step when deciding to become a PA, shadowing.

 

 

References

"History of the PA Profession." American Academy of Physician Assistants. www.aapa.org/threeColumnLanding.aspx?id=429.

 

Physician Assistant History Society. www.pahx.org