history of the physicians assistant
TRANSCRIPT
The Physician Assistant ProfessionRandy D. Danielsen, MPAS, PA-C
Associate Professor & ChairDepartment of Physician Assistant Studies
The Concept of Assistants to Physicians The Russian Feldsher 17th and 18th Century
Introduced in the military by Peter the Great
Retired from military into rural communities By 1913 there were 30,000 By 1976 90% of feldshers were female, and 25% of Russian physicians were previously
feldshers
The Concept of Assistants to Physicians 1930 - US. Federal Prison System trained
former military corpsman on the job to extend services of correctional physicians.
1961 - Charles Hudson, MD proposes training assistants for the primary care physician at an American Medical Association conference.
They were somewhat less than receptive! But 30 years ago is a long time.
Thirty Years Ago (In Perspective)
Medical education was based on the following paradigm:
start with a sound liberal arts background (4 years) and then,
learn the basic sciences in-depth, then normal structure and function
and finally pathophysiology with clinical
correlation.
Thirty Years Ago (In Perspective)
Military corpsman were learning many medical skills without a liberal arts background or a formal basic science knowledge; yet applied those skills during the Vietnam War very effectively.
Many skills could be taught without a significant basic science background.
The Beginning, Thirty Years Ago Circa 1960 - 1965 Duke University
Eugene A. Stead, Jr., MD originally suggested extending capabilities of nurses at Duke Hospital
This was opposed by the National League of Nursing
Duke Hospital was experiencing a shortage of Nurses
Duke Department of Plastic Surgery used fireman and ex-corpsman to staff the burn unit.
Thirty Years Ago (In Perspective)
Stead and E. Harvey Estes, MD create a 24 month curriculum combining basic science and clinical medicine at Duke University.
This is the first time in American History that someone other than physicians officially share the knowledge base of medicine!
Thirty Years Ago, or so...
1963-Four ex-Navy corpsman start the Duke PA Program.
Henry Silver, MD and Loretta Ford, RN (Univ. of Colorado) start a Pediatric Nurse Practitioner Program (that becomes the Child Health Associate Program).
Richard Smith, MD starts the MEDEX program in the State of Washington
PAs and NPsPAs and NPs What is the difference?
MedicalMedical versus NursingNursing modelDependenceDependence versus IndependenceIndependence
General PA Program Information
1999 - 120 accredited PA Programs35,782 graduates55% programs offer Baccalaureate
degree or degree option40% programs offer Masters
Degrees05% programs offer Certificate or
Associate degree
0%
20%
40%
60%
80%
100%
Males Females Never in
Military
Bachelors
Degree
Need
Financial
Aid
PA Program Applicants - 1996 AAPA Survey (n=2,269)
Mean Age 30, Mean GPA = 3.41
PA Graduate Statistics - 1997
AAPA Census (n=15,206)
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
Female
Male
Clinical Practice
Primary Care
Surgery
The Future: Danielsen’s Predictions
PAs will play a prominent role in:
• Rural Health CareRural Health CarePA / Physician teams will put the “doctor” back into rural doctoringThe challenge is to resolve the maldistribution of health care providers in rural areas!ASHS will prove to be a leader in this area.
• Surgical SpecialtiesSurgical SpecialtiesPAs will become 1st assistants in many operations
PAs will play a prominent role in:
• Hospital Inpatient ServicesHospital Inpatient ServicesPAs will continue to become house staff officersThe cut back on licensing international medical graduates has created many spots for PAs.
• Correctional Health ServicesCorrectional Health Services • Managed Care OrganizationsManaged Care Organizations
The EndThe End