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Marking 40 years of change in the PA profession

Richard W. Dehn, MPA, PA-C

Rick Dehn is a clinical professor in the Department of Family and Community Medicine and program director of the PA/FNP program at UC Davis, Sacramento, California. He is a member of the JAAPA editorial advisory board and chair of the PAEA Research Institute.

Recently, the Physician Assistant Education Association (PAEA) celebrated the 40th anniversary of PA education with a special commemorative issue of the Journal of Physician Assistant Education. This issue contains a generous collection of articles that describe many aspects of the PA profession in historical context. Three articles from the issue describe the three distinct models of PA education that developed early in the profession’s history and their evolution over time in response to the changing medical and social environment. Also in the issue is an article describing the current status of the PA profession’s international development. Taken together, these four articles describe in great detail the profession’s beginnings, review the many changes that have occurred over the subsequent four decades, and provide a glimpse into the future.

Dieter PM, Strand J. Snapshots in time: Duke University physician assistant classes, 1967-2007. Journal of Physician Assistant Education. 2007;18(3):16-23. http://www.paeaonline.org/perspective/10072.pdf. Accessed March 21, 2008.

ABSTRACT: October 6, 2007, marks the 40th anniversary of the first students’ graduation from the Duke University Physician Assistant program. The authors describe the first graduating class and the subsequent graduating classes at 10-year intervals. These descriptions include the demographics of the classes, the social and medical milieu at the time of enrollment, and the preclinical and clinical curricula. The earliest graduates were male and military corpsmen by background, but today’s Duke graduates are predominantly women, with a variety of experiences in civilian patient care. From the first PA class of three, who were paid for attending the program and received only certificates upon completion, the program has grown to enroll 52 students per year in a program that awards a master of health sciences degree.

Ballweg R, Wick K. MEDEX Northwest: workforce innovations. Journal of Physician Assistant Education. 2007;18(3):30-39. http://www.paeaonline.org/perspective/10074.pdf. Accessed March 21, 2008.

ABSTRACT: MEDEX Northwest grew from a vision that the health care needs of many medically underserved Americans could be partially met by training military corpsmen and medics to assist overworked physicians. In 1969, 14 people with military medical training formed the first physician assistant (PA) class at the University of Washington in Seattle. Having enlisted the support of physician organizations, individual physicians, local communities, and the state’s medical association and legislators, the program’s founder soon placed these early PAs in primary care practices in rural and underserved areas of Washington State. As the PA profession expanded, program leaders continued to work locally and nationally to gain acceptance and recognition for this new kind of clinician. In the course of nearly 40 years, MEDEX has grown in size (80 students per entering class), range (3 classroom locations and more than 400 clinical sites), and curricular depth (more than 2 years of intensive training). MEDEX graduates work in practices from remote primary care offices to cutting-edge specialty services at large urban institutions. With a background of helping to build a new profession, MEDEX continues to be innovative in training new PAs who seek to improve the health and well-being of their patients.

Glicken AD, Merenstein G, Arthur MS. The child heath associate physician assistant program — an enduring educational model addressing the needs of families and children. Journal of Physician Assistant Education. 2007;18(3):24-29. http://www.paeaonline.org/perspective/10073.pdf. Accessed March 21, 2008.

ABSTRACT: The Child Health Associate (CHA) Physician Assistant Program was established by Dr. Henry Silver in 1968 in response to a need for pediatric health care providers. In 1973, the CHA/PA program was the first PA program in the country to award a master’s degree, and the legislation that originally established the regulatory framework for CHAs was the precursor to many state practice acts for the physician assistant (PA) profession. The program now trains PAs in primary care, with added expertise in pediatrics, through an innovative 36-month curriculum that integrates clinical experience across all 3 years. The program’s unique approach to integrating primary care and specialty care education may serve as a model for developing nations attempting to address a shortage of pediatric providers.

Hooker RS, Hogan K, Leeker E. The globalization of the physician assistant profession. Journal of Physician Assistant Education. 2007;18(3):76-85. http://www.paeaonline.org/perspective/100711.pdf. Accessed March 21, 2008.

ABSTRACT: The global spread of the physician assistant (PA) profession is a medical workforce phenomenon largely born at the turn of the century. Because this observation comes with little analysis, we used investigative journalism techniques to collect information about the use of PAs outside of the United States. As of 2007, at least seven countries—Australia, Canada, England, the Netherlands, Scotland, South Africa, and Taiwan—are in various stages of expansion of PA-like medical workers that function under the supervision of a doctor. With the exception of Taiwan and South Africa, these countries have American-trained PAs working as expatriates, and most are developing educational programs that produce a health care provider functioning as an addition to the doctor. Each country has made its PA a distinct entity, with cultural and educational influences shaping their roles. Common denominators of these PAs are that they function as semiautonomous clinicians under the direct supervision of a doctor and have roles that tend to complement those of the doctor. Historical observations suggest the development of the PA profession in different countries tends to follow a similar path and that lessons learned from these nations may be useful in further expansion of the profession.

DISCUSSION

It would be an understatement to say that the PA profession has undergone substantial change since its birth four decades ago. While it would require an entire book to adequately cover the profession’s history,¹ the special 40th anniversary issue of the Journal of Physician Assistant Education manages to assemble a remarkable collection of data and historical information about the profession in a single issue.

Although the first PA program at Duke University utilized a training model based on an accelerated medical school process used during World War II, other training models also were developed in PA education to address the regional environment of the supporting institution. These unique curricular designs, the MEDEX and Child Health Associate programs, also demonstrated success in training PAs as well as addressing specific societal needs.

The article by Dieter and Strand describes the first Duke University PA Program class of 1967 and the program’s curriculum. This is followed by a similar description of the classes and program curriculums of 1977, 1987, and 2007. Demographic and academic data describing these cohorts show that the first two groups were comprised predominantly of males and that subsequent cohorts demonstrate the profession’s shift to predominantly female. The data also demonstrate a steady increase in both science coursework preparation and entering GPA over time. The Duke model is predominant among PA educational institutions; thus this description of its demographics and curricula are likely representative of similar trends in the profession overall.

Ballweg and Wick describe the development and subsequent history of the MEDEX training model in great detail, as well as provide a detailed description of the political and philosophical factors that led to the development of MEDEX. The authors describe eloquently the external negative pressures that the University of Washington MEDEX program, as well as the PA profession, endured in the early 1980s in response to (inaccurately) predicted future physician surpluses. The authors also make a strong case for the utilization of the MEDEX model in environments outside the United States.

Glicken, Merenstein, and Arthur describe the history of the University of Colorado Child Health Associate (CHA) PA Program, a unique training model that combines primary care and specialty training. This program was also unique, as the first and only 3-year program and also the first program to offer a master’s degree. As with the Duke and MEDEX model, the CHA training model may be utilized in PA training outside of the United States.

Hooker and colleagues describe the expansion of the PA profession since the turn of the century. Many countries besides the United States have experienced shortages and maldistribution of medical providers and have been looking toward the PA model in the United States as a potential solution. As of 2007 at least seven countries—Australia, Canada, England, the Netherlands, Scotland, South Africa, and Taiwan—utilize PAs who work with physician supervision, and five of those countries have employed US-trained PAs. This paper uses a cross sectional study design to include data on countries that have PAs currently in practice, have PA training programs, or have medical professionals that perform tasks similar to US PAs. The authors have collected a rich set of data that present the PA population of each country as well as identifying all PA training programs. The current state of each country’s PA environment is described, as are the developments that can be expected in the future. JAAPA

REFERENCE

1. Hooker RS, Cawley JF. Physician Assistants in American Medicine. 2nd ed. St. Louis, MO: Churchill Livingstone; 2003.