PA Profession History Summary

October 6th is National PA Day which marks the date of the graduation of the first PA class from the Duke University PA program. The first class was composed of three former Navy corpsmen. The below facts about the PA profession came to me courtesy of Steve Cohen, PA-C from Nova Southeastern University and I thought I would share them with you. Every PA should be familiar with the history of their profession. I would suggest you save a copy of this on file or print it out and put it somewhere to review once in a while just to help you remember about the roots of your profession.

1650 - Feldshers, originally German military medical assistants, are introduced into Russian armies by Peter the Great in the 17th Century.

1778 - US Congress provides hospital mates to assist physicians in care of sailors modeled after the "loblolly boys" of the Bristish Royal Navy.

1803 - Officiers de Sante are introduced in France by Fourcroy to help alleviate health personnel shortages in the military and civilian sectors (abolished in 1892).

1891 - Establishment of the first company for "medic" instruction at Fort Riley, Kansas.

1925 - Mary Breckinridge established the Frontier Nursing Service in mountains of Kentucky and builds Wendover, marking the first effort to professionalize midwifery in the United States.

1940 - Community Health Aids introduced in Alaska to improve the village health status of Eskimos and other native Americans.

1940 - Dr. Amos H. Johnson employs Henry "Buddy" Treadwell as office assistant and over time trains him as prototype PA to work in his rural-based general practice in Garland, NC exposing Dr. Eugene Stead, Jr. and general medicine residents at Duke University to the assistant model.

1942 - Dr. Eugene Stead, Jr. is forced to develop a fast track, 3-year applied medical curriculum to educate physicians at Emory University for military service during World War II and has to use medical students and residents to primarily run Emory University and Grady Hospitals in Atlanta, GA.

1957 - Thelma Ingles, RN, begins clinical sabbatical with Dr. Stead at Duke University which leads to the establishment of a master's degree program for nurse clinicians at the School of Nursing. Although successful, the program is denied accreditation by the National League for Nursing (NLN).

1959 - US Surgeon General identifies shortage of medically trained personnel.

1961 - Dr. Charles Hudson, in the Journal of the American Medical Association, calls for a "mid-level" provider from the ranks of former military corpsmen.

World Health Organization (WHO) begins introducing and promoting health care workers in developing countries (e.g., Me'decin Africain, Dresser, Assistant Medical Officer, and Rural Health Technician).

1962 - Dr. Henry McIntosh, cardiologist at Duke University, trains local fireman in emergency procedures for the community; in exchange, off-duty firemen staff the cardiac catheterization laboratory; former Navy hospital corpsmen are hired for similar roles and are classified as physician's assistants by Duke's payroll department.

1964 - Dr. Eugene Stead, Jr., disillusioned by organized nursing rejection of the nurse clinician program, decides that ex-military corpsmen with their previous training and experience would be suitable candidates for his two-year experimental program that he describes in a letter to one of his Duke colleagues, Dr. Charles H. Frenzel.

Dr. Richard A. Smith is assigned to Pacific Northwest by Surgeon General William Stewart to develop physician assistant training program. He develops the MEDEX (Med-icine Ex-tension) model with a strong emphasis on the deployment of students and graduates into medically underserved communities.

1965 - Academic Committee chaired by Dr. Andrew Wallace approves Dr. Stead's proposed PA curriculum and the National Heart Institute funds Dr. Herbert Saltsman's grant to train hyperbaric chamber operators and physician's assistant. This clears the way for the first four physician assistant (PA) students, all ex-Navy hospital corpsmen, to begin training at the Duke University Medical Center in Durham, NC.

1966 - Allied Health Professions Personnel Act (PL-751) promotes the development of programs to train new types of primary care providers.

Look Magazine article entitled "More than a nurse, less than a doctor" catapults the PA concept to national attention but undermines attempts to foster nurses' acceptance of PAs.

1967 - Dr. John W. Kirklin, initiates first surgeon's assistant program at the University of Alabama in Birmingham, AL.

First Class of three PAs, Victor H. Germino, Kenneth F. Ferrell and Richard J. Scheele, graduate from Duke University on October 6th. The American Academy of Physician Assistants (AAPA) adopts the date later as "National PA Day."

1968 Dr. Hu C. Myers establishes first baccalaureate degree program for PAs at Alderson-Broaddus College in Philippi, WV.

Health Manpower Act (PL-490) funds the training of a variety of health providers.

Duke University hosts first of four national conferences on physician assistants to promote development and standardization of educational program curriculums, study and promote the PA concept to professional, private and Federal organizations, and develop model legislation for PAs.

American Association of Physician's Assistants (AAPA) is incorporated in NC to encourage its members to render honest, loyal and efficient service to the medical profession and quality care to the public whom they serve.

1969 - Dr. Richard Smith launches MEDEX program at the University of Washington, Seattle WA to rapidly deploy ex-military corpsmen to rural primary care practices throughout the Northwest.

The American Hospital Association and Joint Commission on Hospital Accreditation release report on the "Utilization of Physician's Assistants in the Hospital."

First class graduates from the University of Alabama Surgeon's Assistant Program. Dr. Henry Silver establishes Child Health Associate (CHA) Program at the University of Colorado.

Students are allowed in the mid-1970s to take additional graduate school courses and earn a master's degree making the CHA program the first to offer advanced degrees to their graduates.

American Medical Association (AMA) Council on Health Manpower explores PA concept and the AMA House of Delegates adopts "Guidelines for the Development of New Health Occupations."

Board of Medicine of the National Academy of Sciences release report classifying physician's assistants as Type A, B, or C according to degree of specialization and level of judgement.

1970 - Kaiser Permanente becomes first HMO to employ PA.

The American Registry of Physician Associates is incorporated in NC to grant and issue certificates to graduates of approved programs or others who could demonstrate by examination that they possessed the knowledge and skills of a graduate of an approved program. Later, the registry is absorbed into the Association of Physician Assistant Programs (APAP) and its certification functions are assumed by the National Commission on Certification of Physician Assistants (NCCPA).

AMA House of Delegates passes resolution recognizing physician's assistants.

1971 - American Medical Association begins work on national certification and codification of PA practice characteristics.

Comprehensive Health Manpower Training Act (PL92-157) contracts for physician assistant education and deployment.

The American Association of Physician Associates publishes its first official Journal Physician's Associate. It is a quarterly publication printed by Charles B. Slack, Inc. with Russell F. Lawrence as editor.

Cartoonist Dick Moores introduces the general public to physician's assistants in his comic strip "Gasoline Alley." The main characters, the Wallets, have a son, Chipper, who is a Vietnam veteran and former military corpsmen. The local general practitioner, Doc, gives Chipper a pamphlet and gets him interested in becoming a physician's assistant.

AMA House of Delegates adopts "Essentials for an Educational Program for the Assistant to the Primary Care Physician."

Dr. Richard Rosen establishes first postgraduate residency program for PAs in surgery at the Montefiore Medical Center in Bronx, NY.

1972 - The Association of Physician Assistant Programs (APAP) is established with sixteen charter members to facilitate communication and cooperation among physician assistant educational programs at universities and colleges throughout the United States. Alfred M. Sadler, Jr., MD is elected as the organizations first president.

The first book written about PAs, The Physician's Assistant: Today and Tomorrow, by Sadler, Sadler and Bliss, is published.

Alderson-Broaddus College graduates its first class of baccalaureate prepared PA students.

The American Medical Association forms a Joint Review Committee on Educational Programs for Physician Assistants (JRC-PA) to evaluate compliance with the "Essentials" adopted by the AMA House of Delegates.

Bureau of Health Professions Health Resources Administration awards first contracts to support the development of primary care physician assistant educational programs.

Nine sponsoring colleges of medicine located throughout the United States establish consortium of MEDEX training programs.

National Board of Medical Examiners begins the process of developing a certification examination to assess the knowledge of graduates of accredited PA educational programs.

1973 - First AAPA Annual Conference on New Health Practitioners was held at Sheppard Air Force Base, Wichita Falls, TX with 275 attendees.

Fourteen national health professional organizations voluntarily form a National Commission on Certification of Physician Assistants with offices located in Atlanta, GA to provide state licensing authorities the names and qualifications of persons who successfully passed the NBME examination.

National Board of Medical Examiners (NBME) administers the first Certifying Examination to 880 candidates, 10% of whom are not PAs but graduates of nurse practitioner programs. Exam consisted of multiple-choice questions and patient management problems using invisible ink technology to expose pertinent information.

Fourteen national health professional organizations voluntarily form a National Commission on Certification of Physician Assistants with offices located in Atlanta, GA to provide state licensing authorities the names and qualifications of persons who successfully passed the NBME examination.

Introduction by Ron Pace, PA-C
Facts furnished by Steve Cohen, PA-C
October 1, 2003