The Physician Assistant Profession Randy D. Danielsen, MPAS, PA-C Associate Professor & Chair Department of Physician Assistant Studies
The Concept of Assistants toPhysicians 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 toPhysicians 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 YearsAgo 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 NPsWhat is the difference? Medical versus Nursing model Dependence versus Independence
General PA ProgramInformation 1999 - 120 accredited PA Programs 35,782 graduates 55% programs offer Baccalaureate degree or degree option 40% programs offer Masters Degrees 05% programs offer Certificate or Associate degree
PA Program Applicants - 1996 AAPA Survey (n=2,269) Mean Age 30, Mean GPA = 3.41100%80%60%40%20% 0% Males Females Never in Bachelors Need Military Degree Financial Aid
PA Graduate Statistics - 1997 AAPA Census (n=15,206) Surgery Primary CareClinical Practice Male Female 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%
PAs will play a prominent role in: • Rural Health Care PA / Physician teams will put the “doctor” back into rural doctoring The challenge is to resolve the maldistribution of health care providers in rural areas! ASHS will prove to be a leader in this area. • Surgical Specialties PAs will become 1st assistants in many operations
PAs will play a prominent role in:• Hospital Inpatient Services PAs will continue to become house staff officers The cut back on licensing international medical graduates has created many spots for PAs.• Correctional Health Services• Managed Care Organizations