1. The Physician Assistant Profession
Randy D. Danielsen, MPAS, PA-C
Associate Professor & Chair
Department of Physician Assistant Studies

2. 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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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!

8. 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

9. PAs and NPs
What is the difference?
 Medical versus Nursing model
 Dependence versus Independence

10. General PA Program
Information
 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

11. PA Program Applicants - 1996 AAPA Survey (n=2,269)
Mean Age 30, Mean GPA = 3.41
100%
80%
60%
40%
20%
0%
Males Females Never in Bachelors Need
Military Degree Financial
Aid

12. PA Graduate Statistics - 1997
AAPA Census (n=15,206)
Surgery
Primary Care
Clinical Practice
Male
Female
0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

13. The Future: Danielsen’s Predictions

14. 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

15. 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

16. The End