A Brief History of the PA Profession
Key takeaways:
Physician associates (PAs) are licensed healthcare providers who practice in all areas of medicine as members of multidisciplinary, physician-led healthcare teams.
The PA role was created to increase healthcare access in the rural U.S. after World War II.
State and local governments, the medical community, educational institutions, and PAs themselves have fostered the profession’s growth.
Physician associates, or PAs (formerly known as physician assistants) are nationally certified, licensed healthcare professionals who work in collaboration with an attending physician to deliver team-based patient care. PAs work in various medical settings and surgical disciplines.Here we’ll look at the history of the PA profession, how it’s grown, and the ongoing challenges PAs face.
More care needed, with fewer physicians
In the post-WWII era, the U.S. faced a shortage of primary care physicians, especially in rural areas. The PA role was created to fill that gap in healthcare.
Factors that contributed to the physician shortage included:
Advanced medical treatment: Medical advances made during the war extended people’s lifespans, which resulted in a larger patient population.
Specialization: Fewer doctors practiced general medicine because more physicians were training in medical and surgical specialties.
Shift toward hospital-centered care: New technologies drew physicians from rural areas into the cities for hospital-based training.
Increased insurance: By 1960, the number of people with insurance had increased to 122 million, up from 32 million in 1945. This increase allowed more people to seek medical care.
Medicare and Medicaid amendments: The amendments provided insurance coverage to those who were previously uninsured. The larger insured population further increased the demand for healthcare providers.
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A solution to the physician shortage
During a 1961 address to the American Medical Association at a conference on medical education, Dr. Charles Hudson, an internal medicine physician, proposed “assistants to doctors” as a solution to the widening healthcare gap.
He said that the best candidates for this role were those with non-nursing allied health backgrounds. Ex-medical corpsmen were the perfect fit: They were highly trained medics who had little opportunity to use their unique skill set once they returned home. Expanding their training as physician associates was a logical solution.
Dr. Eugene Stead turned Dr. Hudson’s concept into a reality 4 years later by creating the first PA program. In 1967, the inaugural class, composed of three ex-Navy corpsmen, graduated from Duke University with PA certificates. This program would serve as the roadmap for future PA programs.
Growth of the profession
Since its formation, the PA profession has undergone remarkable growth. In the 1970s, more than 35 new programs were created within 3 years. And from the mid-90s to the early 2000s, the number of programs nearly doubled. Much of this growth was due to support from state and federal governments, the medical community, academic institutions, and leaders in the profession.
Changes in education
Around the same time the Duke program started, a 4-year academic-based bachelor’s program at Alderson-Broaddus College was created by Dr. Hu Myers, a general practitioner in West Virginia. This program differed from Duke’s in that it did not require prior medical experience and was open to students with non-military backgrounds. The first class graduated in 1972.
Other schools soon followed suit. The profession instantly became accessible to a larger population, thereby changing its demographics and visibility.
It was not long before programs began offering master’s-level training, the first of which was at the University of Colorado in 1975. Today, the master’s degree is the standard degree for the profession. Many PAs, however, are pursuing doctorate degrees in related disciplines – especially those working in non-clinical settings.
Government support
Early on, state and federal governments supported the PA profession. Here are some examples of how the government helped the profession grow:
Numerous states passed legislation that made it easier for corpsmen. They encouraged programs to accept the corpsmen’s medical experience and military training as a substitute for some aspects of formal education.
The Comprehensive Health Manpower Act provided federal funding that significantly increased the number of PA programs.
The Defense Department and the Veterans Administration collaborated with civilian PA programs to provide education and job placement for their veterans. PAs fulfilled their roles by working in rural and underserved communities.
The medical community's support
From the beginning, the medical community fostered and guided the profession’s growth. First, multiple medical societies endorsed the requirements for program accreditation. The requirements were outlined in “Essentials of an Accredited Educational Program for the Assistant to the Primary Care Physician” and monitored by the American Medical Association (AMA) Council of Medical Education.
In 1971, the AMA legitimized the profession with official recognition and continued to monitor its growth. Physicians further showed their support by hiring and mentoring PAs in their practices. They eventually invited PAs to join various committees and take on leadership roles.
Milestones in PA history
Other turning points in the profession’s history include the following:
1973: The first-ever national exam for PA certification was held, as was the first PA conference.
1975: The National Commission on Certification of Physician Assistants (NCCPA), the body that governs PA certification, was established.
1979: Ten states grant PAs the authority to write prescriptions.
1993: PAs begin to register with the Drug Enforcement Administration (DEA) to prescribe controlled substances.
1997: PAs are deemed Medicare-covered providers per the Balanced Budget Act of 1997.
2000: PAs are able to practice in all 50 states after they receive approval to practice in Mississippi.
2001: The Accreditation Review Commission on Education of the Physician Assistant, which awards accreditation status to PA programs, becomes a free-standing organization.
2007: PAs are allowed to prescribe in all 50 states, including Guam and the District of Columbia.
How the profession has changed
PAs initially worked under the supervision of their attending physicians. They were delegated simple tasks to perform in the primary care setting while the physicians attended to more complex issues.
As PAs gained the trust and respect of the medical community and the public, their scope of practice expanded beyond primary care. PAs, like doctors, began practicing in specialized fields of medicine and were soon working in all medical and surgical disciplines.
Over time, PAs became a trustworthy, cost-effective, and competent addition to the healthcare delivery system. This was reflected in the profession’s gains in the following decades.
Two important advancements in the profession were the expansion of Medicare coverage to include PAs in settings outside of primary care in 1987 and increased prescriptive authority.
Today, PAs can prescribe medication in all 50 states, the District of Columbia, and Guam. And they are eligible for DEA certification to dispense controlled substances.
What are the job prospects for PAs?
PAs have an excellent job outlook. They’re ranked third on U.S. News & World Report’s 100 Best Jobs of 2022 list. According to the Bureau of Labor and Statistics, the profession’s projected job growth in the next decade is much faster than average. This growth can be partly attributed to high job satisfaction and the increased need for PAs in the hospital setting after the recent reduction in resident work hours.
Ongoing issues
But the profession does face some hurdles. Challenges the profession confronts as it continues to evolve include:
Diversity: Certain ethnicities are poorly represented in the profession, which is greater than 80% white. Additionally, males account for only 30% of practicing PAs.
Gender pay gap: Even though females make up the majority of the PA workforce, they only earn 90% of what their male colleagues make, according to data presented at the 2021 American Academy of PAs conference.
Balance between autonomy and supervision: The recent name change to “physician associate” and the medical community’s unfavorable reaction to that change highlights differing viewpoints about the PA-physician relationship.
Doctoral degree debate: Some in the PA community are pushing for an entry-level doctorate.
The bottom line
The PA profession has undergone tremendous change in the nearly 60 years since it's been around. It’s gone from a certificate program offered to a select few to a career that high school students aspire to. PAs have proved to be an invaluable part of the healthcare delivery system, and their role and function continue to evolve.
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