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Education: Higher Education

The Physician Assistant Profession: Reflections on Its Past, Present, and Future

Class 2: The “Validation” of the Physician Assistants’ “Jurisdiction” and Rapid Growth of Their Profession

Introduction

During the 1970s and 1980s, a solid foundation was established upon which the physician assistant (PA) profession could grow. A series of actions of many state-level legislatures helped to consolidate the direction of PA education to one that provided a general orientation to medicine, instead of early specialization. U.S. federal government and private foundation awards to PA training programs that emphasized primary care, care for underrepresented minorities, and rural health care helped to shape the profession and make it available for filling shortages in health care delivery services.

A robust model of training emerged that all PA students were to successfully complete, and that led to the creation of a standardized certification for all PAs. They were required to first become generalists before they could work in a more specialized field or obtain further on-the-job training. The high quality of trainees and their subsequent superior performances once in practice led to continued demand for PA graduates as the need for health care providers continued to grow. The number of PA programs began to grow as well. As PAs demonstrated their competence and eagerness to take on more tasks, physicians began to delegate more tasks (and raise their salaries), thereby enhancing PAs’ career prospects even more. And, becoming a PA provided a career in medicine without the expense and time required to become a physician.

Research on the PA profession was widespread and many evaluations emerged during this time. The results of over 100 studies during this seminal period demonstrated that the PA profession was meeting its intended purpose – to assist in the delivery of health care services to underserved and needy populations. Studies showed that supervising physicians, other health care staff and, most importantly, patients favorably viewed PAs’ performance in a wide variety of settings.

Suggested class outline:

  1. The support of organized medicine (in 1969, the American Medical Association stated it was appropriate for physicians to delegate medical tasks to qualified assistants)
  2. Legal authorization and medical malpractice issues (Through what authority would PAs be able to provide patient care? What were the risks of malpractice suits for care provided by PAs? Would the utilization of PAs increase physician liability and insurance premiums?)
  3. The 30-year, state-by-state campaign to authorize PAs to write prescriptions, and the 1986 decision for Medicare to pay for PA services (an authorization known as Other Medicare Required Assessment, or OMRA)
  4. Support from the U.S. government for training and for employment of PAs (the HRSA Title VII Section 747 funding of PA educational programs)
  5. Growth of the PA profession
    1. By 1980, 45 PA programs and 7,500 PAs in practice
    2. Establishment of systems of educational program accreditation and national certification systems
    3. Acceptance of National Commission on Certification of Physician Assistants (NCCPA) certification as qualification for licensure in the states
  6. Emerging trends and pressures on the U.S. health care delivery system: rising costs, maldistribution of physicians, and persistent health inequities
  7. The high quality of PA graduates and their enthusiastic support from physicians
    1. Evidence that PAs were cost-effective for employing practices/organizations and that they delivered a quality of patient care that was “indistinguishable” from physician-only care
    2. The finding that PAs were accepted by physicians, patients, and other health care professionals
Class Resources
Core resources
  • Carter, R., J. Emelio, and Henry B. Perry. “Enrollment and Demographic Characteristics of Physician’s Assistant Students.” Journal of Medical Education 59, no. 4 (1984): 316–322.
  • Cawley, James F. “The Physician Assistant Profession: Current Status and Future Trends.” Journal of Public Health Policy 6, no. 1 (1985): 78–99. doi: 10.2307/3342019.
  • Cawley, James F., E. Cawthon, and R. S. Hooker. “Origins of the Physician Assistant Movement in the United States.” Journal of the American Academy of Physician Assistants 25, no. 12 (2012): 36–40, 42.
  • Cawley, James F., John E. Ott, and Craig A. DeAtley. “The Future for Physician Assistants.” Annals of Internal Medicine 98, no. 6 (1983): 993–997. doi:10.7326/0003-4819-98-6-993.
  • National Institute of Health Office of Science Education. “Meet a Physician Assistant: LifeWorks.” YouTube video, 2:06. Posted November 5, 2012. https://www.youtube.com/watch?v=x3m-mmewRSo (accessed 10/7/2016).
  • Perry, Henry B. and D. Fisher. “The Current Status of the Physician Assistant Profession: Results of a 1978 survey of 3,416 graduates.” Journal of Medical Education 56, no. 4 (1981): 839–847.
  • Piemme, Thomas E., et al. “The Physician Assistant: An Illustrated History.” Acacia Publishing, Inc. 2013.
Supplemental resources
  • Abbott, Andrew. The System of Professions: An Essay on the Division of Expert Labor. Chicago: University of Chicago Press, August 1988.
  • Ballweg, Ruth. The MEDEX Northwest Physician Assistant Program. Charleston, SC: Arcadia Publishing, 2016.
  • Perry, Henry B. “An Analysis of the Professional Performance of Physician’s Assistants.” Journal of Medical Education 52, no. 8 (August 1977): 639–647.
  • ———. “An Analysis of the Specialty and Geographic Location of Physician Assistants in the United States.” American Journal of Public Health 68, no. 10 (1978): 1019–1021. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1654063/ (accessed 10/7/2016).
  • ———. “The Job Satisfaction of Physician Assistants: A Causal Analysis.” Social Sciences & Medicine 12, no. 5A (1978): 377–385. doi:10.1016/0271-7123(78)90092-5.
  • Record, Jane Cassels, ed. Staffing Primary Care in 1990: New Health Practitioners, Cost Savings and Policy Issues. New York: Springer, 1981.
  • U.S. Congress, Office of Technology Assessment. Nurse Practitioners, Physician Assistants, and Certified Nurse-midwives: An Analysis (Health Technology Case Study 37). Washington, DC: U.S. Government Printing Office, December 1986. http://ota.fas.org/reports/8615.pdf (accessed 10/7/2016).
Discussion Questions
  1. Why were people drawn to become a PA when the field was no longer new and the long-term career prospects were limited? Why would prospective PA program applicants consider entering a program as a good career choice, compared to training to become a nurse, physical therapist, or respiratory technician?
  2. What was the continued relationship between the PA field and other health sector occupations, especially nursing?
  3. What was the initial demographic make-up of the PA profession with respect to diversity and gender? How and why has this changed over time?
  4. What were the career satisfactions among PAs that helped to promote its image nationally?
  5. What were other solutions to solving shortages in human resources for health (e.g., the development of family medicine as a new medical specialty and the emergence of nurse practitioners)?
  6. Why were patients generally receptive to receiving health care services from PAs and not just physicians?
  7. Why would one branch of the federal government support the education of PAs while another branch refused to reimburse PAs directly for services they provided to Medicare and Medicaid patients?
  8. Why were the best studies related to PA productivity and cost-benefit analysis performed by Health Maintenance Organizations (HMOs)?
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