History of the Physician Assistant

The first educational program for physician assistants began in 1965 in response to a perceived shortage and maldistribution of physicians. At the same time, many corpsmen were returning from the Vietnam War, who were well trained to address trauma and surgical conditions. Dr. Eugene Stead, chairman of the Department of Medicine at Duke University, established a two-year program to formally educate “physician assistants” in order to address the health care delivery issues of the time. The education model was based in part on his experience of fast-track training of doctors during World War II and on his work developing a new curriculum for undergraduate medical education. In the fall of 1965, four ex-Navy corpsmen began their education at Duke University under Dr. Stead’s direction. The physician assistant, who was initially viewed as a physician substitute, was trained to provide medical care to rural and other medically underserved populations with physician supervision

The PA concept has grown substantially in the past several decades. As of July 2007, there are 141 accredited PA programs throughout the country. Today, PAs practice medicine in all 50 states as well as internationally, and have been authorized to prescribe medications throughout the 50 states, in the District of Columbia, and in the Territory of Guam. There are approximately 79,000 individuals eligible to practice as of January 2008 and 67,000 PAs currently practicing in the United States. In the late 1990’s a white paper developed by the Association of Physician Assistant Programs, recommended the move from undergraduate training to graduate level training. In 2007, there were 4600 students who sat for the national certifying examination (PANCE) which is administered by the National Commission on the Certification of Physician Assistants (NCCPA).

The Competencies of the Physician Assistant Profession

Recently, The American Academy of Physician Assistants (AAPA), the Association of PA Programs and the National Commission on the Certification of Physician Assistants (NCCPA) created a document which outlines the Competencies of the Physician Assistant Profession.
Educated in the medical model, a PA is defined by the AAPA as "a health professional who practices medicine with the supervision of a licensed physician." Physician utilization of physician assistants creates a unique health care team dedicated equally to:

1. increasing accessibility to high quality health care,
2. providing comprehensive health care services,
3. maintaining an atmosphere of caring and trust between the patient, the family, and the health care team, and
4. improving the continuity of patient care within the health care system.

The PA is distinguished from other health care professionals by his education as a generalist, by the breadth of his clinical knowledge, by the extent to which he is given decision-making authority regarding patient care, diagnosis, and treatment, and by the depth of his clinical experience.

Legal Issues

Between 1971 and 1991, Connecticut PAs practiced under Public Health Act 171 which stipulated that legal prohibition against the practice of medicine would not apply to physician assistants. An additional statement defining "the physician assistant" according to necessary education and national certification was added in 1981. On January 1, 1991, a new law on PA licensure and prescriptive rights was enacted. The law, which replaced the former delegatory legislation, allows for the licensure of PAs and grants PAs the authority to prescribe, dispense, and administer controlled substances. Criteria for full Connecticut PA licensure include a baccalaureate degree, graduation from an accredited PA program, passage of the NCCPA certification exam, maintenance of continuing education requirements, 60 hours of pharmacology instruction, and appropriate application and renewal fees. There are provisions for temporary licensure as well. This law precludes individuals lacking minimal credentials from identifying themselves as PAs. Information regarding licensure requirements and application can be found at State of Connecticut Department of Public Health.

The question of malpractice frequently arises among individuals seeking information regarding the profession. Since PAs share legal, ethical, and moral responsibility for patients' care with their supervising physicians, they must carry malpractice insurance. This insurance is available to them as riders to the malpractice policies of employing physicians, or is provided by the institutions where they work. Such insurance is also available on an individual basis through the American Academy of Physician Assistants.