The Physician Assistant ProfessionRandy D. Danielsen, MPAS, PA-C

Associate Professor & ChairDepartment of Physician Assistant Studies

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

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.

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 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.

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 NPsPAs and NPs What is the difference?

MedicalMedical versus NursingNursing modelDependenceDependence versus IndependenceIndependence

General PA Program Information

1999 - 120 accredited PA Programs35,782 graduates55% programs offer Baccalaureate

degree or degree option40% programs offer Masters

Degrees05% programs offer Certificate or

Associate degree

0%

20%

40%

60%

80%

100%

Males Females Never in

Military

Bachelors

Degree

Need

Financial

Aid

PA Program Applicants - 1996 AAPA Survey (n=2,269)

Mean Age 30, Mean GPA = 3.41

PA Graduate Statistics - 1997

AAPA Census (n=15,206)

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

Female

Male

Clinical Practice

Primary Care

Surgery

The Future: Danielsen’s Predictions

PAs will play a prominent role in:

• Rural Health CareRural Health CarePA / Physician teams will put the “doctor” back into rural doctoringThe challenge is to resolve the maldistribution of health care providers in rural areas!ASHS will prove to be a leader in this area.

• Surgical SpecialtiesSurgical SpecialtiesPAs will become 1st assistants in many operations

PAs will play a prominent role in:

• Hospital Inpatient ServicesHospital Inpatient ServicesPAs will continue to become house staff officersThe cut back on licensing international medical graduates has created many spots for PAs.

• Correctional Health ServicesCorrectional Health Services • Managed Care OrganizationsManaged Care Organizations

The EndThe End