Lecture 1 HX of The PA Profession PA Organizations

N243A: Professional Practice 1
History of the Profession;

and PA Organizations
Teresa Thetford, DHSc, MS, PA-C

June 2022
Betty Irene Moore School of Nursing 1

Instructional Objectives:
1. Describe the historic development of the Physician Assistant profession

A. Explain the development of the physician assistant profession in the
United States
B. Describe the growth and current trends in the Physician Assistant
profession in the United States and around the world.
2. Define and discuss the roles of the national organizations (AAPA, PAEA, NCCPA,
and ARC-PA) and state organizations (California: CAPA).
3. Discuss the national PA student organizations (AAPA Student organization, and state
organizations), and identify the services and opportunities offered by each.

HISTORY OF THE
PROFESSION
Birth of PA Profession
• In the mid-1960s, physicians at Duke
University Medical School recognized the need
for a new type of health professional with
comprehensive medical education to increase
access to quality health care.
First PA Students
• Former military corpsmen seeking an
opportunity to use their medical skills in civilian
life.
1967: The first three PAs graduated from Duke
University in 1967

PA Profession
Milestones
• 1961: Proposal for “an advanced medical assistant with special
training, intermediate between that of the technician and that
of the doctor, who could not only handle many technical
procedures, but could also take some degree of medical
responsibility,” appears in an article by Charles L. Hudson, MD,
in the JAMA.
• 1965: Eugene A. Stead, MD, establishes a “physician

assistant” educational program at Duke University in North
Carolina.
• 1967: October 6 Kenneth F. Ferrell, Victor Hugo Germino, Jr., and

Richard John Scheele are the first PA graduates from the Duke
University PA Program.

…PA Profession Milestones
 1968: AAPA is incorporated.

 1971: The AMA recognizes the PA profession and begins work on national certification.
 1972: The Association of Physicians Assistants Programs (APAP) later renamed Physician Assistant Education
Association (PAEA) founded by Alfred M. Sadler Jr., MD.
 1973: First PA conference. 253 attendees. First national certification exam.
 1975: National Commission on Certification of Physician Assistants (NCCPA) established to determine eligibility
criteria and to administer national certifying exam.
 1980: Physician assistants have prescriptive authority in 10 states.
 1981: First NCCPA recertification exam administered – PA National Recertifying Exam (PANRE).
 1991-2000: Maturation and growth of the profession.
 2001-2010: Going international
 2011-2020: Into the Future: The Affordable Care Act doubles the projected need for PAs. PAs are seen as essential
components of new health care delivery structures such as "accountable care organizations" and "medical homes."
– Forbes and Money magazines rate the physician assistant Master's degree as the most desirable advanced
degree in terms of employment opportunity, income potential, and job satisfaction.
 2021-now: Adapting and transforming the profession

Growth and current trends in the Physician
Assistant profession in the United States
Trends:
• Although first PA programs developed with Primary Care and the training
of military corpsman as the focus, the demographics have changed:
o Now more career-oriented applicants in mind (rather than skill-oriented)
o More women than men
o Few minorities.
• Optimal Team Practice

• Name Change: Physician Associate

Optimal Team Practice
 Optimal team practice (OTP) has been defined as “PAs, physicians,

and other health care professionals working together to provide
quality care without burdensome administrative constraints.” (AAPA 2016).
 OTP is the American Academy of Physician Assistants’ (AAPA)

policy for establishing future physician assistant (PA) practice.
 Despite the recommendation, individual state law dictates how a PA

functions. OTP continues to be an iterative process, and as such, is
ever-changing.

Passed in
2021;
implemented
in Jan 2022

https://www.aapa.org/advocacy-central/optimal-team-p
ractice/

Who we are as a Profession
Who we
are as a
profession
today (data
Jan 2022)

No change in data, 2021

There are over 150,000
PAs in the U.S. (2020 stat
from NCCPA).

2018 data

CASPA Data 2020

• In the mid-1990s, other countries were becoming interested in the PA
profession and in individual PAs.
• PAs began working with governments and institutions to transfer the
profession overseas. International clinical rotations were developed to support
this change.
• AAPA and PAEA supported this and built infrastructure to support it.
• PA educators are involved in global health education organizations to bring
together all health professions.
Some controversy as to whether U.S.-trained PAs should stay in U.S. where
the need is great for more clinicians.
• Canada
Growth and • UK and Ireland
current • Africa (were previously called “Medical officers” or “clinical

officers”)
trends in the • The Netherlands: PA students (and grads) since 2001 at Univ
of Applied Sciences in Utrecht. NAPA approved Rx privileges in
Physician 2012.
• India: Over 500 PAs trained by cardiac surgeon since 1992.
Assistant • Australia & New Zealand
profession in • Germany: Three PA programs started since 2012.

• Israel
the world • Saudi Arabia: in conjunction with GW Medical faculty. 1st class
graduated 2013.
• Afghanistan: Afghan PA Program in Kabul. Grads in 2014

Where • Japan
Next? • China
• Singapore
• Belgium
• Switzerland
• Poland
• Spain

National and State PA
Organizations
• AAPA (American Academy of PAs)
• NCCPA (National Commission for the Certification of the PA)
• PAEA (PA Educators Association)
• ARC-PA (Accreditation Review Commission for the Education
of PAs)
• CAPA: California Academy of PAs

https://www.aapa.org/advocacy-central/

CAPA: SP 697 - PA Practice Act Amendment (Jan 2020)
 BPC 3502: Repeals Limitation of Supervising Physician’s Usual and Customary
Practice/Specialty.
– Without delegated authority, the PA’s medical services are not limited to the practice type of
the physician.
 BPC 3502: Repeals Chart Co-signature Requirements
– No co-signatures or medical record review meetings required by law
 BPC 3502: Repeals Protocols for Supervision by law
– No protocols are required by law
 BPC 3502.1: Repeals Formulary Requirements
– No legal requirement to list specific use criteria and contraindications for drugs and devices.
 BPC 3502.3: Repeals Delegation of Services Agreement
– The DSA and the delegated relationship it represents is not mandated by law.
 BPC 3202.1 & 4040: Repeals Information Needed on a Prescription
– No requirement for the name, address or phone number of a supervising physician on the
prescription.

• Student Academy:
• Student Board of Directors
• AOR: the governing body of the student academy
PA Student • HOD: the policy making body of the student academy

• AAPA Conference in May
Organizations • CAPA
• Conference every October
• Student chapter
• Student challenge bowl at annual conference

References
AAPA Facts (2022): accessed at https://www.aapa.org/
AAPA 2020 Salary report:
Ballweg R., Brown, D., & Vetrosky, D. (2022). History of the profession and current trends, Ballweg, R;
and International development of the physician assistant profession, Kuhns, D. H. Physician Assistant: A
Guide to Clinical Practice,. Saunders Elsevier: Philadelphia, PA.
CASPA (2020). Applicant and Matriculant Data.
NCCPA: PA History Society accessed at http://www.nccpa.net/PAHistorySociety
PAEA (2020). 35th Program Report on the physician assistant educational programs in the United States.
Washington, DC PAEA.

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N243A: Professional Practice 1

History of the Profession;

Teresa Thetford, DHSc, MS, PA-C

Betty Irene Moore School of Nursing 1

1. Describe the historic development of the Physician Assistant profession

Betty Irene Moore School of Nursing 2

Betty Irene Moore School of Nursing 4

• 1965: Eugene A. Stead, MD, establishes a “physician

• 1967: October 6 Kenneth F. Ferrell, Victor Hugo Germino, Jr., and

Betty Irene Moore School of Nursing 5

 1968: AAPA is incorporated.

Betty Irene Moore School of Nursing 6

• Optimal Team Practice

Betty Irene Moore School of Nursing 7

 Optimal team practice (OTP) has been defined as “PAs, physicians,

 OTP is the American Academy of Physician Assistants’ (AAPA)

 Despite the recommendation, individual state law dictates how a PA

Betty Irene Moore School of Nursing 8

Betty Irene Moore School of Nursing 9

Betty Irene Moore School of Nursing 10

Betty Irene Moore School of Nursing 11

Betty Irene Moore School of Nursing 13

Betty Irene Moore School of Nursing 15

Betty Irene Moore School of Nursing 21

Betty Irene Moore School of Nursing 23

current • Africa (were previously called “Medical officers” or “clinical

profession in • Germany: Three PA programs started since 2012.

Betty Irene Moore School of Nursing 31

Betty Irene Moore School of Nursing 32

Betty Irene Moore School of Nursing 34

Betty Irene Moore School of Nursing 35

Betty Irene Moore School of Nursing 36

PA Student • HOD: the policy making body of the student academy

Betty Irene Moore School of Nursing 37

AAPA 2020 Salary report:

CASPA (2020). Applicant and Matriculant Data.

NCCPA: PA History Society accessed at http://www.nccpa.net/PAHistorySociety

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