Origins of the physician assistant movement in the United States

Abstract

The 1960s saw a rethinking of health care delivery in the United States. The physician assistant (PA) emerged from that reconceptualization, along with the nurse midwife (CNM) and the nurse practitioner (NP). The PA, CNM, and NP were the product of demand for greater health care access, especially for the nation's poorer citizens. All three groups benefited from federal activism in health workforce policy. The PA had one characteristic not shared with the new nursing professionals: a connection in the public's mind with returning Vietnam War veterans. Several energetic trailblazers--notably Eugene Stead, Richard Smith, E. Harvey Estes, and Henry Silver--conceived and promoted their particular versions of the PA. The boosters of this new health professions movement worked through existing medical education programs and federal health care initiatives. Their efforts, sometimes informed by models of nonphysician health care abroad, received critical support from private philanthropy. Then, in 1969, the American Medical Association (AMA) rather unexpectedly gave its official approval to the concept of the PA. As optimistic as the originators of the PA movement were, even they did not anticipate the critical role PAs would play in health care delivery well into the new century. US physician assistants also continue to influence medical providers in other areas of the world. This paper re-examines the history of the physician assistant movement at the 50th anniversary of the concept. The authors use archival sources, policy analyses, interviews with principal figures, and secondary historical literature to explain the establishment of the PA movement in the 1960s and analyze its continuing influence.