In the beginning: a PA history roundtable

Reginald Carter, PhD, PA; Ken Ferrell, PA; Vic Germino, PA-C; Pamela Moyers Scott, MPAS, PA-C

Reginald Carter is the Executive Director of the PA History Center and the Society for the Preservation of Physician Assistant History (SPPAHx) in Durham, NC. Ken Ferrell is the charge description master at Duke University Medical Center in Durham. Vic Germino is self-employed and provides medical services at three different facilities in the Durham area. Pam Scott owns her own company, Physician Assistant Medical Services (P.A.M.S.), in Williamsburg, WV; she is the President-elect of the SPPAHx, a past president of the AAPA, and a department editor for JAAPA.

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The first PA program was started at Duke University in 1965 by Dr. Eugene Stead, with four former Navy corpsmen—Ken Ferrell, Vic Germino, Don Guffey, and Dick Scheele—as students. Two years later, the PA profession was officially born when three of these gentlemen graduated and became PAs. The profession has undergone rapid and tremendous changes in the past 40 years, and this roundtable was conducted with the surviving members of that first class to obtain their perspectives on its history. Reggie Carter conducted the roundtable for the Society for the Preservation of Physician Assistant History (SPPAHx) as part of the society’s ongoing efforts to accurately preserve the history of the PA profession for future generations. The roundtable took place on June 8, 2005, at the SPPAHx office in Durham, NC, and Pam Scott edited the transcript for publication in JAAPA. For more information on the SPPAHx, please visit their Web site at http://pahx.org.

 
Duke University Archives. Used with permission.

CARTER: You were a member of the first class of a completely new type of health care provider that was nothing more than a concept of Dr. Stead’s at that time. What made you decide to take a chance on becoming one of the first in this new profession? 

FERRELL: I felt it was exactly what I had been looking for but didn’t know existed. I was very excited about it. However, I acknowledged the fact that since it was brand new, it might not succeed. Still, I was very excited about giving it a try, and if it did fall through, I felt that I would not have lost anything and might have gained some more knowledge and skills that would be useful in my current job.

GERMINO: I was already working at Duke and thoroughly enjoyed what I was doing. They laid it on the line and informed me that this was a totally new concept to be able to utilize the talents of ex-military corpsmen. At the time, the only thing my military training had qualified me to do was to work as a research technician or an OR tech. At the same time, I was concerned about how I was going to financially support my family and go to school. So they said, “With your experience, we can sign you up as a patient care technician, and you can work while in the program.” So I agreed to give it a try.

CARTER: So, you were not only able to work part-time while attending PA school but encouraged to do so?  

GERMINO: Right. We worked at least 20 hours a week either as a patient care tech, in the hyperbaric chamber, or doing research. Part-time jobs were plentiful around the hospital at that time. And we also signed up to be part of research studies. You know, for swallowing this or that, or getting stuck here and there, they'd give you 25 or 50 bucks. That was always gravy and fun too. I signed up for all of them I could.  

FERRELL: In addition, we got a $200 monthly stipend and didn’t have to pay tuition. It was a pretty good deal.  

CARTER: That has changed. Today most programs discourage working outside of the program, and you pay the school tuition. Now, what was your impression of what the PA profession was going to be at that time?  

FERRELL: I think I had a pretty good picture because Dr. Stead made it very clear. I think I understood early on what he had envisioned. His favorite term for describing a PA was someone to extend the arms and legs of the physician. You were there really to support the physician, extend the physician’s services, and do basically what that physician wanted or needed you to do.  

GERMINO: That was my understanding as well.  

CARTER: What was the admission interview like?  

GERMINO: What interview? A couple of the physicians that I was working with at Duke informed me of the program and advised me to “look into it and go talk with Dr. Stead.” So one day I went down and talked to Dr. Stead and Jim Mau, the original administrator. Later I was contacted that I had been accepted.  

FERRELL: An old Navy buddy of mine heard about this program, contacted me, and asked if I’d be interested. I told him, absolutely, and he set up the interview during my leave as I was stationed in the Caribbean at the time. I don't remember the details of the meeting except that I met with Dr. Stead and Jim Mau.  

CARTER: The program was essentially 2 years in length, with the first year being didactic and the second clinical. What was the didactic component like?  

GERMINO: There was no formal curriculum, course schedules, or so forth. Everything was still being put together. But we had excellent instructors. However, sometimes we would go to a classroom and we didn't know who was going to come in to teach what. But all of it was quite thorough. And in addition to the class work, we were doing ward work as well.  

FERRELL: And the instructors who were teaching were basically the same ones who taught the medical students, and they taught us the same material.

GERMINO: The program continued to evolve for the first 5, 6, 7, or even 8 years until it became what it is today.  

CARTER: What was the clinical year like?  

FERRELL: It was even less arranged and organized than the didactic part. I think that they would talk to people in the surrounding areas, get approval, and send one of us to that site. I remember very well being told on a Friday that starting Monday, I would be working at the Central Prison in Raleigh. There were no choices of rotation sites. As they developed one, they would send one of us to it.  

GERMINO: And there were no learning objectives. It was, “open up your head and absorb.” Of course, there were no end-of-rotation tests either. You were evaluated by your preceptor.  

CARTER: Being the first of this new profession, how were you accepted by the patients?  

GERMINO: They put us on what at that time were called “public wards.” Those patients were grateful for anything that we could do for them. There might be 30 patients on a ward, which was an open area with beds everywhere. And there were often just one or two nurses to take care of all of the patients. So we ended up doing a lot more than just working up our patients; we were doing everything we could to help the nurses and others care for the patients. And then, you made rounds with Dr. Stead and he would cut you in a minute if you didn’t have all the information.  

FERRELL: I really don’t think the patients realized that we were PA students. We were always just introduced as “a student,” we wore the same short white lab coat as the medical students, and we did essentially the same things that the medical students did.  

GERMINO: Basically, while we were students, we were just part of the system. Dr. Stead said you were going to be there, and you were there, and that was it. It was after we graduated that we had to start really identifying ourselves more. However, we seemed to be well accepted. Some of them said they liked us better than the docs because we more took time with them and explained things better.  

FERRELL: Right. Most new patients had never heard of a PA, so we would explain to them what we were. But then the return patients, like Vic said, sometimes preferred seeing us to the physician.  

GERMINO: They would ask us for us.  

FERRELL: And they would start calling and asking for us because they didn’t want to bother the doctor.  

GERMINO: And they’d get a quicker response from the PA because it was not uncommon at that time for a patient to wait days for a response from the physician.  

CARTER: So it sounds like you were immediately accepted by most patients. How were you received by other health care providers, like nurses and physicians?

FERRELL: It wasn’t a big problem, probably because of Dr. Stead’s clout. Everybody knew that this was Dr. Stead’s program, so I think that kept some of the potential problems to a minimum. And then, too, the nurses we worked with, those in the clinics we were in, they soon learned how to use us, and appreciate us. In fact, we had very little trouble until the article appeared in Look magazine.^* But even then, the problems were with nurses who had not worked with a PA, who had never seen a PA, or who didn’t know a PA. I never had any problems with the ones I worked with and who knew me.  

*The September 6, 1966, edition of Look featured an article regarding the new health care profession that was being established at Duke University. It was a positive article explaining how physician assistants would expand the number of patients a physician could care for and help to alleviate the physician shortage at the time. Unfortunately, the article was entitled, “More than a nurse, less than a doctor.” This caused some friction between the PA and nursing professions.

GERMINO: I disagree. After that article appeared, even some of the nurses here at Duke were a little bit down on us. You know, “How dare you all?” 

FERRELL: Perhaps there were a few. But who could blame them? The article was called, “More than a nurse, less than a doctor.” Talk about a slap in the face. We knew the article was being produced; however, we had no idea of the title until it showed up on the newsstands.  

GERMINO: And the impact of the article was not short-lived. I took a job at UNC in 1974. When I got there the nurses asked, “Who are you?” They said I could not give them orders. They even went to the nursing board. But the physician backed me up and said, “It’s just like it’s coming from me. That’s the way it’s going to be.” And it was terrible working under those conditions. I quit after just 1 year. Over the years, I held several other positions as the first PA to work in these places. So it was a total renewal of what we can do, and everything else. And I think, ultimately, it made me a better PA because I had to keep proving myself again and again.  

CARTER: Looking back now at what your experience was as students, what you then thought PAs could do, and your first couple of years as PAs having to explain the role and to prove yourself, could you ever have imagined the role of PAs becoming what it is today?  

GERMINO: Not really. Our scope of practice has broadened tremendously to within the parameters of the physician you are working with and, of course, state law. Now it’s just fantastic. I love it!  

FERRELL: It’s interesting that you mention limitations set by state laws. Initially, a lot of people wanted to move us quickly to licensure. However, Dr. Stead was against it. He felt it could hold us back because it could be so limiting. He never wanted us to be constrained by anyone or anything; he felt that we should be able to do whatever our supervising physician felt like we could do.  

CARTER: What do you see as the biggest change that has taken place over the course of your career?  

GERMINO: Our expanded scope of practice. Today, we’re doing everything. It’s almost to the point where we’ve reached a pinnacle. It’s just fantastic, but it is a whole new profession. It’s hard to believe sometimes.  

FERRELL: Practicing medicine—diagnosing and prescribing with a tremendous amount of autonomy. That was not the idea in the beginning. The idea was to extend the arms and legs of the physician, not to be an autonomous decision maker.  

CARTER: So what do you think contributed to the success of our profession?  

FERRELL: One thing was being recognized by Medicare and MD organizations. Another big contributor to the success of PAs was obtaining reimbursement.  

GERMINO: And prescription-writing privileges. DEA numbers are assigned to PAs now, and we can write for all classifications of meds. I think that’s played a big part in our success. I mean, they’ve given us all this ammunition, and we’re doing things that weren’t envisioned 35, 40 years ago.  

CARTER: What was your most memorable experience as a PA?  

FERRELL: What comes to mind for me was in 1995, at the Duke PA commencement, I had an opportunity to be recognized as the first graduate with their thousandth graduate. It amazed me how quickly we have grown.  

GERMINO: I think mine actually occurred in the program. I was doing a rotation over at Lincoln Hospital, and I delivered my first baby. It was the greatest feeling in the world. I’d have never had an opportunity to do anything like that, and bam, there he was, right there. And that was special, a special moment and feeling.  

CARTER: You two possess the wisdom of 40 years as PAs. What do you have to say to the next generations of PAs?  

GERMINO: I think the PA profession is still evolving. Today it’s going to take a special individual to go into a PA program and to stick it out, because there’s an awful lot crammed into 2 years nowadays. You’ve got to love medicine. I think that to the person it really means something to, being a PA is a fantastic career.  

FERRELL: There are going to be a lot of expectations placed on you, but you’ll also reap a lot of rewards. If you’re cut out for this kind of thing, I think it’s a very rewarding field. And because there are so many varying job opportunities, don’t limit your reading and learning to just one area.  

GERMINO: Let me just say one more thing. I've talked to some classes and some PAs, and I've always told them about the premise in the beginning, about working in underserved areas. And I did that. And I learned more for it and feel more rewarded for doing that. And I think it’s sad that some of today’s PAs are interested only in the high-money areas. That’s fine, but it’s not what PAs were developed to do. I think everybody needs to go into an underserved area, and do some good there, before they go on to something else.  

CARTER: In closing, I would like to thank you gentlemen for your generosity and willingness to take the time to do this interview and share your experiences and insights. From here on out, there will be a recorded history of what it was like “in the beginning. . . .”    

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