This editorial is dedicated to the memory of Dr. Eugene Stead, founder of the PA profession, who died peacefully in his sleep on June 12, 2005. If not for Dr. Stead's ability to think outside the box, his commitment to quality patient care and to the PA concept, and his willingness to ignore or dissuade those who opposed it, his idea would not have evolved into the wonderful profession it is today. Thank you, Dr. Stead. 

October 6, which was Dr. Stead's birthday (he was born in 1908) and also the date the first PAs graduated from Duke University in 1967, is central to when we celebrate Physician Assistant Week. But why do we have PA Week? Until last year, we had only PA Day, and until 1987, we didn't have PA anything.  

The value of National PA Week

The first reason we have Physician Assistant Week is that it allows us to educate the public about our profession. We do this with newspaper articles; displays at medical facilities, community health fairs, and other events; radio interviews; and, occasionally, television interviews. PAs are our own best public education tool. When someone reads about us in the local newspaper, hears us on the radio or TV, or talks to us at community events, this generates more positive publicity for PAs than any national media campaign ever could.

PA Week is also an opportunity to forget the paperwork, however briefly, and remember what is good about medicine: helping people. The health care system has changed dramatically since the PA profession started. It used to be that we simply saw patients and provided them with the necessary care. Now, we deal with preauthorization, formularies, preferred provider lists, approved facilities lists, and protocols from medical insurance companies. For a brief time, PA Week allows us to bring the focus of health care back where it belongs: to the patient.

PA Week gives us a chance to celebrate our unique profession. When PAs who participated in the AAPA annual conference survey were asked if they would become a PA again if choosing a career today, 90% responded “definitely” or “probably.” This confirms what an amazing profession we have—one that truly deserves to be proud.

Finally, PA Week permits us to reflect on our roots and plan for our future. Consider the tremendous growth we have experienced in sheer numbers, opportunities, practice settings, regulations, and legislation for PAs since the first students entered the Duke program in 1965. Today more than 65,000 people are eligible to practice clinically as PAs, an estimated 55,000 of them in the United States alone.1 In 5 years, the number of PAs in the United States is expected to exceed 85,000.2

The number of PAs in practice today is more than twice what it was just 10 years ago.2 From 1995 to 2003, the number of PA programs also doubled, as did the number of graduates per year between 1995 and 2001.2 Currently, there are 136 PA programs in the United States,3 and since 2001, the number of graduates has leveled off to between 4,200 and 4,400 per year.2

Because PAs are trained as generalists, they have the flexibility to move into various medical specialties to meet the health care system's changing demands. Over the years, we have seen interesting fluctuations in PA practice. Although more and more PAs are being employed in surgical and non-primary care medical specialties, the PA profession is still known as a primary care profession. Census data through the late 1990s and 2000 consistently revealed that the majority of PAs were employed in one of the primary care specialties.4-8 By 2001, however, a decrease in the percentage of PAs practicing in primary care became evident.9-12 In 2001, the percentage of PAs in primary care fields had decreased to 48.5%,9 and the percentage has continued to decline to the 42% reported in the 2004 census.12

These are just a few of the changes that our profession has experienced since its inception. Others of significance have included ensuring that PA program curricula are consistent and    adequate, developing practice laws and regulations in every state, credentialing and privileging PA in hospitals and other settings, expanding the scope of practice, identifying criteria for licensure, testing graduates for a basic fund of knowledge before permitting them to practice, requiring ongoing CME and periodic retesting of PAs, forming professional associations, and developing relationships with physician colleagues.  

Honoring our history

Scientific and technologic developments, including advances in medicine, have evolved at least as rapidly as our profession has over the past 40 years. In the midst of these advances, the beginnings of the PA profession—which was a simple solution to complex medical problems—could easily be forgotten.

Many people involved in PA leadership, education, and practice realized that no comprehensive text or source of information existed for significant events in the origin, development, and progression of the PA profession. Hence, in June 2001, the Physician Assistant History Center was established at Duke University Medical Center (DUMC), in the Department of Community and Family Medicine, under the direction of Reginald Carter, PhD, PA. This office was established for the study, verification, preservation, and sharing of PA history.

Shortly thereafter, preserving the history of PAs became a collaborative effort between the DUMC, AAPA, APAP (Association of Physician Assistant Programs), and NCCPA (National Commission on Certification of Physician Assistants). By January 2002, the Society for the Preservation of Physician Assistant History (SPPAHx) was established to supersede the History Center (see the sidebar). It became fully functional in July 2002 with the election of its first board of directors. The SPPAHx's mission is to be “the preeminent leader in fostering the preservation, study, and presentation of the history of the . . . [PA] profession by creating and presenting [online] a virtual repository of historic and current information on the PA profession.”13

PAs are viewed as being highly involved and indebted to those who pioneered our profession. As more PAs become aware of the SPPAHx and its activities, group and individual membership and donations are sure to increase. After all, PAs are obligated to ensure that our roots are not forgotten and that our unique history is preserved for future generations to review. For the PA profession to continue to succeed, advance, and evolve, we must understand and learn from our past. Without such knowledge, it will be virtually impossible to plan for the future. Author Robert Heinlein said it more eloquently: “A generation [that] ignores history has no past and no future.“ JAAPA

The author is the owner of Physician Assistant Medical Services (P.A.M.S.) in Williamsburg, WV. She is a Past President of the AAPA, the President-elect of the SPPAHx, and a department editor for JAAPA.

REFERENCES

1. American Academy of Physician Assistants. Information update. Projected number of people in clinical practice as PAs as of January 1, 2005. Available at: http://www.aapa.org/research/04-05num-clin-prac.pdf. Accessed August 29, 2005.

2. Division of Data Services and Statistics, American Academy of Physician Assistants. Trends in the Physician Assistant Profession: 1991-2003. January 2004. Available at: http://www.aapa.org/research/91-03trends-report.pdf. Accessed August 29, 2005.

3. American Academy of Physician Assistants. Facts at a Glance. April 2005. Available at: http://www.aapa.org/glance.html. Accessed August 29, 2005.

4. 1996 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/censusa.html. Accessed August 29, 2005.

5. 1997 AAPA Physician Assistant Census Summary. Available at: http://www.aapa.org/research/sum97.html. Accessed August 29, 2005.

6. 1998 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/sum98.html. Accessed August 29, 2005.

7. 1999 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/sum99.html. Accessed August 29, 2005.

8. 2000 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/intro2000.html. Accessed August 29, 2005.

9. 2001 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/01census-intro.html. Accessed August 29, 2005.

10. 2002 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/02census-intro.html. Accessed August 29, 2005.

11. 2003 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/03census-intro.html. Accessed August 29, 2005.

12. 2004 AAPA Physician Assistant Census Report. Available at: http://www.aapa.org/research/04census-intro.html. Accessed August 29, 2005.

13. Society for the Preservation of Physician Assistant History Web site. Available at: http://www.pahx.org/society/index.htm. Accessed August 29, 2005.