Credentialing & Privileging

Celebrate PA Week: A Brief History of the PA Profession

By Tricia Marriott, PA-C, MPAS, Greg Thomas, PA-C Emeritus

PA Week is celebrated Oct. 6–12 every year in recognition of the contributions of physician assistants/associates (PAs) as key members of the healthcare workforce. As the number of PAs continues to grow, medical services professionals are increasingly interacting with these medical practitioners through credentialing, privileging, and enrollment. We are happy to provide a brief history lesson for PA Week.

The PA profession in the United States was borne out of necessity in the 1960s, due to a confluence of circumstance and societal changes. At a time when the U.S. population was rapidly expanding, medical education had contracted, and more of its citizens had access to health insurance through the new Medicare and Medicaid programs, the United States had a classic workforce problem of supply and demand. An insufficient number of medical practitioners could not meet the growing demand for healthcare services. Meanwhile, former military-trained medics and corpsmen returning to civilian life had no defined role in the healthcare workforce and were perfect candidates for the social experiment that became the PA profession. 

The concept of “training up” individuals to provide medical services to supplement the medical workforce is not unique to the United States, dating back many centuries to prototypes such as the 17th-century “feldshers” in the former Soviet Union or the 19th-century “officier de sante’” in France. In 1961, Dr. Charles L. Hudson presented the notion of training “nonprofessionals” to expand medical services, identifying the military-trained workforce as ideal to perform routine medical tasks. 

In 1965, Dr. Eugene A. Stead, Jr. took up that charge, establishing the first formal education program for PAs at Duke University, where ex-military corpsmen were already staffing hospital specialty units. In 1968, Dr. Richard A. Smith at the University of Washington created the first MEDEX PA program, and Dr. Hu Myers established the first baccalaureate degree program for PAs at Alderson-Broadus College in West Virginia. The return of military-trained medics and corpsmen from the conflict in Vietnam initially bolstered the PA candidate pool, helping establish proof of concept and the PA prototype in the early 1970s. As the conflict ended, other individuals with healthcare experience entered PA educational programs.

Education and Accreditation

In 1971, organized medicine established standards for PA education and created an accreditation body to evaluate and approve PA programs. Now known as the Accreditation Review Commission on the Education for the Physician Assistant (ARC-PA), the ARC-PA accredits “qualified PA programs offered by, or located within, institutions chartered by, and physically located within, the United States, and where students are geographically located within the United States for their education.”

Currently, the ARC-PA accredits 317 entry-level programs. The rapid proliferation of PA education programs in the U.S. is not only a testament to the success and popularity of the profession, but also a concern for those committed to upholding the education standards for the practice of medicine as a PA.

Certification

Along with establishing standards for PA education, organized medicine sought validation of the PA program graduates’ qualification. In 1973, the National Board of Medical Examiners developed and administered the first PA examination based on “the tasks and skills expected …  in the management of common illness.” In 1974, the National Commission on Certification of Physician Assistants (NCCPA) assumed responsibility for “eligibility, the setting of passing standards, conditions for initial certification, and other periodic recertification.”

According to the NCCPA, there were 189,107 currently certified PAs at the end of 2024. To become certified, candidates must have graduated from an ARC-PA accredited PA program and achieve a passing score on the NCCPA’s Physician Assistant National Certifying Examination ® (PANCE). In the United States, all 50 states, the District of Columbia, the U.S. territories, the U.S. military, and most employers require NCCPA certification for employment, licensure, and regulation of PAs.

Legislation, Regulation, and Scope of Practice

In 1970, California enacted the first legislation for PAs to practice medicine. Today, all 50 states and U.S. territories authorize PAs to evaluate, diagnose, prescribe medication and treatments, and provide medical care in all specialties and practice settings. In the early days of the profession, the PA role and scope of practice was dictated by the physician with whom they worked, often in an employer-employee relationship. The physician who “supervised” them delegated tasks to the PA. Over time, the physician would increasingly delegate responsibilities and/or more advanced complex care or procedures to the PA based on the concept of “negotiated performance autonomy.” The physician and PA worked as a team, leveraging individual strengths and experience to provide medical care.

The U.S. corporatization of medicine, meant to spur innovation and economy of scale, has virtually eliminated solo physician practices. As physicians become employees, the physician-PA relationship has changed, often with large numbers of physicians teaming up with large numbers of PAs. While scope may be defined by state law, regulations and/or institutional policy, PAs and physicians nonetheless exercise “negotiated performance autonomy” at the practice level. Efforts are underway at the state level to eliminate onerous restrictions that may limit the effective use of PAs. Recent research suggests that removing restrictive laws and regulations to PA practice does not increase overall risks to patients or increase rates of malpractice within U.S. healthcare.

The Future

PAs in the U.S. have an established record of delivering high-quality medical care for over 58 years. Job growth for the PA profession is projected at 27%, “much faster than average.” The generalist nature of NCCPA Board Certification allows PA-Cs to be flexible and adaptable to meet the needs in all areas of medicine. PAs are increasingly practicing in medical and surgical subspecialties, opening access to specialty care. As a solution to the projected shortage of up to 86,000 physicians by 2036, PAs will continue to meet patient needs by providing access to professional medical services and quality medical care.