Physician Assistants in the United States--Lessons Learned.

In the United States, there has been very little organized resistance to the use of PAs by Physicians over the past nearly fifty years. No organized medical group or organization has ever officially voiced opposition. Rather the American Medical Association (AMA), the American College of Surgeons (ACS), the American College of Physicians (ACP) and others, have strongly supported the notion of non-physician team members working with them. Because many American Physicians, while serving in the military services, had worked with battlefield medics (corpsmen), who were trained to deal with major and minor injuries and illnesses in World War II (1942-1945), the Korean War (1950-1953), and the Vietnam War (1967-1973), they were knowledgeable about the extraordinary contribution these individuals made. At the time of the first pilot PA Programs, the Physician leaders of the AMA and the leading specialty organizations were enlightened, flexible and willing to experiment with civilian use of nonphysicians to help carry the burden of care to an expanding American population. Of course, some individual civilian Physicians were skeptical at first, but nearly all of them revised their opinion, once they had the opportunity to work with PAs. Some patients were also skeptical in the beginning, but PAs proved themselves and acceptance has increased over the years. PAs are now fully assimilated into medical practice, in every state in the country. As mentioned in the previous article, the practice of any health professional in the United States is regulated by each of the individual 50 states. Since the original amendments to state medical practice acts to allow PA practice were adopted in the early 1970s, most states have added legislation or regulations that affect what a PA can and cannot do. These have covered such matters as remote supervision of PAs by a Physician in rural areas, where on site supervision is not possible ; allowing the PA to prescribe a full range of medicines ; and order tests and procedures, to name a few. The history of such legislative and administrative change has sometimes been contentious from state to state, but eventually matters have been resolved. In general, PAs scope of practice has expanded, as they have proved their worthiness and competence. They have moved into a variety of medical and surgical specialties.