Physician assistants: Improving access to health care

By Mary Jo Bloominger

I was in grade school when the family practice doctor in our small town died. He had devoted his life and career to taking care of the people of our small rural community in north central Iowa. That was in the late 1970s and recruiting a doctor to a town of 1,000 people was nearly impossible. During this time, a new profession was emerging to fill the primary care shortage occurring across the country in rural areas like ours.

In the 1960s, physicians and educators recognized a shortage of primary care physicians. At the same time, medics and corpsmen returning from the Vietnam War with experience working with patients on the battlefield had no opportunity to utilize these valuable skills back home. Dr. Charles Hudson saw an opportunity to solve the two problems by employing medics and corpsmen returning from war as “mid-level providers.” Dr. Hudson wrote an article published in JAMA (Journal of the American Medical Association) with a proposal for “an advanced medical assistant with specialized training, intermediate between that of a technician and a doctor, who could not only handle many technical procedures, but could also take some degree of medical responsibility.”

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Four years later, Dr. Eugene Stead, Jr. at Duke University started the first Physician Assistant program with former Navy medical corpsmen. He incorporated the fast-track medical training of doctors used during World War II as the basis of the curriculum. In October 1967, three of the corpsmen graduated from the program and the physician assistant profession was born. In 1971, the American Medical Association (AMA) formally recognized the physician assistant profession.

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When the community leaders in my hometown learned about this new profession, they recruited a physician assistant to work in our medical clinic, maintaining access to primary care in our small town.

Today, PAs are educated at the master’s degree level. Admission to a PA program is highly competitive, requiring a bachelor’s degree and completion of courses in basic and behavioral sciences as prerequisites. Incoming PA students bring with them an average of more than 3,000 hours of direct patient contact experience, having worked as paramedics, athletic trainers, medical assistants, or CNAs, as a few examples. PA programs are approximately 27 months long and include classroom instruction and more than 2,000 hours of clinical rotations. There are 277 accredited PA programs nationwide.

New graduates of an accredited PA program must pass the National Commission on Certification of Physician Assistants (NCCPA) exam to be a certified PA. To maintain certification, PAs must complete 100 hours of continuing medical education (CME) every two years and take a recertification exam through the NCCPA every 10 years. This mimics the continuing education requirements for physicians. As of Dec. 31, the NCCPA reported 148,560 certified PAs.

PAs are physician extenders and work under the supervision of a physician in a team-based practice. PAs diagnose illness, develop and manage treatment plans, prescribe medications and often serve as a patient’s primary healthcare provider. The Affordable Care Act (ACA) of 2010 formally recognized PAs as primary care providers, along with physicians and nurse practitioners. PAs now work in most specialties and practice in every state improving access to healthcare.

My hometown of Bancroft is fortunate to have a PA providing primary care to the residents today. This was comforting to me, personally, as my parents were aging and in need of a health care provider who knew them and gave them access to the care they needed. This was crucial for my dad when he had an incarcerated hernia and needed emergency surgery. He was able to see the PA in town who knew him well. My dad was referred emergently to a surgeon in a larger city an hour away. Without this access to care, I’m sure his treatment would have been delayed. I am proud that my chosen profession has improved access to health care for many, including my own family.

The future of the PA profession is bright. The physician assistant profession was named “Best Overall Job” in the 2021 U.S. News & World Report. The ranking is based on factors such as growth potential, work-life balance and salary. More importantly, the PA profession has allowed me to live out my Catholic faith in service to others. I have been a physician assistant for 28 years. In my career I have had the opportunity to work at Community Health Care as the medical provider for the Outreach Team providing healthcare to the homeless at local homeless shelters.

I have also worked in a private practice family practice office. Working with patients, especially underserved populations, is such an honor and a privilege as I have truly felt that I was the “hands and feet of Christ” as I helped patients through difficult challenges.

I currently work as an educator in a PA program and hope to instill in my students the desire to serve others by creating volunteer opportunities to work with underserved populations in our community. PAs are a vital part of the healthcare team and will continue to provide increased access to improve the lives of the people we serve.

(Mary Jo Bloominger is an assistant professor with the Master of Physician Assistant Studies program at St. Ambrose University in Davenport.)


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