Poland and physician assistants.

Historically, physician assistants (PAs) or their equivalent have been used to offset shortages of healthcare providers in many parts of the world. Poland, having been strongly influenced by Russia and the Soviet Union, revived the feldsher in the post-world war era. With a successful expansion of medical schools, the eventual surplus of physicians meant feldshers were no longer needed. In the early 2000s, Poland found itself in yet another medical provider crisis and turned toward the creation of the Polish PA profession.

The Russian feldsher: A PA prototype in transition.

The feldsher is a physician assistant (PA) prototype. Developed in Russia during the 19th century to serve as healthcare personnel at a time of physician scarcity, feldshers provided medical services throughout the Russian Empire and later Soviet Union. Their medical role from the mid-19th century until the Bolshevik revolution in 1917 was crucial, particularly in rural and underserved regions. During wartime, many served in the military as medics. During the late 20th century, feldshers' numbers waned compared with physicians and nurses. In the 21st century, they remain a presence in the Russian medical system but their future is in transition as their numbers decline. However, earlier this year, Russian President Vladimir Putin urged the Russian State Duma to create more feldsher-midwife stations in rural areas. This indicates that the Russian government, at the highest levels, see the need for more feldshers to serve, essentially, as PAs in remote areas.

A history of US Army PAs.

The US military has a long tradition of using physician assistants (PAs). The Army began using PAs in 1971 in an effort to supplement the physicians and surgeons in the medical corps. As their numbers grew, PAs gradually replaced general medical officers assigned to battalions. Later, specialty positions developed in aviation medicine, orthopedics, and emergency medicine. The need for a PA serving as an adviser in the major commands slowly developed at all levels of leadership. In 2015, the Army removed limitations on female PAs assigned to combat units. PAs lead in tactical and clinical settings, filling command roles, senior clinical positions, and administrative leadership roles.

Founding of the Association of Physician Assistant Programs and the Organization's Central Role in the Development of the Physician Assistant Profession.

The Physician Assistant Education Association (PAEA) (formerly Association of Physician Assistant Programs [APAP]) was founded in 1972 by early PA program leaders to encourage collaboration and discussion among program leaders and faculty on a wide range of issues of mutual concern. This article addresses the founding of the organization, which continues to represent PA programs today. It addresses the important accomplishments of APAP during the 1972-1974 period and describes in detail the essential contributions of APAP and its leaders in developing the PA profession. Included are discussions of "the Role of the Registry of Physicians' Associates," which was incorporated into APAP; the sponsorship of "the First National Conference on New Health Practitioners" in collaboration with AAPA; the "Launching a Joint National Office" for APAP and AAPA in Washington, DC, in 1973; and "Places at the Table," which reviews the successful efforts of APAP leaders to gain inclusion of AAPA and APAP in the Joint Review Committee on Educational Programs for Assistants to the Primary Physician (JRC-PA) for accrediting qualified programs, the contribution of APAP leaders to the development of the first Certification Examination for the Assistant to the Primary Care Physician by the National Board of Medical Examiners (NBME) in 1973, leadership in the founding of the National Commission on the Certification of Physician Assistants (NCCPA) in 1974, and collaboration with the Association of American Medical Colleges (AAMC) in developing interdisciplinary education and training. It concludes with a summation of the legacy of APAP (PAEA's) formative years.

Physician Assistant Education Association: Past, Present, and Future.

The Physician Assistant Education Association (PAEA), known as the Association of Physician Assistant Programs (APAP) until 2006, is the professional organization that represents physician assistant (PA) programs in the United States. Its mission is to "pursue excellence, foster faculty development, advance the body of knowledge that defines quality education and patient-centered care, and promote diversity in all aspects of PA education." PAEA has played an important role in promoting and shaping the educational mission of the PA profession. PAEA experienced a modest beginning, but it has evolved quickly as it increased its governance structure, staff, budget, and member services to support a rapidly growing profession over the last couple of decades. PAEA's current progress has positioned the profession well to increase our national visibility and our ability to affect the future of health care delivery. The future of PA education and PAEA will certainly be impacted by our continuing ability to adapt to change and to be visionary in our approach to the significant challenges we will face. Collectively, the Association staff, volunteers, and members will strive to fulfill its mission.

Physician Assistant Educational Research: 50 Years On.

The physician assistant (PA) profession began as an experiment in medical education. Initial research on the PA profession was performed primarily by health service researchers and medical educators who sought to measure the impact of the introduction of early PAs into practice. The introduction of PAs, health care providers who shared the practice of medicine with physicians, was a revolutionary step in health workforce policy, and its impact became a relevant topic of investigation. Research has not been a high priority in many PA programs, and the amount of research on PA education has been limited. This article traces periods of activity and contributions in PA educational research over the past 50 years and discusses prospects for the future of research in PA education.

Preserving 50 Years of Physician Assistant History.

Physician assistants (PAs) have been making history for 50 years. For the past 15 years, the PA History (PAHx) Society has been working to make sure this history is not lost. The Society began in 2002 as a membership organization based at Duke University and since 2011 has been a supporting organization of the National Commission on Certification of Physician Assistants (NCCPA). Highly visible and active in the PA community, the Society encourages all PAs to understand their professional history and embrace it as a part of their professional identity. The Society, through the work of its board of trustees, historians, and staff, tells the story of the collective efforts of physicians, PAs, nurses, lawyers, educators, and policy makers to create a human innovation that has changed how medicine is practiced in the United States and, more recently, in other countries. The Society provides PA faculty and students access to a growing collection of historically relevant and primary source materials that can be used for educational, research, and literary purposes.

The officier de santé in 19th-century France: A PA prototype.

In 1803, shortly after the French Revolution, the French healthcare system was reorganized and a new independent medical officer, the officier de santé (health officer) was introduced. Qualifications included 3 years in a medical school (compared with 6 years for a physician) and an apprenticeship with a physician. Although somewhat independent, officiers de santé were limited in their scope of practice to general medicine, prescribing medications, and minor surgical procedures. Many were deployed to medically underserved areas. After almost a century of activity in a role not unlike physician assistants, the officiers de santé were abolished in 1892. Development of a more rigorous medical education and an adequate supply of physicians meant that physicians were better deployed throughout France, and were largely the reasons for abolishing this PA prototype.

From feldschers to physician assistants in Bulgaria.

The physician assistant (PA) profession was established in Bulgaria in 2014 in response to a growing shortage of medical staff and was modeled on the United States experience. Feldschers provided a similar role in Bulgaria from 1878 to 1999 but feldscher training was discontinued in 1999 because of a physician surplus. However, healthcare in Bulgaria changed after the country joined the European Union, and some physicians left for better opportunities elsewhere. The loss of physicians and an aging population meant that PAs were seen as a strategy to offset Bulgaria's growing healthcare demand.

How PAs became licensed to practice in the United States.

The history of how PAs in the United States were first granted practice authority under the medical practice acts of the various states and territories begins in the 1960s with an imaginative way to circumvent the moratorium on licensure of new healthcare occupations in place at the time, while allowing the requisite flexibility for the new profession to take hold and thrive. In the subsequent decades, separate licensure for PAs was required and adopted. Despite the enormous success of the PA profession over its first 50 years, challenges remain.

Last but not least: PA practice in Mississippi.

This article describes the history of physician assistants (PAs) in Mississippi, the last state to pass legislation allowing for PA practice. A small group of PAs in the state began pursuing a PA practice act in the early 1990s with little political advocacy experience, and in 1994, the American Academy of PAs actively joined "The Battle for Mississippi." In April 2000, after years of PA advocacy, Mississippi passed the bill that would authorize PA practice in the state.

A history of PAs in the US Public Health Service.

Since 1798, the men and women of the Commissioned Corps of the US Public Health Service (USPHS), one of the seven US uniformed services, have served on the front lines of public health. Two hundred years after the start of the USPHS, the first physician assistant (PA) entered the service to carry on the tradition of protecting, promoting, and advancing the health and safety of the nation. These dedicated clinicians are involved in healthcare delivery to underserved and vulnerable populations, disease control and prevention, biomedical research, food and drug regulation, and national and international response efforts for natural and man-made disasters. This article describes how PAs in the Commissioned Corps of the USPHS have impacted the health and safety of not only the United States but also the international community.

Early decades of Madras Medical College: Apothecaries.

The Government at Fort St George determined that a school for instructing and training candidates towards the titles of 'apothecary' was necessary to improve medical help to people in the 1830s. This led to the establishment of the medical school in Madras (presently Chennai) in 1835. The school got renamed as the Madras Medical College in 1850. From 1835, the Madras Medical School offered formal training to personnel to be called either 'apothecaries' or 'dressers' under the superintendence of William Mortimer, who was assisted by George Harding in teaching at the school. Apothecary D'Beaux and Dresser P. S. Muthuswami Mudaliar were subordinate assistants. These apothecaries were recruited essentially under the Subordinate Medical Service of Madras, which was established in 1812 and included non-commissioned medical servants. The Madras apothecaries launched the Madras Apothecaries Society in 1864, which aimed at promoting and advancing medical science and knowledge. This society existed until 1871. Formal training of apothecaries ceased in Madras by the later decades of the 19th century, although informal training continued, especially for army cadets and women. Establishment of medical schools in Royapuram (which developed as the Stanley Medical College and Hospital), Tanjavur and Madurai, in the early decades of the 20th century and the 'branch' of Madras Medical College in Calicut during the Second World War changed the complexion of training of medical personnel immensely in pre- 1947 Madras Presidency. The Royapuram and other Medical Schools in Madras trained medical practitioners granting the title 'Licensed Medical Practitioner' (LMP). Whether the apothecary-dresser training at the 'old' Madras Medical College had a role to play in these developments remains to be verified.

The professional identity of the practicante: the case of Aragon, 1857-1936.

The objective of this study was to reconstruct the professional identity of the practicante (male assistant in medicine and surgery) by analyzing three professional journals of this collective in Zaragoza (Aragón). The discourse of practicantes on their profession insists that they were the only assistants for physicians with technical qualities. This affirmation constituted a key element in shaping their identity, contributing in turn to establish the moral and social legitimization of practicantes and their professional authority. This was constructed in counterpoint to the profile, qualifications and gender identity of the other professional healthcare assistant, the nurse. Despite achieving a clear discourse on their professional identity and developing certain professional infrastructures through the work of institutions and key figures, practicantes were not able to consolidate a collective project of upward social mobility that would improve their status and enhance social recognition of the profession. This led to the construction of a group identity that was largely characterized by apathy, frustration and disunion, elements that eventually weakened the profession.