The Physician Assistant: What's in a Name?

The Physician Assistant: What’s in a name?
By
Brian T. Maurer

While perusing articles on health care in the medical literature as well as in the lay press, I frequently run across the misnomer “physician's assistant.” (Reader, take note of that terminal “apostrophe s.”) What the editor really means, of course, is “physician assistant,” the designated title for the PA profession.

The original proposal for the establishment of the physician assistant profession dates back to the mid 1960s. At that time there was a growing consensus for the need to expand the numbers of primary care doctors in the country. Medical school graduates had begun to pursue careers in specialty care, leaving a dearth of general practitioners. Moreover, many physicians chose to practice in heavily populated areas, leaving residents in rural regions with limited access to medical care.

Dr. Eugene Stead recognized a potential resource in previously trained medical personnel such as registered nurses and prior service military corpsmen. Dr. Stead proposed that experienced individuals selected from these ranks be provided additional training to allow them to function as primary care clinicians, who would then practice under the auspices of supervising physicians.

The nursing profession wanted no part of a new profession which perpetuated what was perceived to be a subordinate role in the medical hierarchy. (Eventually, nursing would develop the concept of the advanced practice registered nurse or nurse practitioner, clinicians legally permitted to practice independently from the physician.) Dr. Stead opted to target military corpsmen and medics as candidates for advanced clinical training. Thus the profession of “assistant to the primary care physician” was created.

With the explosion of knowledge gleaned through medical research over the second half of the 20th century, medical training became more and more rigorous. Today’s medical school graduates receive an exponentially greater fund of knowledge and training than their counterparts of sixty or seventy years ago. I would argue that the same learning curve applies to contemporary physician assistant graduates, who digest a substantially meatier curriculum than their counterparts of forty-five years ago.

In “Handing One Another Along,” a compilation of his lectures to Harvard students, Emeritus Professor and physician Robert Coles muses about his early encounters as an undergraduate with Dr. William Carlos Williams, the pediatrician poet from Paterson, New Jersey. Dr. Coles writes:

“Dr. Williams prompted me to think differently about what I wanted to do with my life. When I started taking premed courses, I complained to him, but he didn’t have much sympathy, since he had never taken them; they weren’t part of a doctor’s education when he was a student.” (William Carlos Williams didn’t attend college or sit for the MCAT exam; at that time neither was required for medical school, which he entered at eighteen years of age.) “He found such courses utterly unnecessary for what he thought being a good doctor was about.”

I imagine Dr. Stead would have voiced a similar opinion. I also imagine that any graduate of a modern physician assistant program has received a superior medical education in comparison to the medical school graduate of Dr. Williams’ day.

Specific to the nomenclature of the physician assistant profession, the issue has become that, in this day and age, PAs no longer “assist” primary care physicians; rather, they practice with them as associates. Physician assistants have been integrated into not only primary care but practically every medical subspecialty in existence. Professional PA societies thrive in dermatology, emergency medicine, obstetrics-gynecology, neonatology, psychiatry, pediatrics, and general surgery, as well as several of the surgical subspecialties, such as cardiothoracic and plastic surgery. Indeed, for the first time in the history of the profession, nearly half of all graduate PAs elect to practice outside the realm of primary care medicine.

PAs are granted prescriptive privilege; many states allow them to enter into partnership or practice ownership agreements with physicians. As such, PAs have come a long way toward receiving recognition as bona fide clinicians by their medical colleagues.

For these reasons many in the PA profession have come to view the title “physician assistant” as somewhat outdated, erroneous—even demeaning. If the title “physician assistant” is demeaning, how much more so that of “physician’s assistant.” (There’s that terminal “apostrophe s” again.) The latter label connotes that the PA is completely beholden to the physician as the physician’s personal assistant—an implication which falls just short of suggesting a master-servant relationship.

There has been a movement afoot for two decades to alter the name of the profession to “Physician Associate.” Indeed, the Yale PA program confers this title upon its graduates. Such a change would allow the “PA” designation to remain in effect. But if the physician assistant profession were to undergo a name change, all of the legislation that governs PA practice would have to be revised and edited, state by state—a rather daunting, if not impossible, task.

At the very least, perhaps we could agree to put to rest the nagging issue of that terminal “apostrophe s.”

by Brian T Maurer (posted for author by blog moderator, Ed Volpintesta)