Cawley James F, Cawthon Elisabeth, Hooker Roderick S
Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University, Washington, DC, USA.
JAAPA. 2012 Dec;25(12):36-40, 42. doi: 10.1097/01720610-201212000-00008.
The 1960s saw a rethinking of health care delivery in the United States. The physician assistant (PA) emerged from that reconceptualization, along with the nurse midwife (CNM) and the nurse practitioner (NP). The PA, CNM, and NP were the product of demand for greater health care access, especially for the nation's poorer citizens. All three groups benefited from federal activism in health workforce policy. The PA had one characteristic not shared with the new nursing professionals: a connection in the public's mind with returning Vietnam War veterans. Several energetic trailblazers--notably Eugene Stead, Richard Smith, E. Harvey Estes, and Henry Silver--conceived and promoted their particular versions of the PA. The boosters of this new health professions movement worked through existing medical education programs and federal health care initiatives. Their efforts, sometimes informed by models of nonphysician health care abroad, received critical support from private philanthropy. Then, in 1969, the American Medical Association (AMA) rather unexpectedly gave its official approval to the concept of the PA. As optimistic as the originators of the PA movement were, even they did not anticipate the critical role PAs would play in health care delivery well into the new century. US physician assistants also continue to influence medical providers in other areas of the world. This paper re-examines the history of the physician assistant movement at the 50th anniversary of the concept. The authors use archival sources, policy analyses, interviews with principal figures, and secondary historical literature to explain the establishment of the PA movement in the 1960s and analyze its continuing influence.
20世纪60年代，美国对医疗保健服务进行了重新思考。医师助理（PA）以及助产士（CNM）和执业护士（NP）正是在这一重新概念化过程中应运而生的。PA、CNM和NP的出现是为了满足人们对扩大医疗保健服务的需求，尤其是为该国贫困公民提供更多医疗服务。这三个群体都受益于联邦政府在卫生人力政策方面的积极行动。PA有一个新的护理专业人员所没有的特点：在公众心目中，它与越南战争退伍军人返乡存在关联。几位精力充沛的开拓者——尤金·斯特德、理查德·史密斯、E. 哈维·埃斯蒂斯和亨利·西尔弗——构思并推广了他们各自版本的PA。这场新的卫生专业运动的推动者通过现有的医学教育项目和联邦医疗保健倡议开展工作。他们的努力有时受到国外非医师医疗保健模式的启发，并得到了私人慈善事业的关键支持。然后，在1969年，美国医学协会（AMA）出人意料地正式批准了PA的概念。尽管PA运动的发起者们非常乐观，但他们甚至也没有预料到PA在进入新世纪后将在医疗保健服务中发挥的关键作用。美国的医师助理也继续在世界其他地区影响着医疗服务提供者。本文在PA概念诞生50周年之际重新审视了医师助理运动的历史。作者利用档案资料、政策分析、对主要人物的访谈以及二手历史文献来解释20世纪60年代PA运动的建立，并分析其持续影响。
