Oral History Interviews: Estes & Mau

Interviewees: E. Harvey Estes, Jr. and James Mau
Interviewer: Justine Barr
Place and Date: Durham, NC — February 20, 2007 and February 22, 2007

Summary: These interviews were conducted under a grant from the US Army Special Operations Command to investigate the history of the Special Forces medic, including its role as a progenitor for the Physician’s Assistant. Mr. James Mau was the first administrator of the Duke PA program and Dr. E. Harvey Estes, Jr., is the former Chairman of the Department of Community and Family Medicine at Duke University, who took responsibility for the Duke PA Program early in its development. Both men discuss their roles in the development of the PA program, the factors underlying Dr. Eugene Stead’s decision to use former military corpsmen as his first candidates for training as physician assistants and the impact these corpsmen had on the curriculum and profession.

Note: Transcripts are edited for clarity, punctuation and grammar or to fill in gaps of missing information. So the transcript may deviate from the actual audio recording.

Mau’s perspective on the establishment of the PA program at Duke:

JB: Can you talk about how the program began or what perspective you saw from when the program initiated?

JM: Dr. Stead had a general idea of what we were about. He felt there was a need for a career for men in health care below the physician. At this time there were a number of corpsmen getting out of the service. They could not get a job in health care at a level that utilized their skills or which paid a living wage. He felt we needed a program that attracted those skill levels and provided an entry into the health care profession.

Also, at the time a Duke physician had visited Russia and has seen first-hand the feldsher position, which was very similar to what we were trying to develop. He related that the concept was working very well.

Also at this time, Dr. Dill DeMaria, a pediatrician on the Duke faculty, had contacts at Fort Bragg. He described a unique group of corpsmen assigned to the Special Forces. They have more specialized training than the normal corpsmen for they were equipped to handle filed injuries on site. We decided to make a trip to Ft. Bragg to study the program.

JB: When year was that sir?

JM: ’65, I imagine.

Estes’ perspective on the establishment of the PA program at Duke:

JB: When was the idea of a PA first floated around, or when did you first hear about it?
HE: It evolved in Gene Stead’s head, but it evolved for a reason. The person who followed me in cardiology at the VA was Henry MacIntosh. Henry Macintosh went on to head the new cardiac catheterization lab at Duke. And the cath lab operated with nurses as assistants. This was the beginning, I guess, of the national nursing shortage, but they could not find nurses as assistants for the cardiac cath lab. Henry Macintosh was really desperate, and he talked to Eugene Stead, his chief, about how to get around the situation. Gene Stead was an innovator and he said “well does it have to be a nurse?” “No, it doesn’t have to be.” It has to be someone who is intelligent, responsible, and who is willing to learn. So, who might fill those shoes, meet those criteria? Henry began to think of ways of doing it and he thought about firemen. Firemen have jobs that occupy them for three days a week, roughly, and then they are off for three or four days and many of them take other jobs. Henry said let’s see if there are firemen who want to moonlight. So he found three or four firemen who wanted to do this and thought they could recruit sufficient numbers to meet their manpower needs. This worked and they found firemen to be satisfactory assistants. Then somebody suggested that there were navy corpsman who were assisting in a new catheterization laboratory at the Naval Hospital in Norfolk. So Henry had a bright idea; instead of getting firemen, who have to be trained from scratch, let’s see if the Norfolk cardiac cath lab has people who have been trained already as hospital corpsmen to become cath assistants. When they are discharged, we can bring them here and hire them full time.

JB: Do you know what year this was?

HE: My guess is 62, 63.

JB: So they started using firemen in the late 50s?

HE: In the early 60s. It was not 50s, it was 60s. So Henry began to recruit people from the Norfolk Naval Hospital. He recruited several and they came here and were quite satisfactory, they did a great job. So I think this may have been the antecedent to Gene Stead thinking about hospital corpsman and medics of various types as recruits for various jobs around the hospital.