Oral History Interview: Sadler

Interviewee:  Alfred M. Sadler, Jr.
Interviewer:  William “Bill” Wilson
Place and Date:  Sadler’s Home in Carmel CA, February 5, 2003.

The complete 48 minute Oral History with Dr. Sadler can be found at: http://pahx.pastperfectonline.com/archive/3B38606E-BF4A-4C73-B263-461635333706

Summary: In 1970, Alfred (Fred) M. Sadler helped establish the Physician Assistant Program at the Yale University School of Medicine. In 1972, he coauthored The Physician’s Assistant: Today and Tomorrow with his brother, Blair an attorney, and Ann A. Bliss, a nurse and psychiatric social worker. The book was an outgrowth of a “White paper on physician’s assistants: looking at the future” which they prepared at the request of five Foundations. The book addressed important policy issues relating to PA’s and emphasized the importance of interdependence among health professionals.

Prior to 1970, the Sadler brothers conducted a review of each state’s licensing laws involving all allied health personnel and each state’s medical practice act. This was done at the request of DHEW’s Assistant Secretary of Health, Roger O. Egeberg, MD. They submitted their report on the topic to Egeberg in 1970. They collaborated with Martha Ballenger, JD, and E. Harvey Estes, MD, at Duke University who were working on similar issues. They all concluded that amending each state’s medical practice act to enable PAs to practice under physician supervision was the preferred legal choice at that time.

Sadler recounts that decision here:

Dr. Alfred Sadler on the Medical Practice Act PA History Society on Vimeo.

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.

AS: So our recommendation was to simply amend the medical practice acts of the various states and make it clear that nothing in the medical practice act would prohibit a doctor from turning over part of his or her function to a specially trained person. The key words were to operate, diagnose, treat and prescribe; those were the functions that only a doctor could do at least in an unlimited way so those broader physician functions were delegable to specially trained personnel. This was what the federal position was, and what a number of programs began to support. The task was to go to each state in the country and pass an amendment to the medical practice act. Blair and I got involved later in doing this in Connecticut. Some states got more elaborate and had a regulatory amendment that were very detailed in how a program should be set up and what the graduates were like — while others were more basic with two or three sentences which said nothing in the medical practice act shall prevent delegation of these authorities to a PA.

As a researcher and educator, Sadler attended conferences at Duke University on physician assistants and became involved with the American Registry of Physician’s Associates, the formation of the Association of Physician Assistant Programs (APAP) and the development of a national certification examination for physician assistants by the National Board of Medical Examiners (NBME).

He describes the purpose of the Registry, the formation of APAP and those involved in developing the first national PA certification examination here.

Dr. Alfred Sadler on Early Curriculum Development for PAs from  PA History Society Vimeo

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.

AS: Well, my recollection Bill was the Registry was set up as a place to put in one setting a list of graduates of all PA programs so if a state legislature wanted to find out if this person was a legitimate graduate of the Duke or some other program — they could, it was that simple. At these early {Registry} meetings in the late 1960s, we realized that we had a lot more to worry about than registering PAs, we needed to talk about curriculum, what worked in your program and what worked in our program. MEDEX after all was a very decentralized curriculum, with just three months of didactic training at the university setting and the remaining time of training with a preceptor. While at Yale, Duke and some others, we provided a more centralized training. So how could we learn back and forth from that … and how much basic science should be taught and how broad should clinical training be, should it include subspecialty elements. Very much, the same issues faced in medical education. So we decided that we needed to form an association, and naturally called ourselves the Association of Physician Assistant Training Programs, APAP. And they elected me first president and we started meeting and having our conferences. We also recognized a need for testing and certification of physician assistant graduates. At that time the National Board of Medical Examiners based in Philadelphia became interested in what we were doing. John Hubbard was the president and Edithe “Edie” Levit, who later became president was one of his chief deputies, were looking at credentialing physicians — something called the GAP Report — in subspecialty areas of training. In the course of that, they were aware of physician assistant training, and for the first time were willing to consider credentialing non-physicians. So we convened a group in the early 1970s that Blair and I co-chaired. There were fifteen of us sitting around. I remember Archie Golden from Johns Hopkins, Bob King, Chuck Lewis, Tom Piemme and some of the MEDEX people, not sure who they were now. We met to come up with a credentialing examination and Barbara Andrews was a Ph.D. of the National Board of Medical Examiners was assigned to help write the test.