Dr. Eugene A. Stead, Jr. – Oral History

Video Clips of Oral History Interviews

Interviewee:  Eugene A. Stead, Jr.
Interviewer:  Brien Williams
Place and Date:  Home of Dr. Stead, Bullock, NC – July 23, 1998

Summary:  Eugene A. Stead, Jr., MD is regarded as the founder of the physician assistant profession. He tried to meet the growing demands for patient care services at Duke University by expanding the clinical decision-making skills of nurses. However he failed to gain accreditation for a master’s program for nurse clinicians that he and Thelma Ingles, a nurse educator, had established at Duke in the late 1950s. Based upon his and colleagues growing use of ex-military corpsmen in the early 1960s to help run specialty units at Duke, Dr. Stead began to formulate his two-year curriculum to expand the prior education and experience of these corpsmen to become competent physician assistants. With the support of the Duke’s faculty and administration, he launched the first formal educational program for physician assistants in 1965.  Stead talks about the advanced nurse clinician program that failed to gain accreditation but produced a group of “super nurses” that proved valuable when he established his physician assistant program at Duke University in 1965.

Interview with Dr. Stead: Clip 1 from 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.

ES:  So we set up a graduate nursing program, a master’s degree in nursing, which as a degree, if you had it, would make you a more capable nurse.  Nearly all advanced nursing was given in economics, psychology, and sociology – none of it made you a better nurse.  We set up a program that if you went through it, you were a better nurse.  So they wanted by derision, the students, to be called “super nurses,” and I joined up to call them “super nurses” – not in derision – but, because they were “super nurses.”

BW:  Now you are referring to a program that you started at Duke with Thelma …….

ES:  Ingles

BW:  Ingles! Ok.

ES:   The authorities in nursing would not accredit the program, so the students had a degree, but a non-accredited degree because we did not have the right semester hours, we didn’t give the right number of lectures and what not.  But they were superb nurses.  When I started the PA Program, Ms. Ingles had already gone to the Rockefeller, but some of her students, the “super nurses,” were still there.  And one of them was very helpful in beginning the PA Program.  I wanted the PA students to be generalist, and wanted them to know what a nurse knew made a difference to the patient lying in the bed.  I didn’t care about all the falderal, but I wanted the hands-on experience of these nurses to be known by our PAs.  So I needed a nursing instructor, and they were hard to find. If it had not been for that residual group of Ms. Ingles, I couldn’t have found one.  Stead explains why former military corpsmen and males were his first choice as candidates for training as physician assistants, knowing that the concept would meet resistance from some nurses, physicians and hospital administrators.

Interview with Dr. Stead: Clip 2 from PA History Society on Vimeo.

ES:  Well, fortunately at that time, we had people returning from the Korean War.  And we had looked at the training of green berets and how they functioned in the field.  We went down to camp {Fort} Bragg and looked at the Special Forces and looked at their {medical} training programs and what not. Then we realized that when these people got out of service they had no place to go in civilian medicine.  Unlike, military personnel trained in aviation that had easy access to civilian jobs.  The people with health care experience, except nurses, when discharged, had no place available to them in medicine of any kind.  That seemed ridiculous to us since manpower needs were greater than we could supply.  Seemed the ideal thing for us to do was to start with corpsmen. 

Now there was one more reason we wanted to start with corpsmen.  As I said before, because of the rigidity of the nursing profession, they had to recruit rather passive people, because anybody who was not passive – got out of it.  You saw many nurses leave because they did not want to put up with all this “busy work.”  Also, we knew that we were going to have an unpopular service {physician assistants} so I wanted to recruit men for it that would be tough enough.  Secondly, I wanted to recruit men because we envisioned using them across a much greater spectrum than nurses were usually used.  We expected them to be in the office, emergency clinic, hospital, and nursing home.  We expected them to be wherever the doctor was.  We thought at the time we started that the freedom to move geographically through the system {of clinical training} was easier for men than for women.

Edited Deletion for brevity of Video Clip.

ES:  I thought if we started off with pretty confident people who had been behind the {combat} lines and handled desperately ill people, they would be able to simply go ahead in spite of opposition of nurses, nursing hierarchy and physicians; in general, the hospital wasn’t enthusiastic about this because the nurses been so passive they wanted to keep it that way.  Doctors never had anybody really recruited and trained as part of them.  So, they didn’t know what we were talking about.  For all these reasons we finally decided that at the beginning we would stick with males and generally you had to be a male with experience in the health care field sufficiently to know that you wanted to take care of sick people.  Stead talks about the team that put the PA Program together, his retirement as chairman of the Department of Medicine, and his turning the PA Program over to Dr. E. Harvey, Estes, Jr. whom he credits with bringing his concept of PAs to fruition.

Interview with Dr. Stead: Clip 3 from PA History Society on Vimeo.

ES: And I could never tell exactly what I did and what some other people did.  So when the PAs got started I got the curriculum made by Andy Wallace who just retired as Dean of the Dartmouth Medical School.  He put together the original two year PA curriculum.  I had Harvey and his people out with the general practitioners building a support system because the rural people {physicians} needed this worse than anybody else and they were influential in the medical society.  We were interested in picking a few expert general practitioners saying that the thing I need is time and if you can give it to me, I’ll support you {to establish family medicine as a specialty}. So Harvey was out there.  We had Martha Henderson {Ballenger} who under Harvey’s guidance was taking over the judicial or legal side of getting our PAs accepted.  I had Jim Mau, who was the man I got to run my outpatient department. 

BW:  So you are telling me that you developed a team that put this program together.   

ES:  Sure and then I had Harvey.  From the very beginning Harvey was interested.  Now I was reaching the age of retirement – I retired at age 60.  I did no administrative functions after age 60.  I looked around at all the professors of medicine between ages 60 and 70, and I couldn’t find a single one that was as good as I was between 40 and 45.  It would have been nuts for me to have stayed although I had a lot of fun [being chairman}.

  Edited Deletion for brevity of Video Clip.

ES:  Harvey Estes had just a family practice unit at Duke; it was under another name but that was what it was.  I got an agreement between Jim Weingarten who was taking my place {as chair of medicine} and Harvey that the PA  Program would be transferred from the department of medicine to Harvey’s department.  After about three years, I was totally out of all administrative activity and Harvey was completely in charge of the PA Program.  For many years I tried to get Harvey accepted in the position that I am accepted in {i.e., the founder of the PA Profession}.  But for whatever reasons he is always listed kind of second.  I would have listed him first because he is man who really worked the longest and hardest … and still does.  Harvey is a great man.