Journal Article Reference

Fine, L. L. Silver, H. K. Comparative Diagnostic Abilities of Child Health Associate Interns and Practicing Pediatricians. The Journal of Pediatrics 83, no.2: 332-335. August 1973.

In rural Wyoming, the child health associate (CHA) provides initial and primary health care to children. Analysis of 1744 patient visits to the CHA during 12 months showed that: (1) the CHA was able to provide health care to 90.8 % of patients without direct physician supervision; (2) 52 % of the patients’ visits were for acte medical problems, 46 % for well child care, and 2 % for chronic problems; (3) the CHA diagnosed 258 medical problems in 806 children seen for well child care; and (4) the average cost per patient visit was $26.35; of this $4.01 (15 %) was for care provided by the CHA.

Holt, N. Confusion’s Masterpiece: The Development of the Physician Assistant Profession. Bull. Hist. Med. 1998; 72: 246-278.

Holt’s extensive interviews with Eugene Stead, Harvey Estes, and others, and her review of Thelma Ingles’s papers reveal details of the clinically successful nurse clinician program at Duke University in the 1950s that failed accreditation by the National League for Nursing (NLN). The result led to the initiation of physician assistant training in the next decade.

Hudson, C. L. Expansion of medical professional services with nonprofessional personnel. JAMA. 1961; 176: 839-841.

Hudson addresses the need for more medical professional help in hospitals. A situation caused by a growing population as evident by the yearly gain of new hospital beds and an increase in the number of admissions and the number of procedures performed per patient. Hudson suggests that one solution might be the creation of two new groups of assistants to doctors from non-medical and non-nursing personnel. He points out that the Army and Navy had used corpsmen in similar roles and that these “laymen with relatively little training can be very efficient assistants.” By using such personnel, physicians would be freed to handle more complex procedures or see additional patients.

Larsen, K. M., & Kirkwood, C. R. (1982). Procedures performed by family physicians, internists, and a Medex in a small group practice. The Journal of family practice, 15(2), 285-292.

Encounter forms for all patient visits to a small group practice (two internists, three family physicians, and one Medex) were examined retrospectively for October 1979 and January, April, and July 1980. A total of 5,694 patient encounters (2,327 male, 3,367 female) were recorded during the four months studied. Diagnostic and therapeutic procedures were performed on 592 patients (9.6 percent), 321 male and 271 female. The family physicians performed fewer procedures on their patients (6.1, 7.5, and 8.6 percent of the total patients seen). The Medex did 18.4 percent of all office procedures for that time period. The ten most commonly performed procedures included electrocardiogram (ECG), rhythm strip or ambulatory ECG, splint application, suture removal, pulmonary function test, suturing, exercise treadmill test, wart removal, removal of skin lesion or punch biopsy, application or removal of plaster cast, and application of ace wrap, sling, or collar. The majority of the procedures performed by the family physicians were also done by the Medex; however, the diversity of the procedures performed by the family physicians was comparable with that of the internists. There were large economic differences between groups, with the internists having the highest total billings and the Medex the lowest average charge per procedure performed.

Komaroff, A. L., W. L. Black, W. L., et. al. Protocols for Physician Assistants: Management of Diabetes and Hypertension, New England Journal of Medicine. 1974; 290: 307-312.

Physician assistants use problem-oriented protocols in management of patients with diabetes and hypertension. The protocols directed the physician assistant in determining what data to collect, and whether the patients required a physician’s care at the visit. On 37 % of visits during 11 months, the patients went home without seeing a physician. Physicians accepted the protocol disposition decision in 94 % of the cases. Patients accepted the system, as reflected by their attendance rate at the clinic.

Sadler, A. M. Jr., Sadler, B. L. Recent Developments in the Law Relating to the Physician’s Assistant. Vanderbilt Law Review; 24, no. 6: 1193-1212. November 1971.

Article describes important developments in laws related to the physician assistant profession with special emphasis on their scope of practice. It contains many footnotes and references.

Silver H. K., Ott J. E. The child health associate: A new health professional to provide comprehensive health care to children. Pediatrics. 1973; 51:1-7.

The child health associate (CHA) represents a new and unique pediatric health care professional — a nonphysician with the ability and role orientation to assume primary responsibility for the diagnosis and treatment of the problems in over 80% of ambulatory pediatric patients. The practicing physician’s acceptance of the CHA was a primary determinant in the associate’s role conceptualization and identity formulation.

Smith, R. A., Bassett G., Markarian C., et. al. A strategy for health manpower: Reflections on an experience called Medex. JAMA. 1971; 217(1): 1362-1367.

MEDEX is a program creating a new class of medical professionals who are helping overworked physicians provide more and better medical services. The program takes advantage of training give medical corpsmen by the Armed Forces. Working with a physician, the Medex relieves the practitioner of much routine work not requiring a physician’s sophisticated knowledge and skill. The term MEDEX provides an opportunity to base health professional imagery upon actual performance rather than traditional roles and hierarchically based terminology.

Smith, R. A. Medex – An operational and replicated manpower program: Increasing the delivery of health services (editorial). Am J Public Health. 1972; 62(12): 1563-1565.

This paper describes the inception and development of MEDEX training programs and how Medex trainees are deployed. Emphasis is on linking the physician and community with the Medex trainee early in his paraprofessional development. Physician productivity, in terms of numbers of patients seen, has been shown to go up anywhere from 75% to 149%. Deployment, receptivity and legal issues are discussed.

Stead, E. A., Jr. Conserving costly talents – Providing physician’s new assistants. JAMA. 1966; 198(10): 182-183.

On April 7, 1965, an ad hoc committee was appointed at Duke University Medical Center for the purpose of evaluating programs within the medical center designed to bring new types of personnel into the health field. This report represents the recommendations of that committee regarding the objectives and most effective methods for developing such programs. A description of the physician assistant is contained in the committee’s report.

Storms, D. M., & Fox, J. G. (1979). The public’s view of physicians’ assistants and nurse practitioners: a survey of Baltimore urban residents. Medical care, 526-535.

This study of public attitudes toward physicians’ assistants and nurse practitioners finds that the public regards the two groups of health workers as remarkably similar. A telephone survey of 2,583 households in the Baltimore, Maryland, metropolitan area indicates that about half the population have heard of a PA or NP, though only 4 per cent report receiving care from such workers. In this urban sample, respondents accepted the principle that important medical care functions can be delegated, as long as the PA or NP is considered assistant to the physician. The public reported more acceptance of tasks performed by nurse practitioners than by physicians’ assistants, though the differences are small.

Sox, H., Tompkins, R. The Training of Physician’s Assistants: The Use of the Clinical Algorithm System for Patient Care, Audit of Performance and Education. New England Journal of Medicine, 1973; 288: 818-824.

A large-scale audit of patient records was used to educate and evaluate physician’s assistants. Clinical algorithms (sets of step-by-step instructions for solving a medical problem) for 11 acute medical complaints were used in patient care by physician’s assistant trainees. Checklist records from 3024 patients showed that a physician’s assistant could have evaluated 45 per cent of these patients accurately without direct physician involvement if he had correctly followed the algorithm logic. This clinical algorithm system provides guidance in problem solving and also measures the ability of a trainee to follow instructions.