1991 to 2000

Maturation and Growth

During the decade of the 1990s, there is sharp growth in the number of accredited programs from 45 to 114. Most of the new programs appear in smaller colleges affiliated with community hospitals. As applications soar, the vast majority of students admitted already possess a baccalaureate degree. The result is a trend toward the award of the Master’s degree to graduating PAs. In a reversal from past experience, the majority of applicants are now women. Employment opportunities far exceed the number of graduates. VA medical centers, the Military, and other state and Federally-sponsored health institutions rely heavily on PAs to bolster medical staffs. Published studies lead to greater HMO reliance on PAs to reduce cost. States continue to revise legislation, rules and regulations in order to enhance the effectiveness of PAs. The Balanced Budget Act of 1997 recognizes PAs as covered providers in all settings at a uniform rate of payment. The last of the branches of the military service grant commissioned status to PAs. Mississippi becomes the last of the states to authorize physicians to delegate the practice of medicine to PAs. Administrative responsibility for ARC-PA is transferred from the AMA to AAPA; the corporate office moves to Marshfield, WI. The NCCPA examination is administered by computer in a move toward administration throughout the calendar year.

1991

With the concurrence of the AMA, the AAPA assumes administrative responsibility of the Accreditation Review Committee on Education for Physician Assistants (ARC-PA, formerly the JRC-PA). John McCarty, Treasurer of the Committee, and a physician assistant at the Marshfield Clinic, assumes the role of Executive Director, initially on a part-time basis. He becomes the first PA to become CEO of any of the major PA governing bodies. The corporate offices of the ARC-PA move to Marshfield, Wisconsin.

The Student Academy Challenge Bowl is founded to offer a "Jeopardy-style" competition for PA students at the AAPA Annual Conference.

Clinician Reviews is published as the first clinical journal targeting PAs and NPs. David Mittman, PA-C, co-founder of Clincians Publishing Group, becomes Editor-in-Chief.

1992

US Army and US Coast Guard PAs are commissioned.

The AAPA and the APAP Board of Directors begin the first of a series of annual joint planning meetings.

The APAP faculty development scholarship is established.

The APAP offers the first of a series of workshops for institutions considering the development of new physician assistant programs.

1993

The Role of the Physician Assistant and Nurse Practitioner in Primary Care, edited by Kay Clawson and Marian Osterwise, is published by the Association of Academic Health Centers.

The first pilot test administration of NCCPA's Pathway II recertification examination is offered as an alternative to the proctored PANRE.

Advance for Physician Assistants is published to provide PAs with the latest in practice and clinical information.

1994

Physician Assistants: A Guide to Clinical Practice, the first formal textbook intended for PA education, is edited by Ruth Ballweg, Sherry Stolberg, and Edward Sullivan, is published by W.B. Saunders Company, Philadelphia, PA.

The AMA's Committee on Allied Health Education and Accreditation (CAHEA) is replaced by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), and becomes the overarching accrediting body that includes the accrediation of PA programs.

Wayne VonSeggen was appointed to the North Carolina Medical Board by Governor James Hunt in March and became president of the Board in 1999, the first PA to hold such a position in the United States.

The AAPA is granted observer status in the House of Delegates of the American Medical Association.

1995

Physician Assistants in the Health Workforce 1994, a report by the Advisory Group on PAs and the Workforce (AGPAW) is published by the Health Resources and Services Administration, Bureau of Health Professions.

APAP establishes PATH (Program Assistance and Technical Help) to provide guidance to new and developing programs.

The Surgical Physician Assistant is published as a joint effort of the Association of PAs in Cardiovascular Surgery, the American Association of Surgeon Assistants, and PAs in Orthopedic Surgery.

1996

APAP develops and publishes PACKRAT (PA Clinical Knowledge Rating and Assessment Tool), a student self-assessment examination, to specifically identify areas of strengths and weaknesses.

The military services combined their various physician assistant programs to form the Interservice Physician Assistant Program (IPAP), located at the Army Medical Department Center and school (AMEDDC&S), Forts Sam Houston, Texas, due to mandatory cutbacks by the federal government.

1997

Physician Assistants in American Medicine, by Roderick Hooker and James Cawley, is published. It is the second textbook, intended for PAs, to be written or edited by physician assistants.

The NCCPA redesigns PANCE, eliminating clinical skills problems (CSPs) because of the complexity and cost of administration at the designated test centers. At the same time, it eliminates the extended core components in primary care and surgery. Instead it introduces a new "stand-alone" Surgery Examination, allowing PAs to earn "special recognition." For the first time, the examination is offered twice each year - once in the spring and once in the fall.

APAP develops a Research Institute and Endowment Fund to support PA faculty research initiatives.

The Balanced Budget Act of 1997 recognizes PAs, for the first time, as Medicare covered providers in all settings at a uniform rate of payment

1998

Perspective on PA Education becomes the official peer-reviewed Journal of the Association of Physician Assistant Programs. Donald Pedersen, PhD, PA-C, is named Editor-in-Chief.

Pathway II pilot testing is completed, and the alternative examination is administered by the NCCPA as a formal alternative to PANRE.

The NCCPA begins requiring PAs to pass the recertifying examination within two attempts.

The APAP Faculty Development Institute is established to provide oversight to all APAP sponsored faculty development activities.

Confusion's Masterpiece: The Development of the Physician Assistant Profession, by Natalie Holt, is published (Bull.Hist.Med 1998, 72:246-278). 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.

1999

The NCCPA's Physician Assistant National Certifying Examination (PANCE) is administered for the first time by computer at multiple sites around the country through a process developed by the National Board of Medical Examiners, and already in place for the licensing of physicians. The computer-based examination soon becomes universal for certification and licensure of all health professionals throughout the country.

APAP develops and releases GRADRAT (Graduate Rating and Assessment Tool), a self-assessment examination, designed to help certified PAs prepare for the PANRE.

Manitoba passes Clinical Associate Act which allow PAs and International Medical graduates to practice as PAs in Canada.

2000

Mississippi enacts legislation authorizing PAs to practice in the state after 25 years of effort by local and national organizations. Physician assistant practice is finally universally accepted in all of the states and territories of the nation.

The NCCPA's Physician Assistant National Recertifying Examination (PANRE) and Surgery Examination are administered for the first time by computer.

NCCPA launches a new web-based CME logging system and provides secure access for PA-C designees to their certification maintenance record.

AAPA receives clarification from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that physicians may delegate the performance of history and physical examinations to physician assistants.

End of the Decade

Number of PA programs accredited: 114
Number of physician assistants initially certified: 45,847