A Brief History of the Physician Assistant Board

The creation of the Physician Assistant Board (PAB) of the State of California occurred in response to the genesis of the physician assistant profession itself, which began almost forty years ago and has since evolved throughout the nation.

In 1961, the concept of "physician assistant" originated in an article written by Charles L. Hudson, MD, in the Journal of the American Medical Association, calling for "an advanced medical assistant with special training, intermediate between that of the technician and that of the doctor, who could not only handle any technical procedures but could also take some degree of medical responsibility."

The first Physician Assistant training program commenced in 1965, at the Duke University in North Carolina, with the admission of four ex-military corpsmen into a two-year program, headed by Eugene A. Stead, MD. In the early 1970s, the United States Congress took steps toward facilitating the development of physician assistant practice by allocating funds totaling over eleven million dollars for PA education programs through Health Manpower Educational Initiative Awards.

In this state over a quarter of a century ago, The Physician's Assistant Law (Statutes of 1970, Chapter 1327) was passed, introducing a new category of health care provider, termed the "physician’s assistant," to redress "the growing shortage and geographic misdistribution of health care services in California." This law, in part, (1) permitted the supervised delegation of certain medical services to these physician assistants, thus freeing physicians to focus their skills on other procedures; (2) conferred upon the then Medical Board of Examiners (BME) of California the approval and certification of physician assistant training programs and the approval of applications of licensed physicians to supervise physician assistants; and (3) established the Advisory Committee on Physician's Assistant Programs (ACPAP), later amended to also include jurisdiction over nurse practitioners (Statutes of 1972, Chapter 933). The purpose of this legislation was to prepare for future initiatives to "establish a system of certifying or licensing physician's assistants so that the quality of service is insured," and the MBE, in conjunction with the ACPAP, was charged with recommending how to do so, as well as with formulating criteria for approval of both PA training programs and for supervising physicians.

The need to fulfill this legislative intent and to utilize the considerable clinical experience of returning Vietnam veterans interested in civilian medical practice and capable of alleviating the continuing health care shortage in under-served areas, as well as the need to combat growing dissatisfaction with the organization of the BME, soon prompted a number of political proposals to address these concerns. One such bill (AB1XX), authored by Assemblyman Barry Keene, passed into law in 1975. This legislation renamed the BME the Board of Medical Quality Assurance (BMQA) and revised its original structure into three autonomous divisions (Division of Medical Quality, Division of Licensing, and Division of Allied Health Professions) to more effectively function. To assist the Board in its responsibilities, The Division of Allied Health Professions (DAHP) was given statutory authority over nine committees that were given purview over the licensing and disciplining of specific allied health professions. One such committee became the newly established Physician's Assistant Committee, decreed by a separate legislative initiative that passed within the same time period.

The creative bill (AB 392) was introduced by Assemblyman Gordon Duffy on January 6, 1975, amended several times, and then signed into law on September 9, 1975, by Governor Edmund G. Brown, Jr. This legislation (Statutes of 1975, Chapter 634) enacted "The Physician's Assistant Practice Act," which abolished the Advisory Committee on Physician’s Assistants and Nurse Practitioner Programs and created, instead, the Physician’s Assistant Examining Committee (PAC) in order to:

(1) "establish in this chapter a framework for the development of a new category of health manpower—the physician's assistant;"

(2) "encourage the more effective utilization of the skills of physicians by enabling them to delegate health care tasks to qualified physicians' assistants where such delegation is consistent with the patient's health and welfare;"

(3) "encourage the utilization of physician's assistants by physicians, and to provide that existing legal constraints should not be an unnecessary hindrance to the more effective provision of health care services;" and

(4) "allow for innovative development of programs for the education of physician's assistants." This legislation then prescribed the new Committee's membership, powers, duties, and relationship to the BMQA and DAHP in accomplishing these goals. To this very day, the Committee, now called the Physician Assistant Board, continues on in its responsibility to facilitate and encourage physician assistant service by advocating and enforcing regulations necessary to licensing, monitoring, and expanding physician assistant practice, by assuring the public that all PA licensees, approved supervising physicians, and PA training programs have met certain minimum requirements, and by protecting the public, as well as the profession, from inadequately trained, unethical, or incompetent practitioners.

THE PHYSICIAN’S ASSISTANT IN CALIFORNIA Final Progress Report of the California State Board of Medical Examiners and the Advisory Committee on Physician’s Assistant and Nurse Practitioner Programs(Stats. 1970, ch, 1327)

Attitudes Toward the Physician's Assistant Program Among the Public, Physicians and Allied Health Professionals