I have always felt the things in medicine that count are the things that change" -- Eugene A. Stead Jr., MD
Duke University: We stood there, my husband and I, gazing in absolute awe at this breathtaking building, surrounded by so many other amazing buildings, each with its unique, beautifully detailed, and refined architecture, reflecting the dedication to excellence of this great university.
It was December 2019, before the pandemic. We were at Duke's School of Medicine, attending the weeklong celebration of the 50th anniversary of the graduating class of 1969. My husband, an MD of 50 years, stood there feeling a sense of pride; he was a member of that class. And I, a PA of 27 years, stood there with a feeling of gratitude, as the PA profession was started at Duke in 1965.
In 1947, Eugene A. Stead Jr., MD, became professor of medicine and chairman of the Department of Medicine at Duke. He had a vision for training non-physicians as medical providers in expanded clinical roles. This idea of training non-physicians as providers with advanced clinical skills in medicine, in order to provide direct assistance to physicians with an emphasis on primary care, was first conceived in 1957 by Stead.
Several years later, Stead and a visionary nurse, Thelma Ingles, RN, MA, established an advanced degree program for nurses to become clinicians. However, the National League of Nurses denied accreditation of the program due to reliance on physician instruction and oversight in the training program. Later on, in 1965, another leader in nursing, Loretta Ford, partnered with a physician, Henry Silver, to create the very first training program for NPs. Their program, offered at the University of Colorado, focused on family health, disease prevention, and the promotion of health.
During that same time period, in the 1960s, skilled medical military were returning from Vietnam but without degrees to work at what they had done during their deployment. The U.S. population had grown to 180 million. Stead saw this as a great opportunity, as he had never lost sight of his vision. In 1965 he established the first PA program, for former military corpsmen. The training focused on assisting the MD in a variety of specialty and practice settings. In 1967, the first class of PAs graduated from Duke. He hoped these newly trained providers would help lessen physicians' burden, as well as expand access to healthcare for more Americans. By that time, in 1967, the U.S. population had grown to almost 200,000 million.
More evident then was the need for physician assistants and nurse practitioners, under the auspices of and in collaboration with physicians, to aid in providing healthcare to our ever-growing population. I have seen what great care can be offered to patients when this collaboration is present. Over the past 27 years working as a physician assistant in both internal medicine and infectious disease, I have been honored to work alongside MDs, my fellow PAs, and NPs in providing healthcare to many patients. I have witnessed when we work together as team, so much can be accomplished for the good of the patients, who have entrusted their lives in our hands.
"It's unrealistic to say anyone can't be found a place in the health organization" -- Eugene A. Stead Jr.
I am aware that many reading this article may take offense to the use of the term "non-physician providers" when referring to physician assistants and nurse practitioners. No disrespect is intended; however, we are not physicians and our training does not equal that of physicians. Medical doctors, physician assistants, and nurse practitioners -- all three disciplines have different training and that training should be acknowledged and respected.
Physicians complete a four-year undergraduate program prior to admittance to medical school and must pass the MCAT. This is followed by four years in medical school and three to seven years in a residency program. The USMLE , a 3-part exam is taken during and after medical school. It may take between 10-14 years to complete training depending on area of expertise.
Physician assistant boards are under the jurisdiction of state medical boards. The physician assistant programs today are three-year master programs and follow the medical model of instruction. Undergraduate science courses must be completed before entering the program. The program includes an intense first year of medical didactics including clinical medicine with 48 + weeks of clinical rotations the remainder of the program. PAs must pass a national board examination-the PANCE (Physician Assistant National Certifying Examination) to be licensed to practice medicine under the auspices of an MD and prescribe medications.
Nurse practitioners obtain their licensure from the American Association of Nurse Practitioners and are under the jurisdiction of the respective state boards of nursing. The nurse practitioner programs are also three-year masters programs and follow an advanced nursing model, therefore, in order to be eligible to enter an NP program, you must already be a registered nurse.
Over the past several years, there has been much disagreement amongst non-physician providers, specifically physician assistants and nurse practitioners regarding their roles, to the point that even physicians are questioning what roles we should play in providing healthcare.
The graduates of these two advanced clinical programs, in collaboration with MDs, contribute in meeting the healthcare needs of many, especially in rural areas where patients otherwise, might not have access.
Today in the U.S., there are 1,022,000 practicing physicians, 140,000 practicing physician assistants, and 290,000 practicing nurse practitioners. Surely together we can meet the healthcare needs of our country's 331 million people.
During this COVID-19 pandemic, seeing patients as an infectious disease provider, I have been proud to see the amazing teamwork and collaboration between MDs, PAs, and NPs at it's best. As we all work together, in the ICUs and COVID units, to save the lives of so many afflicted from this deadly virus, putting our very lives on the line, I am more convinced than ever we all have a role to play in the healthcare community to offer the best medical care to as many as possible.
Stead's vision was for everyone who needed it to have access to quality healthcare. He believed in addition to physicians, others could be trained at various levels under the healthcare spectrum, to help in meeting that need. Physician, physician assistant or nurse practitioner, whatever path we have chosen to contribute in meeting the healthcare needs of our nation, let's be supportive of one another and remember we are all in this together. It was Dr. Stead's vision for all of us to work together as a team. I hope, if Stead was here today, he would be proud of how far his vision has come in terms of the best medical care being offered and the teamwork needed to accomplish this.
"There are many careers in medicine. My job is to find out where a thousand complex systems fit into the health field." -- Eugene A. Stead Jr.