Vol. 24 Annals of Health Law 288
This article examines the PA profession as a workforce innovation, and
the policies and laws that impact PA scope of practice in an evolving
healthcare system. Part II examines the innovations that influenced the creation of the profession, the adoption of state legislation, and the legal concepts used to frame legislation and policy. Part III describes the unique determinants of PA scope of practice and how these have evolved over time.
Part IV analyzes PA scope of practice in primary, specialty, and subspecialty care, and examines the quality of care and range of services provided by
PAs. Part V describes the scope of practice for PAs in a changing healthcare
system and the determinants of change. Finally, Part VI predicts the future
of PA scope of practice and the role the PA-physician team model will play
in the evolution of healthcare.
II. INNOVATION MEETS LAW
The establishment of the PA profession in the 1960s brought about a
voluntary sharing of privileges from one medical professional to another.15
This decade also saw the creation of the nurse practitioner (“NP”) and the
revitalization of the role of the nurse midwife.16 This represents a major
transformation in American medical practice.17 The PA movement in the
United States resulted from a convergence of circumstances: increased specialization of doctors, the demise of the general practitioner, advancing
technology, returning veterans with medical training, the war on poverty
and other federal policies, and charismatic leaders who understood the processes of education and clinical training.18 The public accepted the PA concept because doctors approved it and members of the public found that PAs
improved access to care in underserved and rural areas.19 Many doctors
seemed comfortable with the need for the new profession and the American
Medical Association (“AMA”) offered its stamp of approval.20 The fledg-
15. See Cawley et al., supra note 12, at 36-42.
16. Natalie Holt, “Confusion’s Masterpiece”: The Development of The Physician Assistant Profession, 72 BULL. HIST. MED. 246, 246-78 (1998).
17. See Cawley et al., supra note 12, at 36-42; see also W. Kissem, Physician’s Assistant and Nurse Practitioner Laws: A Study of Health Law Reform, 24 U. KAN. L. REV.
1 (1975) (discussing the notion that PAs were authorized to perform the tasks of medicine).
18. SeeALFREDM.SADLER ET AL.,THEPHYSICIAN’SASSISTANT:TODAY AND
TOMORROW 9-18 (Yale Univ. School of Med. 2d ed. 1975). See also Roderick S. Hooker et
al., The Changing Physician Assistant Profession: A Gender Shift, 26 J. AM. ACAD.
PHYSICIAN ASSISTANTS 36, 36-37 (2013). See also W. Spitzer, The Nurse Practitioner: Slow
Death of a Good Idea, 310 NEW ENG. J. MED. 1049, 1049-1051 (1984).
19. GARA & DAVIS ET AL., supra note 14. See also Martha Ballenger & E. Harvey Estes,
Licensure or Responsible Delegation?, 284 NEW ENG. J. MED. 331, 331-34 (1971). See generally GERALDINE SABOL ET AL., ASPEN SYSTEMS CORPORATION, PHYSICIAN’S ASSISTANTS
LEGAL REGULATORY SURVEY (Aspen Systems Corp. 1972).
20. Thomas C. Points, Guidelines for Development of New Health Occupations, 213 J.