289 Physician Assistant Scope of Practice 2015
ling PA profession took on tasks from the once sovereign domain of medi-
cine.21 The empowerment of PAs was facilitated, in part, by relative animosity between organized medicine and organized nursing.22 The failure of
these two powerful professions to collaborate to solve the problem of access
to health care in the post-WWII decades advanced the concept of the PA.23
Those who pioneered the profession were successful in certain strategies
they employed, including initially utilizing veterans, not taking other professionals out of their roles in the healthcare workforce, and creating a practice framework that allowed PAs to function in concert with physicians rather than in competition with them.24 This construct marks the major
difference between PAs and NPs who seek a more independent stance in
practice from physicians.25
In 1965, Dr. Eugene A. Stead, Jr., then former Chair of the Department
of Medicine, founded Duke University’s Physician Assistant Program.26
The Duke program was the first in the country to train this new professional
group.27 However, the only legal framework that existed to authorize PA
practice upon graduating from the program was a 1966 opinion from the
Attorney General of North Carolina, which provided that the performance
of delegated, physician-supervised activities by a PA did not violate state
law.28 Although this opinion facilitated the utilization of the profession in
North Carolina, it was advisory in nature and had no legal authority in other
AM. MED. ASS’N 1169-1171 (1970) (discussing the work of the AMA’s Council on Health
Manpower and supporting the utilization of PAs, as well as the development of guidelines
for the establishment of educational and training criteria for new health professions, including PAs).
21. PAUL STARR, THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE 223 (Basic
Books 1982) (discussing the assumption by persons who are not physicians (CRNAs, CNMs,
others) performing medical tasks).
22. Cawley et al., supra note 12, at 42.
23. Holt, supra note 16, at 248-53.
25. See John K. Iglehart, Expanding the Role of Advanced Nurse Practitioners — Risks
and Rewards, 368 NEW ENG. J. MED. 1935, 1935 (2013) (discussing how PAs, by law, work
with physicians under their legal authorization and how this differs from the legal basis of
NP practice, which does not always require physician supervision).
26. Eugene A. Stead, Jr., Conserving Costly Talents—Providing Physicians’ New Assistants, 198 J. AM. MED. ASS’N 1108, 1108-09 (1966); Physician Assistant Program, DUKE
UNIV. MED. CENTER, http://paprogram.mc.duke.edu/PA-Program/ (last visited Nov. 21,
2014) (asserting that Dr. Stead began the Duke PA program and was the chair of the department of medicine at the time cited).
27. Reginald D. Carter & Justine Strand, Physician Assistants: A Young Profession Celebrates the 35th Anniversary of Its Birth in North Carolina, 61 N. C. MED. J. 249, 249 (2000).
28. Id. (“The first three PA students graduated at Duke on October 6, 1967.”); DUKE
UNIV., DEP’T. OF CMTY. HEALTH SCI., MODEL LEGISLATION PROJECT FOR PHYSICIAN’S
ASSISTANTS (1970), available at https://medspace.mc.duke.edu/model-legislation-project-