Vol. 24 Annals of Health Law 306
tice.194 Theoretically, the closeness of interdependent individuals sharing
responsibilities for outcomes of patients and communities produces performance feedback, trust, and rewards.195 The outcomes of improved patient
physical and emotional health when teams are involved in their care may in
fact be the feedback that keeps the PA-physician team functioning and the
scope of practice evolving.196
IV. PRIMARY, SPECIALTY, QUALITY
The advent of the PA profession brought new players into the arena of
medical practice and set up new relationships in the delivery of patient
care.197 Key to the introduction and acceptance of the PA concept was the
legal premise that PAs would have a defined relationship with physicians
and would practice medicine in partnership with their physician col-
In the 1970s, Eugene Schneller, a medical sociologist, observed PAs in
the field.199 Schneller’s aim was to define and describe the activities and
measure the performance of the newly introduced PA in medical practice.200
Among his observations was his description of the physician-PA clinical
relationship, which he termed “negotiated performance autonomy.”201 This
notion describes the PA-physician relationship as an evolutionary process
where the PA initially demonstrates a capability to perform medical tasks
that, in turn, leads to the delegation of more and more medical responsibili-
ties.202 Key to this concept of increasing delegation is the reward of autonomy to the PA in performing clinical work.203 As the physician gains trust
in the PA, the PA takes on an increasing extent of medical tasks and does so
on an autonomous basis.204 Once the PA masters a series of diagnostic and
194. Gara & Davis, supra note 14, at 741-42.
195. Eric Sundstrom et al., Work Teams: Applications and Effectiveness. 45 Am. Psychologist 120 (1990).
196. Douglas W. Roblin et al., An Evaluation of the Influence of Primary Care Team
Functioning on the Health of Medicare Beneficiaries, 68 MED. CARE RES. & REV. 177, 177-
201 (2011); see also Christine M. Everett et al., Division of Primary Care Services Between
Physicians, Physician Assistants, and Nurse Practitioners for Older Patients with Diabetes,
70 MED. CARE RES. & REV. 531, 531-41 (2013).
197. History of the PA Profession, AM. ACAD. OF PHYSICIAN ASSISTANTS,
http://www.aapa.org/threeColumnLanding.aspx?id=429 (last visited Nov. 21 2014).
199. EUGENE S. SCHNELLER, THE PHYSICIAN’S ASSISTANT: INNOVATION IN THE MEDICAL
DIVISION OF LABOR xxi (Lexington Books 1978).
200. Id. at 47.
201. Id. at 121.
203. Id. at 122.
204. See generally id. at 123 (hypothesizing from interviews with PA recruits, that as a
PA is intellectually challenged, and is more involved in patient communication, the PA is