Vol. 24 Annals of Health Law 308
formed by the physician and required in a medical practice setting.215 It appears to be a significantly underappreciated factor in the success and acceptance of the PA in U.S. medicine.216
The adaptability of the profession has also contributed to its success and
acceptance.217 All PA educational programs are required to adhere to uniform accreditation standards that include a general medical education fo-
cus.218 Unlike physicians, who enter specialties through residency and fellowship training, all PAs receive the same training and enter specialties
after graduation. PAs who maintain current certification by the NCCPA are
required to demonstrate their generalist medical knowledge by taking and
passing the NCCPA’s PA National Recertification Examination every ten
years.219 This assures that PAs remain up to date on medical treatments and
are able to draw from a deep pool of medical knowledge, which in turn allows the PA to adapt to a wide variety of medical specialties and subspe-
A. PAs and Primary Care
According to the Institute of Medicine, primary care is the provision of
integrated, accessible health care services by clinicians who are competent
to deliver a large majority of personal health care needs, who develop a sustained partnership with patients, and practice medicine in the context of
family and community.221 In the U.S., primary care incorporates the specialties of family medicine, general internal medicine, and general pediat-
rics.222 The primary care field contains the largest concentration of PAs.223
215. New Health Professions, supra note 114, at 472–480.
216. R. E. Johnson et al., Delegation of Office Visits in Primary Care to PAs and NPs:
The Physicians’ View, 9 PHYSICIAN ASSISTANT 159, 159-61 (1985).
217. D. Fisher & W. Stanhope, Physician Assistants Achieve Wide Acceptance in
Health Care Field, 2 FORUM, no. 4, 1978, 6, at 6-10.
218. See generally ACCREDITATION REV. COMM’N ON EDUC. FOR THE PHYSICIAN
ASSISTANT, ACCREDITATION STANDARDS FOR PHYSICIAN ASSISTANT EDUCATION. 1-30 (4th
ed. 2013), available at http://www.arc-pa.org/documents/Standards4theditionwithclarifying
changes9.2013%20FNL.pdf (a PA program cannot exist nor function unless it is accredited.
Their graduates would not be eligible to take the PANCE. Functionally, every existing PA
program has to hold accreditation status.).
219. Nat’l Comm’n on Certification of Physician Assistants, Certification Maintenance,
http://www.nccpa.net/CertMain (last visited Nov. 15, 2014).
221. INST. OF MED., DEFINING PRIMARY CARE: AN INTERIM REPORT 1 (Molla Donaldson
et al. eds., Nat’l Acad. Press 1994), available at http://www.nap.edu/openbook
222. Barbara Starfield et al., Contribution of Primary Care to Health Systems and
Health, 83 MILBANK Q. 457, 460 (2005).
223. AM.ACAD. OFPHYSICIANASSISTANTS,PHYSICIANASSISTANTCENSUSREPORT:
RESULTS FROM THE 2010 AAPA CENSUS 15 (2010), available at http://www.aapa
.org/workarea/ downloadasset.aspx?id=1454 [hereinafter 2010 AAPA CENSUS]. Approxi-