ISSUE: Regional Medical Program Support of projects for the training of physicians assistants. The Division staff offers the following background. ,BACKGROTLJI@ There is universal agreement that existing manpower deficiencies are impeding the satisfactory delivery of health services. Shortages in numbers of physicians and allied health personnel seems to persist as the critical issue in most instances while improper utilization and poor distribution of services are cited as contributory factors in health services inadequacies. In the past few years increasing attention has been given to the possibility of extending the services of physicians through the development of a new category of allied health personnel or by the expansion and re-direction of the functions of existing types of health professionals. The priorities which are given to manpower needs by Regional Medical Programs reflect the national situation. Shortages of physician services appear to be most acute in the Pd4Ps with essentially rural populations where the services of a physician's assistant would seem to have the most obvious application. @lp Pr@Oi MTS One physician's assistant type program is currently funded by Regional Medical Programs. This project funded by the Georgia Regional Medical Program is a training program for medical specialty assistants in coronary care. The two year hospital based program is sponsored jointly by the Medical Department of Emory University and Grady Memorial Hospital. It is now in its third year and there are two graduates. The Georgia RMP has expressed its intent to.soon affiliate the current program with a junior college so that the students may obtain an associate degree. Now under revi(:!w,is a physician's assistant training project submitted by the North Carolina RMP. This is a 2 year hospital based training program in- tended to prepare allied health personnel to assist physicians in their clinical and/or research endeavors. Upon completion of the course the students are awarded a certificate of accomplishment by the Duke Medical Center. ISSUES Both projects involve basic education programs. In considerations leading to the funding of the Georgia RMP project and in the dis- cussions thus far of the North Carolina project by the Continuing Education Panel and, the Review Committee three basic issues seem crucial. Training of Physician's AssL-. -2- A.ugust 12, 1969 1. The establishment of need for the category of allied health worker called a "Physician's Assistant.' 2. Tne current state of development of training programs for physician's assistants. 3. The possibility of other sources of funding. Issue I - The Need for Phvsician's Assistants A major issue which was raised in discussions of physician's assistant proorams relatet,,paii-ci:ty of data to document the need for an allied health worker oe@this type to extend the services of the physician. Over a period of almost a decade, individual physicians have cited the need for an assistant to the physician and there is a rapidly expanding bibliography on the subject. One of the first contri- butors was Dr. Charles Hudson, who in 1.961, presented to the American Medical Association's Congress on Medical Education a paper entitled "Expansion of Medical Professional Services with non- professional Personnel." Dr. Hudson described the need for a physician's assistant to be drawn from non-medical and non-nursing personnel with major attention to ex-niedical corpsmen. He discussed potential functions, suggested a curriculum, methodology, and the educational setting for such programs. Many of the essential elements in current developing programs can be found described in Dr. Iludson's paper. At that time, the idea was so novel that the published paper (JLNIA, June 10, 1961) carried a disclaimer by the AMA's Council on Medical Service on which Dr. Hudson served as a member. In more recent years, Dr. Eugene Stead's name appears prominently in the literature on the physician's assistant. It is difficult at this time to assess the medical profession's collective reaction to an assistant level., except perhaps through the growing support among specialty groups for an allied health worker of this type. Recently, the Academy of Pediatrics supported a study of Pediatrician functions in order to identify responsibilities which can be delegated. As a result of this study, the Academy is now preparing a statement of functions and suggested curricula for three levels of assistants - the pediatric associate, the pediatric assistant and the pediatric aide. In addition to the latter, the American Academy of Orthopedic Surgeons, the American Association of Anesthesiologists, the American Association of Ophthalmology and the American College of Radiology are actively cooperating in the development of training programs for assistants. Although the American Medical Association has issued no official statement as yet it has established a special committee on the physician's assistant under its Council on Health Manpower. This committee has not to date issued a report to the Council. A growing number of federal agencies @ai@.ng of P'jiysician's Asst. -3- August 12, 1969 includinc, the Bureau of Health Professions Education and Manpower Training, the Health Services Research and Development Center, Regional Medical Programs and possibly others are funding physician's assistant demonstration projects of one type or another* Foundations such as the Josiah Macy Foundation, Commonwealth and Kellogg are supporting projects. Within recent months an Office of New Health Careers has been established in the Office of the Secretary of Health, Education and Welfare. Statements thus far from the new Office indicate that a major emphasis will be on the physician's assistant particularly with respect to the use of ex-medical corpsmen. This degree of national interest and activity by agencies and organizations representing many segments of medicine and the community provides evidence of a felt need for allied health personnel to assist the physician directly. Issue II - State of Development of Phy-sician's Assistant Training Progr@@@ The current programs for physician's assistants are essentially demonstration projects. The training programs currently funded by Federal agencies and by foundations vary widely in such basic elements as objectives, in curriculum design,in methodology and in proposed functions of the graduates. Among these training programs, students are selected from a variety of backgrounds, some with no previous experience in the health field, others with experience such as nurses and ex- 'medical corpsmen. The length of training among the programs varies from a few months to five years. Some programs lead to an associate degree, others to a bachelor's degree, while a few give no academic credit. One prooram includes an internship. Examples of eight currently funded assistants' programs are a two-year associate degree orthopedic assistant program at City College of San Francisco; a five year University of Colorado Child Health Associate Program and a four year Bachelor of Science physician's assistant program at Alderson Broaddus College. Two programs in development include a physician's assistant program at Bowman-Gray School of Medicine and a clinical associate program at the University of Texas School of Medicine. At the present time, these training programs are not sufficiently developed and tested to warrant accreditation by a recognized agency. Issue III - Other ',ources o Funding The following agencies are those ro-,n w ic training programs for pbysician's assistants might receive support. National Institutes of Health Bureau of Health Professions Education and Manpower Training (BIIM) The major portion of funds go to accredited schools of the specifically designated health professions for construction, institutions and special Training of Physicians Asst. -4- Agusut August 12, 1969 project grants and student aid. The Division of Allied Health Manpower and the Division of Ph@sician Manpower are currently supporting an ic assistant training am and a pro _ject to evaluate need and to design curricula and methods of tra n@itL f siciants assistants. These projects are funded under the Division's Developmental Grants, and special project Grants respectively. Funds are currently severely limited. Office of Education This agency has some funds available to support specific research aspects of training programs such as task analyses, curriculum development, employment opportunities and evaluation of projects. The training program must be below the baccalaureate level and preferably at the vocational leve Department of Labor The emphasis at this time in this agency is in training programs for the disadvantaged, the poor, the unemployed and the underemployed. Baccalaureate programs may not be funded. Norinally, programs supported are of one year duration. There is some flexibility in the definition of membership in the latter groups which could allow for the funding of projects for ex-medical corpsmen. Ex-medical corpsmen could be considered within the priority groups of this program. Health Services and Mental Health Administration Health Services Research and Development Center The Center is authorized to fund research aspects of training programs as well as demonstration training projects. Currently funded is a study of the legal implications of new health occupations and a demonstration traini o ram for ex-nledical corpsme-P. CONCL;USIONS AND @91SENDATIONS The hi-h level of nationwide interest in the development of the physician s assistant suggests that training programs for these allied health personnel will continue to multiply at an ever accelerated rate. The current fragmentation of effort in the development of assistants to physicians emphasizes the need for the support of one or more demonstration projects which by virtue of quality, medical profession support, and prestige of educational setting would be accepted as national models. @aining of Physic.@t@'@'I's Asst. -5- RugubL, 11-1 ]:)U@ Regional Medi cal programs, because of cooperative arrangements with major educational institutions) would have access to university resources in both the ffi@-dical and behavorial sciences whose collective talents are needed to,.thorbughly study this developing allied health group. @Tther, Regional Medical Programs, be(;,iuse of the close relationship anc involvement with practicing physicians, are in a strong position to provide leadership in this new manpower area which is so closely allied to the rr@edical profession. Therefore, the Council recomends that,training programs for physician's assistants be regarded as developmental rather than.established and that they be considered for funding under the criteria outlined by the National Advisory Council for basic training of allied health professions.