Physician Assistants and Health System Reform

NATIONAL efforts to reform the health care system will likely result in changes in the roles and responsibilities, practice combinations, and distribution of health professionals, including midlevel providers such as physician assistants (PAs), nurse practitioners (NPs), and certified nurse-midwives. Although recent studies have addressed differing scenarios of the projected roles of midlevel providers,1-5implementation of initiatives that involve PAs may be influenced by an overall shortage of PAs, existing barriers to PA practice, and the need for commitment to physician-dependent practice relationships in a team-oriented health care delivery system. This article reviews the history, academic preparation, clinical capabilities, distribution, and practice activities of PAs and discusses the potential roles of PAs in the changing health system environment. The origin of the PA can be traced to the new health practitioner movement of the 1960s, during which the PA concept emerged from a combination of events. As experienced hospital corpsmen