Stanford Medicine marks 50 years of physician assistant education - Stanford Medical Center Report

A physician assistant training program that began in 1971 to certify battlefield medics returning from Vietnam has evolved into a sought-after master's degree.

February 9, 2022 - By Mandy Erickson

Second-year PA students learn how to insert an intravenous line.
Courtesy of Stanford's Master of Science in Physician Assistant Studies Program

In 1971, after 10 years of treating wounded soldiers in Vietnam, Dennis Langone landed in the San Francisco Bay Area, unclear about his future.

He had emergency medical training after enlisting in the U.S. Navy, where, he said, "We learned how to bandage wounds and get people on helicopters while someone's trying to blow our brains out."

Still, even with his ­y­ears of Navy experience treating bullet wounds and shrapnel injuries, he couldn't use those skills back in the U.S. without a medical or nursing license.

 A friend convinced him to apply to a joint Stanford University-Foothill College program, one of several around the country that had recently been created for Vietnam veterans with a medical background. After two years of classwork and clinical training, Langone would be a certified physician assistant, able to care for patients under the supervision of a medical doctor.

"I wasn't sure it was what I wanted to do," he said, "but I was accepted to the program, so I went."

After he graduated in 1975, his career took him to rural California and Oregon, where he acted as a general practitioner, then to a hospital in California's Central Valley, where he cared for patients in an emergency department.

"It worked out," said a newly retired Langone of his lengthy career as a PA. "I really liked taking care of people."

Langone was one of the first graduates of the Stanford-Foothill PA program, which began in the fall of 1971. Now run by the Stanford School of Medicine alone, the program,  which marks its 50^th anniversary this academic year,  has evolved from an associate degree, whose graduates had somewhat limited career options, into a three-year master's degree program whose graduates are in demand all over the country.

"We were an experiment," said Dave Mittman, a PA, veteran and former president of the American Academy of Physician Associates. "Fifty years ago, we were not a profession. Today, we are a profession of about 160,000 people."

A new profession

Physician assistants, also known as physician associates, are on par with nurse practitioners in that they are able to see patients, diagnose illnesses and prescribe medications. But while nurse practitioners are licensed in fields such as obstetrics/gynecology or psychiatry, PAs graduate as generalists, often learning a specialty on the job. Some assist surgeons in the operating room; others treat common ailments, such as sinus infections and sprained fingers. Still others work alongside physicians in specialties such as cardiology, adjusting pacemakers or running tests.

Dennis Langone

The first PA training program in the United States was started in 1965 at Duke University. The goal was to ease a national shortage of doctors by providing medical training to veterans who had experience treating patients. Medicare, enacted in 1965, had increased the demand for physicians throughout the country.

"The idea was to train the students quickly because their help was sorely needed," said Michelle Schabowki, an archivist at the Physician Assistant History Society.

Similar programs proliferated around the country, and by 1969 the American Medical Association had endorsed the new profession and started an accreditation program.

Though veterans and, increasingly, nonveterans, were entering the profession initially, few people knew what PAs were, Schabowski said. That changed in 1970, when a character in the Gasoline Alley comic strip, former Vietnam Navy medic Thomas Walter "Chipper" Wallet, enrolled in a PA training program. "A lot of the early PAs learned about the profession through the comic strip," she said.

A master's program

When Langone was studying to become a PA, he took classes at the Stanford School of Medicine and at Foothill, a two-year community college in nearby Los Altos Hills. Graduates earned an associate degree from Foothill and a certificate from Stanford; they were able to practice once they passed a board exam.

Early on, most PA programs also offered nonbaccalaureate degrees, but over the decades, some began offering bachelor's and master's degrees. PA educators wanted to bring the profession in line with that of nurse practitioners, whose licensing requires graduate education. Eventually, the accrediting body for PA education announced that by 2020, all new PAs would need a master's degree.

In 2013, PAs Susan Fernandes, now director of the Master of Science in Physician Assistant Studies Program, and Rhonda Larsen, now associate director, had recently begun teaching PA students at Stanford. They met with Lloyd Minor, MD, the dean of the School of Medicine, to discuss creating a master's program.

Asma Dahir

"We spoke about how this campus had everything needed for a world-class PA program," Larsen said. They designed a three-year program in which PA and MD students would take half their classes together before each group began clinical training, an approach Larsen said would "benefit both the PA and MD students in better understanding the roles each will play in their careers."

Another advantage, she added, was that Stanford Health Care and Stanford Children's Health needed PAs and nurse practitioners. "The PA program could serve as a pipeline for the hospitals," she said.

The dean welcomed the idea, and the university's faculty senate approved the program in 2016. The first master's degree class enrolled in 2017, and two classes have since graduated, with all alumni passing the certifying exam on their first try. About a third of the graduates now work for Stanford Health Care or Stanford Children's Health.

High-demand, patient-centered field

In the early years of the discipline, PAs often found work only in remote areas of the country, where physician shortages were most acute. Many headed to Alaska, where they cared for workers building the trans-Alaska pipeline in the 1970s, according to Schabowski. Today, in contrast, the PA field is considered one of the top three professions in the United States, according to U.S. News and World Report. Ongoing physician shortages, and more widespread use of PA skills, have created a high demand.    

Unsurprisingly, training programs have become competitive: Only 2% of PA applicants for the class of 2024 were accepted to Stanford's program. Many students say they chose the profession because they want to work closely with patients.

Asma Dahir, a first-year PA student, planned to become a physician after witnessing her grandmother, who had hepatitis C, struggle to understand and manage the disease. Her mother, a Somali immigrant, kept her children away from their grandmother, mistakenly fearing they could catch her illness.

Dahir switched her career goals after meeting PAs during a college job at a hospital. She noticed that they spent more time speaking with patients — answering questions and explaining procedures — than physicians did.

"That's when I realized that the PA field emphasizes the patient encounter," she said — a focus that aligned well with her interests. "Maybe if my grandmother had a PA who could have explained the disease to her, my mother wouldn't have lived in fear."

Mittman agrees, describing PAs as similar to the "old-time general practitioner." While medical doctors are needed to perform surgery and other specialty care, he added, PAs can provide routine care, such as treating bronchitis, conducting Pap smears and fixing ingrown toenails.

"We can supply a high percentage of the care that America needs," he said.

• Mandy Erickson

  Mandy Erickson is associate editor in the Office of Communications. Email her at merickso@stanford.edu.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.