Physician Assistants: A Social Innovation in the Delivery of Health Care Services

Transcription

1 Physician Assistants: A Social Innovation in the Delivery of Health Care Services By Reginald Carter, PhD PA Historian Emeritus PA History Society National Commission on Certification of Physician Assistants Physician Assistant History Society Honoring our History; Ensuring our Future

2 A Social Innovation is a novel solution to a social problem that is more effective, efficient, sustainable, or just - than existing solutions and for which, the value created accrues primarily to society as a whole rather than private individual. - Phills, James A, Deiglmeier, Kriss, and Miller, Dale T. Rediscovering Social Innovation. Stanford Social Innovation Review; Fall 2008; 6, 4; pg. 38. The Physician s Assistant Eugene Stewart Schneller Innovation in the Medical Division of Labor 1978 Lexington Books

3 Social Innovation Drivers 1. Exchange of ideas and values 2. Shifts in roles and relationships 3. Integration of private capital with public and philanthropic support

4 Setting the Stage for the Development of a Social Innovation in Post-War LBJ signs Medicare Act 1965 America By 1960s Demand >> Supply GDP Buying Capacity Blues & Medicare/Medicaid Technology/Scientific breakthroughs Social and Civil Unrest Physicians and Hospitals Low End High End Market Place Advances diagnostics, therapeutic and rehabilitative services Increase medical schools enrollments & residency programs Increase specialist and subspecialist Geographic/Specialty Maldistribution physicians by 1965 specialist output surpass generalist leveling off 2:1 ratio by 1985

5 Unable to Address a Growing Social Problem Necessity is the Mother of Innovation As physicians and hospitals struggled to meet the high end demands in the marketplace, their ability to deliver accessible, affordable and quality health care services to the lower end of the marketplace waned

6 Exchange of Ideas: One Doctor s Solution to a Growing Demand for Health Care Services Treadwell is made an Honorary PA in 1970 by the DUMC PA Program Dr. Amos Johnson and Buddy Treadwell

7 Exchange of Ideas and Values: A Novel Solution Presented to the American Medical Association 1961 Charles Hudson, MD in the Journal of the American Medical Association, calls for the training of a "midlevel" provider to assist doctors from a new source of health manpower such as former military corpsmen.

8 Shifts in Roles and Relationships Eugene A Stead, Jr and Thelma Ingles, RN Nurse Clinicians/Physician s Assistant Loretta Ford RN and Henry Silver Pediatric Nurse Practitioner/ Child Health Associate Innovators John Kirklin Surgeon s Assistant Hu C. Myers Physician s Assistants Baccalaureate Program Richard Smith MEDEX Rapid Deployment Model

9 Exchange of Ideas and Values: Duke Conferences and National Conferences

10 Integration of private capital with public and philanthropic support Educational Programs Conferences Research & Evaluations Accreditation Process Foundation and Federal Funding Certification Process 10

11 Legislative Model and National Certification developed to Support the Social Innovation o Delegatory Authority (CO, KS, AZ, OK; ) o Licensure Act (CO; CHA; 1969) o Regulatory Authority (CA, NC; 1970, 1971) o National vs State Certification AMA and NBME collaborate to produce and administer National Exam initially open to graduates of AMA/JRC-PA accredited programs, nurse practitioners and informally trained PAs (1973) Commission formed (1974) from 14 participating health professions and organizations; responsible for setting standards, certifying PAs and recertifying PAs in 2 year cycles (CME) and 6 year cycles (by examination).

12 External Value Networks formed to Support the Social Innovation (tangible/intangible support) o AMA, NBME, AHA, AAMC, FSMB (Various Medical Specialty Organizations) o Veterans Administration Medical Centers Support Education Hospital Privileges Utilization Patterns o US Public Health Service (corps) o US Department of Defense (commissioning issues) o Health Workforce Alliances o Political Action Committee Alliances o Pharmaceutical Industry o Private Foundations o Consumer Health Advocacies

13 PAs as a Novel Social Innovation Examples Building Alaska pipeline in the 1970s. (value PAs performed lower end duties more cost effectively than MDs could) Rural Satellite Clinics in 1970s. (value cost effective, convenient, decentralized low end services) Alternative to House Staff in Hospitals in 1970s. (value reduce dependence on MD housestaff, reduce number of specialist being trained in overpopulated field, as cost effective with more stability in delivery of care) Military opts to train own Physician Assistants in 1970s. (value- Air Force/Rand Study (1980) showed clearly that USAF PAs could provide same quality of care as MDs for large percentage of patients) Walk-in or MinuteClinics in 2000s (CVS, Walgreens). (value cost effective, convenient, decentralized low end services) Patient Centered Medical Care in 2000s (Health Care Centers). (value cost effective, improved outcomes, collaborative practice model team development)

14 Performance Autonomy The PA is a competency-based occupation. Different PAs do different work. It is based on a "negotiated" role between an individual physician and a PA. This makes it unique. It means PAs can do a very wide range of tasks- and can have roles that change and expand significantly over the course of a career. Eugene Schneller A Social Innovation in the Medical Division of Labor 1978

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