Physician Assistant Past, Present and Future

Ashish GaurBS(BITS),M.D(AM),PG Dip PPHC

ITS 1650.

The first documented “not a nurse, neither a doctor” position was in Russia in 1650 with the feldshers who provided healthcare in rural locations throughout the country.

During the French Revolution, there was officer de santé who worked in the battlefield providing healthcare since many doctors and nurses were being killed along with the soldiers.

China-1966 Bare foot Doctor.

Know your past and learn for present to improve your future

Dr Eugene Stead innovated.

Kenneth Farewell-First qualified Physician Assistant (PA)

India-Started in 1991

History

First PA graduated from Duke University in 1967. John Kirklin initiated the first formal educational program for

training PA. His wife was the program coordinator. John Byrnes founded APACVS in 1981. APACVS recognition by AATS.(IAPA by MCI?)

History

Among the most famous PA (1970) Was assistant to Dr. Blalock who devised BT shunt. Later was teacher to Dr. Denton Cooley in Blalock’s unit. During the first live human child heart operation he looped and

anastomosed for Dr. Blalock. Was recognized despite being BLACK Movie-Something the lord made.---”A Must watch”

Vivian Thomas

Wanted to be a doctor---missed a seat. Enthusiasm and zeal towards patient treatment and care. Best profession which takes you to nearest to patient (excluding

doctors ) in comparison to all other paramedics.

DID YOU BECOME A PA

Recognition-Only in parent institute Confusion- As nurse and unqualified Salary-Meager Job-Not defined job profile and difficult placements. Future-Not defined. Migrated to USA.

Past-Problems

Defined job profile. Descent starting salary. Numbers-700 till date? North and central India is open for jobs. Escorts, Medanta, Narayana, Asian Heart, Kokilaben, Fortis and

Wockhardt.

Present

Job Profile-harvesting vein ,radial artery, opening and closing of sternum, assisting as first /second assistant.

ICU-IABP and ICD insertion and removal. Hemodynamic management. Rounds and wound management.

Present

Harvesting vein, radial Graduate to IMA Opening and closing of sternum. Assisting as first/second assistant. Operation Theater booking/scheduling cases.

Job Profile-OT

Hemodynamic monitoring Diagnose the problem before it arises. Procedures-ICD, IABP, Intravenous, arterial lines (in association

with Surgeon). Rounds.

Job Profile-ICU

Initially a surgeon assisted another surgeon. This team doesn’t exist now in any part of the world. Because assistant surgeon wants to create his own team.

Did not pursue for long as need for independence and identity arises. A PA/SA is anchor to the team. Together with a surgeon, PA can build the team under trust and

mutual understanding which can last permanently. Both can grow independently and interdependently. Symbiotic Relation.

Anchor and Team Builder

Approach APACVS. Approach MCI. Open branches and encourage PAs working in those respective

areas to be members and help to groom future of PA s in those respective states.

Journal-Need to go online. Induce more hospitals for training. Approach central health government body.

Future

Training-Should be practical but theoretical is must. More emphasis on theory. Courses less than 4 years should be discouraged. Conduct campus interviews for jobs post completion of the course. Involve senior PAs working in different states and hospitals in job

interviews. Massive demand in hospitals in north and central India but due to

unavailability of qualified PAs they opt for quacks.

Future

Student Union/Group. Active participation in association. Senior PA to be approachable, to come back to association. PAs should help the juniors for fetching job CME-twice a year and alumni meet once a year.

Future

IAPA to associate with other universities rather than hospitals to start PA courses.

IAPA should open more branches. IAPA to conduct regular training sessions in form of CMEs UNITY.

Future

Develop endoscopic program. (Future) Minimally invasive training .(An assistant should know what his

boss is looking at and approaching ) In ICU-Train on IABP insertion and central line and intubation. Wound management clinic should be manned by PA –As they close

wound and should graduate to better management techs (VAC). TEE -Developing scenario in Intraoperative(we have started doing

it)-Centers-Pune and Bangalore. Diversify-Interest based. Huge demand in neurosurgery and

general surgery too.

Goals

Where are we—where we should be?

Present

Knowledge Unidimensional job profile Recognition by Unit Self or Pear recommendation BHMS, BAMS,unqualified also

work as PA. Central IAPA

Aim Growth. Multidimensional MCI Defined profile BAN by association Decentralize the body. Open more branches

Untrained Unqualified Homeo, Ayurs and Bsc Graduates. Association ban . Letter to hospitals employing them.

Quacks

Assistant name does not adequately represent all that a PA does. Worldwide PA- Physician associate or Surgical Associate. PA name drives confusion in patients and staff (often mistaken as medical

assistant). In USA AAPA has passed a bill to rename PA to physician associate. Easy to do in India as still controlling body is one and numbers are

limited. Should be done to avoid confusion.

Misnomer

IAPA to associate with IACVTS. IACVTS to conduct regular exams only after passing out the degree. To certify the Surgical associate that he can perform. It will help

eliminate QUACKS and will give platform . Further IAPA meet to be held with IACVTS meet. It will regularize

the forum and then we can take it from there (example- Perfusionist).

Should speak to Dr Suresh Rao and Dr Rajan and get it done.

IAPA ---IACVTS

If an Indian surgeon wants to give USMLE/MRCS to migrate to US/UK for bigger and better fortunes.

What needs for an Indian PA to do the same in US/UK. NEED HOMEWORK and Logistical planning . Should be discussed and shared in fraternity. On priority basis and can take help from PA s working in USA and

cardiac surgeons worked in US/UK.

Migration To Western World

Approach MCI

• Via senior doctors

• Via Local MCI body

Approach

Health Ministry

• Political approach

• Write Letters

Articles• Newspaper• Camps

Recognition By MCI

Yearly Elections. Please don’t retain presidentship for long. Recruit youngsters from class level as CR. Responsibility of office bearers to approach MCI and conduct

regular meets. Journal Club where very PA can publish online atleast triyearly. PA working in other states and hospitals to take lead in organizing

future IAPA meets.

IAPA

A BIG ISSUE

Should open MS PA

Should train and start courses post BS .

Can plan off campus.

It can stop migration.

Post Graduation

AAPA has included IAPA in their official website and has a link.

GOOD NEWS

Involvement

Dependence

Training

Protocol following

Trust

RECOGNITION

Cardiac surgery lures .Want to perform.

KnowledgeTrainTrustTimeCare

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