1. Physician Assistant
Past, Present and Future
Ashish Gaur
BS(BITS),M.D(AM),PG Dip PPHC

2. 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

3. Dr Eugene Stead innovated.
Kenneth Farewell-First qualified Physician Assistant (PA)
India-Started in 1991
History

4. 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

5. 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

7. 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

8. 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

9. 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

10. 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

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

13. Hemodynamic monitoring
Diagnose the problem before it arises.
Procedures-ICD, IABP, Intravenous, arterial lines (in association
with Surgeon).
Rounds.
Job Profile-ICU

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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

22. 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

23. 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

24. 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

25. Approach
MCI
•Via senior
doctors
•Via Local MCI
body
Approach
Health
Ministry
•Political
approach
•Write Letters
Articles
•Newspaper
•Camps
Recognition By MCI

26. 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

27. A BIG ISSUE
Should open MS PA
Should train and start courses post BS .
Can plan off campus.
It can stop migration.
Post Graduation

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

29. Involvement
Dependence
Training
Protocol following
Trust
RECOGNITION

30. Cardiac surgery lures .
Want to perform.
Knowledge
Train
Trust
Time
Care