Nurse Practitioners and Physician Assistants

  • Medicine & Health
  • 1965

The increase of American population plus general affluence following World War II caused an acute shortage of doctors, especially in rural communities, and an escalation of medical costs. The University of Colorado responded by starting a program to train registered nurses into mid-level responsibilities as nurse practitioners. This pioneering effort was made possible by a $253,998 grant from the Commonwealth Fund.

By making nurse practitioners responsible for things like routine examinations, administering immunizations, and conducting basic tests, doctors were freed up for more complicated procedures and diagnoses. A particular specialty of nurse practitioners trained to work in schools emerged after an additional grant from the Commonwealth Fund. In 1976, funding from the Robert Wood Johnson Foundation helped standardize and improve the training of nurse practitioners, and the next year the foundation funded fellowships at nursing schools to expand the profession.

At about the same time as the Colorado experiment, faculty at the Duke University Department of Medicine were pushing for a new class of medical professional who could operate in the gap between nurses and doctors. Eventually a program was created that enrolled former military medics and gave them an intense two-year immersion in biological sciences and clinical medicine. This abbreviated version of medical school allowed the resulting “physician assistants” to perform many of the routine duties of a doctor, under direction of a supervising physician. Philanthropic grants from the Josiah Macy Jr. Foundation, the Carnegie Corporation, the Rockefeller Foundation, and the Commonwealth Fund supported this new initiative.

With additional funding from Commonwealth and Robert Wood Johnson, the Duke innovation was spread to other medical schools in the late ’60s to mid ’70s. Physician assistant programs were structured as B.S. degrees until the mid-1980s. Then a master of health sciences degree for P.A.s was established.

Physician assistants and nurse practitioners are now board-certified in nearly all states, and their numbers have roughly doubled over the last decade—to more than 91,000 P.A.s and 250,000 N.P.s as of 2014. These two new classes of care-provider have fundamentally changed the practice and economics of medicine. And strong philanthropic support was crucial in overcoming extensive resistance from the nursing establishment and initial reluctance in government to fund the new professions.