HISTORY

Alabama has historically been a state that has not had adequate access to health care providers and services. The problem has been extremely acute in rural areas leading to an increase in the cost of health care costs and adversely affecting health status in the state. The state has been fortunate to have forward thinking individuals who were at the forefront of seeking solutions to this health care problem.

Alabama played an important role in the development of the physician assistant profession in this country. As far back as 1959 when the U.S. Surgeon General identified the shortage of medically trained individuals there were young physicians being exposed to the concept of assistants to physicians that would eventually impact this state. In 1961 the "seeds" were set into motion with an article by Dr. Charles Hudson in the Journal of the American Medical Association calling for a "mid-level" provider from the ranks of former military corpsmen. In 1966 the Allied Health Professions Personnel Act (PL-751) promoted the development of programs to train new types of primary care providers.

The following year in 1967 Dr. John W. Kirklin initiated the first surgeon's assistant program at the University of Alabama in Birmingham, Al. Dr. Kirklin, as a pioneer in cardiac surgery, saw training an assistant with the cardiovascular surgery residents and fellows, would provide those physicians with well-trained assistants that would be the early stages of the "team" approach to cardiac surgery that has continued to develop into the highly skilled teams we see utilized today.

In addition, on the heels of the surgical assistant concept of the physician assistant, Dr. Tinsley Harrison (of Harrison's Principles of Internal Medicine fame) was involved in the development of the physician assistant program in medicine at the University of Alabama where he served as the dean and chairman of the Department of Medicine. The focus of the program was to train assistants to work as "assistants to physicians" in medically underserved areas, in particular the rural medically underserved areas.

In 1971, the Alabama legislature responded to the shortages of skilled health personnel and understood that new uses for allied health personnel was a critical issue to be resolved if the supply of health manpower was to be used effectively and productively. In its concern with the growing shortage and geographic maldistribution of health care services in Alabama, the legislature established a framework for legal recognition and development of new categories of health manpower - assistants to physicians.

The legislature also encouraged the utilization of the "assistants to physicians" by physicians by removing existing legal constraints. It also allowed for innovative developments of programs for the education of assistants to physicians within the state. These changes by the legislature set into motion the establishment of training programs and the first graduates were beginning to matriculate.

Like many areas of the country the physician assistants were slow to be understood and accepted outside of the major universities where they were training. But the perseverance of those early physician assistants in the state has and continues to make a difference. In the early 1970s the Alabama Society of Physician Assistants (ASPA) was formed. The early role of the association was more of a social gathering of the PAs but quickly developed into an organization that provided CME, representation to the fledging national organization and a voice of the PA. The first American Academy of Physician Assistant Conference was in 1973 with 275 attendees with many Alabama PAs and their physician counterparts such as Dr. Kirklin involved with propelling the profession along.

The ASPA grew dramatically through the 1980's and was instrumental in achieving major changes in the laws in the state of Alabama in the early 1990's that allowed the use of PAs in remote site practices, to obtain prescriptive privileges, form an advisory board to the state Board of Medical Examiners and secure mandated reimbursement for PA services. The ASPA was involved in the subsequent long seven year battle to resolve the payment for services for PA by third party insurance payers when the major insurer in the State, Blue Cross and Blue Shield of Alabama refused to pay. The Society was successful in this pursuit.

As the profession grew at a tremendous rate across the country, the needs in Alabama continued to be such a concern that another PA program was initiated at the University of South Alabama. This program focused on training physician assistants primarily for the medical underserved areas within the state and gives preference to potential students from within the state and northwest Florida. The ASPA leadership has begun to come from many individuals that are involved with the USA PA program. This diversity has continued to help the organization to grow within the state and reaches out to all corners of the state to make sure the concerns of the practicing PA are being addressed.

ASPA continues to work to improve the third party payment issues, access to health care and health care providers in rural and medically underserved areas and is working to gain more input into the decision making process of the Board of Medical Examiners as it relates to the regulation of the PA profession. ASPA is the primary provider of CME for PAs within Alabama. ASPA is considered the voice of the Alabama PA.

Much of this history was complied by James R. Kilgore, Ph.D., PA-C, a 1981 Emory graduate and a practicing PA in Alabama since that time.