Abstract
INTRODUCTION: The American physician assistant (PA) was created through a series of federal policies and legislative acts. Each was intended to improve society through advancements in the delivery of healthcare. The theory why this public policy developed has been unexplored. METHOD: A search of reports was undertaken to identify national legislation that enabled the PA to be included in the American medical workforce. The effect was a chronology of federal acts and policies. RESULTS: In the early 1960s editorials, conference proceedings, and reports signaled that more access to physician services was needed for a growing American society. Beginning in 1965 with a series of congressional acts such as Medicare and Medicaid, a call was made for a physician analog. Envisioned was a type of assistant who could undertake many of the routine responsibilities of the doctor. Half a century later the number of clinically active PAs exceeds 120,000 and 260 PA programs are operational. What policies gave impetus to this novel health workforce innovation? All the acts and policies produced by Congress or federal agencies that involved PAs were analyzed, summarized, and placed in chronological order. The result reveals an evolution of healthcare reform that continues well into the 21st century. CONCLUSION: From 1966 to 2024 (58 years) there were 18 significant federal acts, policies, and improvements that enabled PAs to provide medical services in American society. With each enactment drawing on the success of preceding ones, more expansion of the PA took place and their utilization grew.