The passing of Eugene Stead Jr., MD, marks a milestone in the history of the PA profession. It is hard to overestimate the impact and influence that Dr. Stead had in the establishment and success of the PA concept in American medicine. Many of today's PAs may not have a good sense of Stead's pervasive influence and contributions to medicine and to the PA profession, since the majority of PAs have been educated in the last 15 years. The tributes and recollections in this issue of ADVANCE for Physician Assistants, including this column, are intended to help the younger generations of PAs to fully appreciate Dr. Stead's life and work.

A Giant Figure

Most PAs recognize that Stead is credited as the "founder" of the PA profession (or at least one of them), but they may not be familiar with exactly who he was and how he came to create this profession.

Eugene Stead was a giant figure in American medicine in the mid-20th century, having trained under the legendary Soma Weiss at Harvard Medical School. He had an unparalleled pedigree as an academic internist¹ during medicine's golden era, when the physician was king and the academic internist was the ber-physician.

Stead became chair of medicine at Emory University School of Medicine and later at Duke University, where he established himself as a leading clinical researcher and mentor to a multitude of future leaders in academic medicine. While at Emory he was involved in the World War II era modification of the medical curriculum in which physicians were produced in three years. This led him to consider reforms in medical education that later materialized in the creation of the concept of the physician assistant.

Stead founded the Duke PA Program in 1965, which was actually fairly late in his professional career (he retired in the early 1970s). Stead had achieved a string of major accomplishments in cardiology, internal medicine and medical research well before he turned his attention to the reform of medical education and the creation of PAs. The biography of Stead is well known, and much has been written on his accomplishments, but several interesting historical tidbits may not be widely known and deserve mention.

A Nursing Model

One such item is the fact that Stead originally intended to build his concept of the PA on a nursing model. In 1962, a Duke nursing leader, Thelma Ingles, was looking for additional medical training as part of her sabbatical leave and approached Stead with an idea to give nurses "advanced"' medical training. This struck a chord with Stead, who for years had pondered various ideas to change the structure of physician education.

In Ingles's sabbatical year, she served what was essentially a set of third-year medical clerkships. The "experiment" was considered successful and led to the development of a formal nursing/medical curriculum based on this experiment. Since this program was based in nursing education, it required the ultimate acceptance of the nursing education establishment and was denied accreditation three times by the National League for Nursing. In frustration, Stead decided to build the PA concept on the ex-military corpsmen model rather that his original notion of nursing.²

Using the military medical corpsman as the foundation to build the PA concept gave Stead several advantages over the initial notion of nursing and served to assure the success of the new profession. First of all, Stead was free to be innovative in the newly created medical educational program, since it did not require the approval of a nursing accreditation body. Secondly, the selection of the ex-military corpsman as the foundation for the PA insured a high degree of acceptance by the American people, who did not want to close the door for opportunities in the civilian sector for these soldiers returning from Vietnam and elsewhere. Had organized nursing been more open to the then-radical idea of advanced nursing/medical practice, the history of the new health professional movement would have been very different, and the PA profession as we know it likely would not exist.

That a physician of Stead's stature created and then lent his stature to the fledgling PA profession was in no small measure a key reason it was able to survive and later prosper. Yet Stead was only the most prominent of a group of several physicians that saw the future of new health care providers. When the term "founders" of the PA profession is used, credit should also be given to Dr. Henry Silver at the University of Colorado, Dr. Hu C. Myers at Alderson-Broaddus College and Dr. Richard A. Smith of the University of Washington.

Dependent Practitioners

Another remarkable and underappreciated part of Stead's vision was his concept of PAs as dependent practitioners. While some expressed doubts as to the wisdom of establishing the profession (if it could then be called a profession) on a physician-dependent basis, Stead was firm on this matter. He clearly understood the mindset of physicians and organized medicine and knew that it was critical for the new PA not to be seen as a threat to the physician.

By linking the role of the PA to the physicians practice, PAs were protected from professional competition and critique and were free to assume a great deal of clinical responsibility and status. As it has turned out, PAs have come to enjoy a great deal of professional autonomy and satisfaction in their work. Stead later noted that "setting no ceilings and allowing the PA to grow has made this profession useful and satisfying. Restricting PAs to medical supervision has given them great freedom. Ideally, they do any part of their mentors' practice that they can do as well as their mentors."³

That has turned out to be exactly the case, a lasting tribute to the vision and wisdom of this great man.

James F. Cawley is director of the PA/MPH program and professor and vice chair of the Department of Prevention and Community Health, School of Public Health and Health Services at The George Washington University in Washington. He also is professor of health care sciences at the university's School of Medicine and Health Science.

References

1. Hollingsworth W. The Legacy of Soma Weiss, Eugene Stead, and Paul Beeson. Chapel Hill, NC: Professional Press, 1994.

2. Holt N. 'Confusion's Masterpiece': the development of the physician assistant profession. Bull Hist Med. 1998;72:246-278.

3. Stead EA Jr. The new profession: the physician assistant. Personal Web site of Eugene A. Stead Jr. Available at: http://www.easteadjr.org/profession.html. Accessed June 23, 2005.