Organizations frequently record their history by dividing it into notable time frames. Sometimes, these time frames are defined by leaders who place an indelible and lasting stamp on the activities and accomplishments of the organization.

A notable milestone in the history of the PA profession was marked recently with the announcement of the resignation of Stephen Crane, PhD, MPH, as executive vice president of the American Academy of Physician Assistants. Facile and influential, Crane was the fifth executive director of the academy and had served in the position for more than 13 years.

The AAPA has been fortunate to have had three strong executives, each of whom defined an era in the academy's history and contributed significantly to the development of the organization and the profession. Each presided over periods during which significant growth and advancement occurred.

The Donald Fisher Era

The first AAPA executive was Donald W. Fisher, PhD, an anatomist by training who was hired in 1973. Fisher had been the program director at the now defunct University of Mississippi PA Program. As he attended early meetings of what was then the Association of Physician Assistant Programs (now the Physician Assistant Education Association), his smooth communication skills and organizational capabilities became apparent. This led to his selection to come to Washington to head up the fledgling AAPA and APAP offices (the two organizations shared management staff at that time).

Fisher was enormously effective in his new role and impressed many in the medical and political community with his classy, courteous and effective style. Fisher advanced the organization in important ways-establishing a presence for the profession in the Washington scene, starting a journal, obtaining grant funding for the operation of the organization, hiring key staff (some of whom have remained with the academy for decades)-and he was clearly the right person at the right time for the profession. Fisher was a contemporary of revered academy leaders such as Carl Fasser, Tom Godkins, Bill Stanhope and others, and his successful tenure set the table for the rapid growth of the profession that was to come in the 1980s.

The Lynn May Era

The second influential executive director was F. Lynn May. May was a federal government official who in the early 1980s worked for the Health Care Finance Administration (now the Centers for Medicare and Medicaid Services) and was involved in public relations efforts to institute the newly developed diagnosis-related group system in hospitals.

May was an attractive candidate in the academy's eyes. It was felt that his knowledge of health care finance systems and Congress and his persuasive style would be assets in the campaign to secure Medicare reimbursement. This landmark goal was reached two years after his hiring in 1986.

May was a commanding figure who had a limited tolerance for dissenting opinions, whether they were held by staff or leaders. He presided over the construction of the AAPA headquarters building in Alexandria, Va., which opened in 1987, and was involved in the efforts to achieve full commissioned officer status for PAs in the military. He was a driving force in efforts to advance the academy's governance structure, initiating, for example, the institution of councils and board committees. His strong sense of organization helped to build components of the organization, such as the PA Foundation, which are still very much in place today.

The Steve Crane Era

Steve Crane became AAPA executive vice president in 1993 and brought with him a background perfectly suited for the job. Trained in politics and health economics at Princeton and the University of Michigan, he had been involved in health service research studies related to PAs on the state level during the 1970s and thus was quite familiar with PA regulatory, practice and policy issues.

He ascended over time to become an association leader, a post that gave him contact with leading health services researchers and provided access to the Washington health policy scene. Crane took over the academy during the heady years of the Clinton health care reform initiative, an effort that gave heightened visibility to the nonphysician health professions.

A few years later, as the PA educational sector was in the process of doubling the number of educational programs, Crane was the resolute chief advocate of the "supply-induced demand" theory, which held that producing more PAs would in turn create an even greater demand for PAs in the marketplace. Skeptics (such as myself) doubted and debated this theory with him and warned of an oversupply due to the rapid expansion of PA numbers-an oversupply that never happened. Crane's eternal optimism that PAs would become ever more popular and more extensively utilized in the health system turned out to be correct. The profession boomed spectacularly in the later years of the 1990s and early 2000s.

A key question for the future post-Crane academy is whether the next executive should be a PA. In the past, as each of the major executive directors departed, discussion ran free about the pros and cons of having a PA serve as association executive director. Again PAs are asking: Is it time for one of our own to serve as the leader of our professional association?

Some argue that indeed that time has come, yet others note that the skill set needed in the position are those with extensive association and management experience. The matter is now in the hands of AAPA's recently appointed executive search committee. Yet the record is clear that the AAPA and the profession have been well served by three dedicated non-PAs who have provided vision and effective leadership. We should be grateful to them all. In particular, while we have not always agreed with him on various issues, we salute Stephen Crane on his departure, thank him for his notable contributions and wish him well in the next step of his distinguished career.

James F. Cawley is professor and interim director of the PA program at the School of Medicine and Health Sciences at The George Washington University in Washington.