The Gold Standard

Health equity—the desire to extend quality care to people who lack it—is not a new idea. The concept is at the heart of the movement that established the physician assistant as a profession.

Since the field itself was in its infancy, the University of Utah has been at the forefront.

In 2021, the Utah Physician Assistant Program (UPAP) is celebrating its 50th anniversary. The program perennially ranks in the top five nationally among its peers and stands as University of Utah Health’s highest-rated graduate program. Its leaders and faculty have helped shape the profession while ensuring that the program provides extraordinary health education and cultivates a growing research enterprise.

“The beauty of it at the very start was, people knew there was a need out there and they wanted to train people to meet that need,” said Don Pedersen, PA-C ’78, PhD ’88, an alumnus and professor emeritus who led the program between 1989 and 2011. “The PA is flexible and adaptable, so it fits hand in glove with what’s needed. And I love the way we’ve developed the program at the U as a real student-centered offering.”

Fifty years is a special milestone, a time for celebrating all that’s been accomplished—and also for looking ahead at the challenges to come.

“Fifty years is certainly a milestone,” said interim division chief Leigh Elrod. “As a student and faculty member you’re aware of UPAP’s legacy and impact. There is a sense of pride knowing you are now a part of this historic program. It’s incumbent upon all of us to ensure UPAP’s mission and legacy continue over the next 50 years.”

Extending Health Care Access

The present-day physician assistant position grew from a confluence of factors unique to the 1960s.

In 1959, the US surgeon general publicly warned that there were too few doctors and other medical personnel to meet the nation’s health needs.

The mid-’60s saw long-fought struggles for equal treatment finally influence policy in forms such as the Civil Rights Act and the War on Poverty.

Meanwhile, young soldiers returned from Vietnam with skills they acquired as battlefield medics.

At the intersection of widespread unmet medical needs, emerging social consciousness, and an able workforce seeking employment, the first PA program was established at Duke University in 1965—the same year that Medicare and Medicaid were created. The vision was to build on students’ experience to train a new brand of health professional able to practice medicine with physician supervision. By 1968, the University of Washington had developed an apprenticeship model called “MEDEX,” a combination of “medical” and “extension.”

People in Utah, particularly those in rural regions, suffered from lack of access to medical care. With this pressing need, the Utah MEDEX Demonstration Project was launched in 1970 by cardiologist Charles Hilmon Castle, the inaugural chair of what is now the Department of Family and Preventive Medicine. Castle was an Air Force veteran and a protégé of the Duke Physician Assistant Program founder. Castle’s co-founder at the U, William Wilson, became the program’s first director.

After diligent efforts to garner funding, in 1971 Castle and Wilson welcomed the first class of a dozen students to the Physician Assistant Program’s initial iteration, a 15-month certificate program in the Spencer Fox Eccles School of Medicine. A guiding model for the program came from accelerated medical training designed to address a shortage of doctors during World War II.

Former students remember Castlefor his pioneering spirit and devotion to patients.

“He was a real groundbreaker,” said Dave Keahey, PA-C ’83, an adjunct associate professor of physician assistant studies at U of U Health and chief advocacy and research officer for the Physician Assistant Education Association. “Patients loved him, too, because he had an incredible bedside manner and really cared for people.”

In the early years of the physician assistant profession in Utah and the Mountain West, word of mouth was a substantial boon to the program. Overworked physicians in far-flung practices took on U of U students as trainees, often hiring them upon graduation. Finding the physician assistants to be fine partners in delivering health care, they shared the news with their peers. Credit for the success of the program goes, in part, to the early graduates’ commitment to serving the underserved.

“The PA was as much a social movement as a workforce or education movement,” said Roderick Hooker, an observer of the field. “It came from the ground up, rather than from the top down, and that was a strength.”

A Trajectory of Growth and Excellence

Pedersen, the second director of the Utah Physician Assistant Program, was himself a product of the program.

Entering the program with experience serving in the National Guard and Air Force Reserves, as well as a master’s degree in health education, he commuted from Idaho to Utah each week as a student and lived in his van on weekdays while pursuing his studies. Pedersen graduated in 1978, then returned to the U the next year as academic coordinator.

In more than 40 years on the faculty, he shaped the program—and the field—in numerous ways.

“He is one of the founding fathers,” Virginia Valentin, the program’s recently departed chief, said in the fall. “So much of what we still do in the program was developed by Don. He has accomplished a lot, which tells you about his acumen, and yet he is the quietest, kindest, calmest person.”

Pedersen has been prolific in his service to the profession as a leader nationally in the Physician Assistant Education Association, the Physician Assistant Foundation, and the Utah Physician Assistant Licensing Board. Founder of the first national peer-reviewed journal concerning PA education, he advanced research in the field, including his own important publications exploring questions related to economics and workforce deployment.

“Don brought scholarship to the profession like no other person has,” Hooker said. “A lot of the Utah PA Program’s influence is carried by his legacy in research.”

Pedersen and his wife, Kathy Pedersen, PA-C ’80, MPAS ’02, associate professor of physician assistant studies, have increased the global reach of the program and the physician assistant profession. They developed initiatives that have brought U of U Health students to locales including Nepal, Thailand, and Papua New Guinea for rotations. They have also helped export education for physician assistant-like positions to countries around the world, and Don Pedersen has led by example with volunteer international relief work, such as service in Thailand after the 2004 tsunami.

Early in his time as director, Don led an effort that stabilized the Utah Physician Assistant Program’s funding. He later successfully advocated that the program grow into a degree-granting graduate offering, with the Master of Physician Assistant Studies degree authorized in 2000 by the Utah State Board of Regents. In 2010, the Division of Physician Assistant Studies was constituted within the Spencer Fox Eccles School of Medicine’s Department of Family and Preventive Medicine, with Pedersen as its first chief. Since retiring, he has remained an ardent supporter and trusted adviser.

“Founding division chief, the initial editor of our education journal—Don has been the first at many things,” said Jared Spackman, director of the Utah Physician Assistant Program. “A lot of our national stature as a program is related to the fact that Don and Kathy were here for so long.”

A Continuing Commitment to Serving the Underserved

Much has changed since the Utah Physician Assistant Program first launched 50 years ago. There are currently more than 125,000 physician assistants working in all states and in every conceivable specialty.

The position encompasses a great deal more specialization and independence compared to its early days. It is also no longer primarily a second career for ex-service members. In the approximately 260 US educational programs, the average age of students has dropped, with women now outnumbering men.

The Utah Physician Assistant Program has likewise grown and adapted. A satellite program, begun in 2018 at Dixie State University, expands the program’s reach to southern Utah communities. Graduating classes now approach 70 students across both campuses.

The cumulative impact over the years touches hundreds of thousands of lives today, especially those in underserved communities.

“There are many people—I would say maybe a quarter of all rural geriatric patients, half of all Native Americans and migrant workers in Utah, and one-third of all Utahns—who have never known what it’s like to not have a PA in their midst,” Hooker said.

Charged with preparing the next generation of compassionate practitioners in a field with surging interest, the leaders of today’s Utah Physician Assistant Program still hold the original precepts of the profession as their ideal: the drive to improve quality of health and access to care, with a commitment to the underserved.

To support that goal, there is a focus on placing students in underserved communities during their clinical education, with rotations in rural Utah and the Navajo Nation reservation.

“We want our students to learn about the practice environment, the culture, and the wonderful people on the reservation,” Spackman said. “We’ve had multiple students who ended up working for the Utah Navajo Health System to fulfill those needs.”

The program’s leaders also take an intentional approach to promoting diversity in the student body, with the goal of matching the diversity in the community.

Back in 2011, Darin Ryujin MPAS ’03, associate professor of physician assistant studies, was hired as director of inclusion and diversity, the first appointment of its kind at U of U Health and one of the first among PA programs nationally. The mindset of cultivating diversity permeates the curriculum itself, as well as activities in admission, retention, and the recruitment of preceptors. The program was recently selected for the 2021 Excellence Through Diversity Award, a national award given by the Physician Assistant Education Association.

Uniformly, the educators connected with the Utah Physician Assistant Program identify students as one of its greatest assets.

“The secret sauce to our success is being able to enroll folks who identify with our mission,” Keahey said. “We want a special group of people that live the mission, vision and values.”

Looking ahead, the program’s leaders will seek ways to take increasing specialization in the PA profession and funnel it toward areas of need.

“I’m very excited about the future of PAs and PA education,” Elrod said. “The COVID pandemic has again highlighted this gap in medical care for rural and underserved communities. I believe PAs are well positioned to answer that call not only on the front lines but in leadership positions to address health policy and inequities.”

Spackman added, “I describe the PA as sort of a pluripotent stem cell. We have always been able to flow to areas of need within our health care system, and we have to sustain our ability to be nimble and responsive to future needs.”