CWO2 James Rich (center) treating a patient aboard USS Kitty Hawk, ca 1979. Rich was one of the first PAs assigned to an aircraft carrier on an “experimental basis.” Photos from BUMED Archives

Below is reprinted with permission from the article "A Short History Of Navy Physician Assistants. Part II: Through Heavy Weather and Fair Winds, 1975-1999" by Andre B. Sobocinski, which was published in the February 2021 edition of the US Navy Medical Service Corps newsletter The Rudder.

A Short History Of Navy Physician Assistants

Part II: Through Heavy Weather and Fair Winds, 1975-1999

This is one article of a three-part series:
Part I: https://navypa.com/navy-pa-info/blog/advent-of-physician-assistants-in-the-navy
Part II: https://navypa.com/navy-pa-info/blog/through-heavy-weather-and-fair-winds-1975-1999
Part III: https://navypa.com/navy-pa-info/blog/becoming-the-cornerstone-of-operational-medicine-2000-present

By 1975, Navy physician assistants (PAs) were playing vital roles at hospitals and clinics across Navy Medicine. Vice Adm. Donald Custis, a strong proponent of the program throughout his time as Surgeon General, noted that PAs “have proved their worth in extending the effectiveness of the scarce primary care physician.”

Despite support from the Navy’s top physician, others in the Medical Department saw PAs as a temporary solution to the post-war physician shortage. And for some in the budgetary realm the in-service PA training programs were not cost effective. This thinking was shaped in part by the belief that many military PAs left the service for the civilian sector soon after graduation.

In November 1975, Program Budget Decision (PBD) 120 directed the end of the military PA training programs. The last Navy PA students graduated from Sheppard Air Force Base in 1976 and all training billets were cancelled thereafter. The Navy expanded its PA ranks solely through civilian recruitment until 1979, when BUMED reinstituted an in-service training program. New applicants (E-5 to E-9), agreed to 54 months of obligated service. The first class commenced at the Naval Regional Medical Center Portsmouth in April 1979, followed by a second class at the Naval Regional Medical Center San Diego in mid-summer.

CWO2 James Rich (center) treating a patient aboard USS Kitty Hawk, ca 1979.
Rich was one of the first PAs assigned to an  aircraft carrier on an “experimental basis.” Photos from BUMED Archives.

Graduates of the new programs were qualified to diagnose, treat illnesses, perform minor surgery, order and interpret lab tests and x-rays and prescribe drugs. In 1979, BUMED also began sending PAs to aircraft carriers on what was termed an “experimental basis.” PAs were still primary limited to clinical settings and were not yet permitted to serve with and deploy with other operational units.

Although PAs were a welcome addition for most, they had their share of detractors in the early 1980s, notably the Navy’s new Surgeon General in 1983, Vice Adm. Lew Seaton. For Seaton, PAs were an impermanent solution conceived in the waning years of Vietnam to address the loss of Berry Planners. With a physician shortage no longer a problem Seaton sought to dismantle the program. He commissioned an OPNAV-931 study on November 1, 1984 on the viability of phasing out the program and used the findings to recommend the discontinuation of the program (beginning in August 1985) and explore converting PA billets to physician billets.

There were problems with doing this. Since 1974, PAs served as warrant officers and their grades CWO1 to CWO4 did not equal physician billets 0-3 to 0-6. Second, the decision was made without consulting the Secretary of the Navy or looking at the impact on SECNAV Policy.

CDR(ret.) Steven Galeski, was a Navy PA stationed at the Naval Branch Clinic, Kaneohe, Hawaii in 1984. He was unaware that the program was under fire until Vice. Adm. Seaton visited the clinic that year. Galeski, a former FMF Corpsman, asked Seaton if PAs would be permitted to serve with Marines in the future. “I was the first one to ask a question, and a lot of my brother PAs from the clinic were there,” remembered Galeski. “To my dismay he said, ‘I do not like the PA concept and I have taken steps to close the PA training program and to ultimately do away with all the PAs in the Navy.’ He took no further questions, and then he left the stage.”

Seaton’s decision proved unpopular, especially those who saw the loss of PAs as affecting the care of given to retirees. In March 1985, the Advisory Committee on Retired Personnel (ACRP) expressed concern over the potential loss of PAs and recommended that all PAs be retained until a full complement of physicians were reached. Based on these recommendations the Secretary of the Navy ordered the program reinstated and also directed that new guidance be developed expanding the role of PAs with the objective to: remove limitations on primary care, emphasize operational and combat medical support, and minimize the need for expensive physicians.

The PA program was further buoyed by the appointment of Vice Admiral James Zimble as Surgeon General in 1987. Zimble, a former Medical Officer of the Marine Corps who earned a reputation for his vision and focus on operational readiness, sought to further revitalize the program by seeking to ensure career progression, new opportunities and corps affiliation. Until 1989, PAs were a specialty without their own corps and specialty leader. Through Zimble’s advocacy, 88 Warrant Officer PAs became commissioned officers in the Medical Service Corps in 1989, and the Navy once again began an in-service PA training program. The remaining PAs on duty were permitted to serve out their careers as warrant officer. The last warrant officer PA retired in 1998. By the 1990s, PAs could be found serving with the fleet, embedded with Marine Corps and special warfare units, as well as at hospitals and clinics. In July 1999-on the 25th anniversary, Physician Assistants represented the largest clinical specialty in the Medical Service Corps (with 280 active duty and reserves PAs).

First Physician Assistants to become part of the Medical Service Corps, May 1989.

Sources:
- Brakhage, C. “Physician Assistant Anniversary.” Navy Medicine. Vol, 90, No. 4, July-August 1999
- Custis, D.A. P.A. “Program Under Fire.” U.S. Navy Medicine, Vol. 67, No. 2, February 1976.
- Davenport, J. “Civic Action Team Member Becomes Physician’s Assistant.” U.S. Navy Medicine, Vol. 72, No. 4, April 1981.
- Gray, D.A. Many Specialties One Corps: A Pictorial History of the U.S. Navy Medical Service Corps. 2017.
- Tandy, R.. P.A. “Program in the Navy: A Preliminary Report, 17 November 1978.
- “PA Program Reinstituted.” U.S. Navy Medicine, Vol. 70, No. 1, January 1979.