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Musings: Blog of the JAAPA Editorial Board


Blog of the JAAPA editorial board.

Monday, October 17, 2016

The GMENAC report and the PA profession

Brian T. Maurer, PA-C

As we head into the 50th year of the PA profession, the October 2016 issue of JAAPA houses a true historical gem: a reappraisal of the 1981 Graduate Medical Education National Advisory Committee (GMENAC ) report and how it nearly derailed the growth of the fledgling PA profession.

The GMENAC was convened in 1976 to forecast the supply and demand for physicians nationwide in 1990 and 2000. Despite the use of sophisticated analytic models, predicted trends ultimately missed the mark in breadth and scope.

GMENAC predicted a surplus of 70,000 physicians in the United States workforce by 1990, with escalation to a surplus of 145,000 physicians nationwide by the year 2000. Accordingly, the committee recommended limiting the number of students admitted to US medical schools, as well as curtailing the influx of foreign medical graduates. In response to these recommendations, Congress passed legislation designed to limit the number of US medical school graduates; but in a quirk of legislated fate, enhanced payments to teaching hospitals designed to bolster graduate medical education and research ultimately encouraged the widespread hiring of foreign medical graduates to fill intern and residency slots.

The predicted oversupply of physicians raised doubts about the need for physician extenders. From 1981 to 1990, no new PA programs were established, and several existing programs at major medical teaching institutions were closed. Two landmark events allowed the PA profession to survive in this tenuous environment: the passage of an amendment granting reimbursement for PA services under Medicare Part B in 1986 and the attainment of commissioned officer status for PAs in the uniformed services in 1988.

These two milestones, coupled with continued efforts by the American Academy of PAs to lobby legislators and educate the public about PAs, led to exponential growth of the PA profession in the 1990s and into the new millennium.

When I had my nose to the grindstone from 1977 to 1979 as a student in a now-defunct PA program, I had no idea of the challenges the PA profession would be facing the following decade. Now, as I approach the final years of my clinical career, historical hindsight permits a certain appreciation for those turbulent times; it was dogged perseverance and hope that brought us through.

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at The views expressed in this blog post are those of the author and may not reflect AAPA policies.