Timeline: VAPAA's History and Accomplishments

1965: The PA Profession is born

1967

• First PAs Graduate - Duke University
• VA hired first PA in Durham, NC

1971: 

• The PA Certificate Program is developed, a collaborative effort by Michael E. DeBakey VAMC & Baylor University
• First PA Qualifications are established for positions GS-7 through GS -11
• Comprehensive Health Manpower Act of 1971: Congress includes $4 million for establishment of new PA educational programs

1972:

• First “PA Utilization Guidelines” are established - VA standardizes the role of PAs by defining specific hospital departments and the functions in which PAs can be utilized
• First Bachelor’s Degree program for PAs is established at Alderson-Broaddus College (West Virginia)

1975:

• NCCPA is established, the national PA certifying exam is created, PA-C becomes the new credentials

1980: 

• PAs are granted prescriptive authority in 10 states

1984: VAPAA is founded 

1986: 717 PAs employed by the VA

1988: 

• 869 PAs employed by the VA
• Master’s Degree in PA Studies is first awarded, Duke University

1989: VAPAA is chartered as a constituent chapter of the AAPA

1991: 

“General Guidelines for Physician Assistants” (VA circular 10-91-117) is published:

• PAs have “managing” physicians required to be available for immediate consultation via telephone
• All PA orders require physician co-signature

1993: First Chairperson of the VA’s PA Field Advisory Committee is appointed and involved in writing the

           PA Qualification Standards, including the ability for PAs to advance to Grade 13

1994: VAPAA holds its first independent CME conference in Minneapolis, MN

1995: 

• VAPAA meets with Under Secretary for Health (USH) to advocate signing of a revised utilization policy

which restructures VA PA practice

• “PA Guidelines for Utilization” (VA Directive 10-95-020) is signed and published

  -PAs have a SOP and “supervising” physicians that require daily contact by phone or in person

  -All initial inpatient/outpatient H&Ps and discharge summaries require co-signature

  -PAs have Rx authority and orders written by PAs no longer require co-signature

1997: 

• VAPAA works with DEA to allow controlled substance prescriptive authority
• VHA utilizes a national “Lead PA,” an informal position that advises on policy and gives guidance on PA practice 2000:
• National PA Advisor role is established, reports to the USH within VHA, advises on PA employment and utilization (Public Law 106-419

2000:

• 1,100 PAs employed by the VA
• National PA Advisor role is established, reports to the USH within VHA, advises on PA employment and utilization 

2002

• Educational Debt Reduction Plan (EDRP) is established which includes PA
• First PA Doctoral Program is established at Nova Southeastern University (Florida)

2004:

• A Field Advisory Committee (PA-FAC) is established
• PA Advisor and PA-FAC makes comprehensive revisions to Directive 2004-029: “Utilization of PAs:”

  -Lists specific duties PAs can perform

  -Provides requirements for PAs to prescribe controlled and non-controlled medication

  -PAs are considered to be “supervised” by physicians

2007: PAs have prescriptive authority in all 50 states, DC and Guam

2008: Over 1,600 PAs employed by the VA

2010: 1,878 PAs employed by the VA

2011:

• First PA residency program established
• Congress promotes the VHA PA Advisor to Director of PA Services, a full-time position reporting on PA education, training, employment, utilization, and optimal participation of PAs in the VA (H.R. 1302)
• NCCPA administers first “Certificate of Added Qualifications” (CAQ), developed to credential PAs in specialty fields

2013:

• “Utilization of Physician Assistants” (Directive 1063) is revised and published:

               -the term "collaborate" is used to describe the relationship between PAs and Physicians instead of the term “supervise” 

               -Physician co-signature is not required on PA notes or orders

               -PA autonomy levels established

               -Facility Lead PA positions are established

2015:

• 2,020 PAs employed in the VA
• VAPAA Legislative Committee Member provides testimony to Congress; recommendation highlights:

  -Convert PAs to LPS to remain competitive with the private sector

  -Include education debt reduction incentive (EDRP) in all PA job postings

  -Include PAs in the hierarchy for funding allocation for scholarship program (EISP)

  -Streamline PA hiring process at VA

2017:

• The Choice and Quality Employment Act of 2017 is approved and allows for competitive pay for VA PAs by 

     adding them to the Title 38 Locality Pay System (LPS)

• VA’s Health Professional Scholarship Program (HPSP) awards scholarships to PAs

2018:

• 2,400+ PAs employed by VA
• Federal Rule: “Anywhere to Anywhere Care” is established and allows VA providers (including PAs) ability to provide care to Veterans across state lines when using telehealth technology

2020:

• 2,600+ PAs employed by VA
• Implementation of “The Choice and Quality Employment Act of 2017”: PAs in the VA are converted from GS scale 

          to LPS (PA 1-5), allowing for competitive pay with private sector

2021:

• PA profession is named best overall job in US News & and World Report
• PA title is changed to “Physician Associate” by AAPA

2022:

• 2,700 PAs employed by VA
• R.A.I.S.E (Retention and Income Security Enhancement) Act signed into LAW and increases PA and nurse pay caps