The History of the OPA-C | Read ASOPA's White Paper on this topic

The concept for physician extenders began in the midst of the Vietnam War. Diverse and highly skilled men and women from the armed forces medical corps who had extensive on the job training were returning from active duty unable to be utilized to their full potential. This along with a projected physician shortage led to the creation of the medical extender programs (MEDEX) in the middle 1960s. These MEDEX programs were started in 1966 and 1967 to recruit military trained medics and corpsmen for additional training that would enable them to practice as Physician Extenders in the civilian sector as they had in the military. One of the first programs to be established was at Duke University in North Carolina. Soon after this, other programs began to be established across the country. At this same time orthopedic surgeons were looking for help with a variety of duties in their practice which included first assistants at surgery, application of immobilization devices, and general patient care.

Due to the fact that the MEDEX or "primary care" physician assistant programs did not provide focused education with regard to orthopedics the American Academy of Orthopaedic Surgeons began to look at ways in which to train physician extenders for their field. In 1967 the American Academy of Orthopaedic Surgeons accredited the first program for "Orthopedic Assistants." The AAOS committee developed a curriculum for the program to present to the AMA's commission. Elaborate plans for accreditation and certification procedures were outlined and reviewed prior to approval by the AMA and the AAOS in 1970. Following this, other programs began to open, and a total of nine programs of education for orthopedic assistants were opened in the civilian sector. A 10th program was opened in the US Army.

In May of 1971, the Council on Health Manpower of the American Medical Association encouraged the title change of the "Orthopedic Assistant" to Orthopedic Physician's Assistant. This was done to bring uniformity to the names of physician extenders while at the same time identifying the specialty that they were trained in. This was also done with Urology Assistants by calling them Urology Physician's Assistants. The Executive Committee of the American Academy of Orthopaedic Surgeons adopted this change and awarded the title accordingly.

Programs for training the Orthopedic Physician's Assistant continued with both AMA and AAOS accreditation until 1974 when a review by the Board of Directors of the AAOS determined that it did not have the "manpower" to continue to accredit these programs and recommended that this be completely undertaken by the AMA and the American College of Surgeons. When this occurred, the AMA and the American College of Surgeons were developing and supporting "generic" physician assistant, and with the withdrawal of the AAOS as an accrediting body the AMA felt that it wanted to continue to train only "generic" physician assistants. The last accredited AMA OPA program was in 1977; the last AAOS-supported OPA program was in 1976.

The demand for trained orthopedic help continued even though the AMA and AAOS were no longer accrediting programs, and in 1979 the National Board of Certification for Orthopedic Physician's Assistants was created. This board consisted of seven OPA members, four orthopedic surgeons who were certified by the American Board of Orthopaedic Surgery, and the examination administrator Ms. Sally Anne Henry, Ph.D., of the Professional Testing Corporation. This board and exam were created following numerous communications with the National Commission on Certification of Physician Assistants (NCCPA). In 1977, a communication from David Glazer, Executive Director for NCCPA, indicated that the NCCPA was interested in establishing a specialty physician assistant certification examination. When this was not established by 1979, the American Society of Orthopedic Physician's Assistants voiced their support for the creation of an independent certifying body for OPA's.

The first certification exam for orthopedic physician's assistants was given in the fall of 1980 at Tulane University in New Orleans, LA. The examination is still given annually at sites across the United States. Individuals who meet the criteria for taking the examination and receive a passing score are awarded the short title "OPA-C" (Orthopedic Physician's Assistant, Certified). Certification is then maintained by voluntary participation in continuing medical education programs meeting the AMA guidelines. Certification is "good" for four years at which time the OPA must have achieved 120 hours of continuing education or they must retest and pass the examination. The National Board for Certification of Orthopedic Physician's Assistants meets annually to review the examination, thus keeping it current with trends in orthopedic medicine.

Even with these decisions, OPA educational programs continued. Slowly because of difficulty finding program coordinators, these programs began to close. In 1990, the Kirkwood program graduated the last class of program trained OPAs.