Is physician assistant autonomy inevitable?

After a half-century of development, the physician assistant (PA) movement is robust, dynamic, and has moved onto the world stage in ways its creators never imagined.1 One of the recurring topics discussed by PAs, nurse practitioners (NPs), and physicians is the autonomy of PAs and advanced practice registered nurses. A historical connection with organized medicine endeared the PA to physicians as befi tting a dependent relationship. Such professional groups as the American Medical Association, American Osteopathic Association, Association of American Medical Colleges, and American Academy of Family Physicians greeted PAs warmly because of a mutual interest—keeping physicians in the leadership role of medicine. On the other hand, the coolness of physician associations to the independence of NPs has been palpable.2 This causes some tension between the three health professions. NP animosity sometimes spills over to PA rhetoric on the subject and vice versa. However, as of 2015, NPs are independently licensed in 19 jurisdictions and such licensure in all states seems inevitable. At the same time, there is little uncertainty for PAs that change is coming in many ways and many forms. One of the ways is the trend toward autonomy. This self-suffi ciency is not so much a push as a pull. The AAPA is not pushing nor is there a concerted effort to do so on any other front. What is pulling is history—the inevitable evolution of a profession: the tendency to be self-suffi cient and selfgoverning. A cavalcade of observers has noted the trend of dependent occupations to eventually succeed to positions of independent licensure. These begin with psychology, optometry, and podiatry, then include physical therapy, audiology, occupational therapy, and nurse anesthetists, to name a few. The evolution of legislation and regulation over the past 4 decades has been remarkable. In this short span, all states and most territories now enable PAs to practice, prescribe treatments and devices, and be reimbursed for their services. Many states permit PAs to be semi-autonomous and function in remote locations. In Alaska, physician supervision has been changed to collaboration to be consistent with Is physician assistant autonomy inevitable?