Support of Nurse Practitioners and Physician Assistants

Since the Foundation began as a national philanthropy in 1972, it has given high priority to increasing access to medical care. Survey research in the 1970s revealed that Americans felt that having access to a physician was one of their most serious health needs. In its earliest programs, the Foundation tried to address this problem. Its very first grants were medical school scholarships for minorities, women and students from rural areas—on the grounds that these people were likely to provide services to those with the least access. In succeeding years, the Foundation supported rural health initiatives, programs designed to bring services to inner cities, training of generalist physicians, and a host of other efforts designed to make physicians more accessible to patients.

The Foundation also recognized that increasing the availability of physicians, although important, was not the only answer to solving the problem of lack of access. Other health care professionals needed to be trained—particularly those thought to be more likely to work in underserved locations such as inner cities and rural areas.

Among those professionals were physician assistants and nurse practitioners. In the 70s, these professions were just becoming established, and federal funding for training was not yet available. In fact, there was some opposition from both the medical and the nursing communities to establishing a new category of health professional. The Foundation entered at a very opportune time and was able to boost the development of a new breed of health professionals. In time, nurse practitioners and physician assistants became recognized health care professionals, but when the Foundation initiated its support, both groups were in their infancy and it was not at all certain they would survive to maturity.

Terrance Keenan, who joined the Foundation in 1972 as a vice president, played a key role in shaping the development of programs that developed the fields of nurse practitioners and physician assistants. Now serving as a senior fellow with the Foundation, he tells the story of the early days of nurse practitioners and physician assistants.

Unlike the other chapters in this book, this chapter of the Anthology takes a look back. It offers the chance to reflect upon grantmaking done largely in the relatively distant past and to consider the lessons to be drawn from more than a quarter century's experience.