Predicting the past

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The human brain is famously bad at predicting the future. Psychologists have built entire careers proving that idea. Not only does the mind fumble the task of assigning probability to uncertain events, it also has the nasty habit of revising past predictions, of convincing itself that it had the right answer all along. Or was, at the very least, pretty close.
That tendency puts a lot of pressure on healthcare historians who, it seems, cannot resist periodically turning their sights on the future even as they study the past. The chapters of physician assistant (PA) history are speckled with those few souls brave enough to put prediction to paper for the next generation to scrutinize. Although the rest of the world can stroke its collective chin and modify its predictions in hindsight, the well-intentioned scholars of yesteryear must face their forecasting follies in damning black and white.
As we celebrate the PA profession's 50th anniversary, it is tempting to join their ranks and try to predict the next 50 years, to make sweeping claims or paint postapocalyptic visions of the world our children might one day inherit. But that prognostication would almost assuredly fail. Besides, who has the patience to wait and see how it will all pan out?
In a show of solidarity with my not-so-clairvoyant predecessors, however, I would like to travel back in time and look ahead, as one might have done in the early days of the PA profession. Perhaps by predicting the past—those pivotal first 50 years of the PA profession—we can avoid the mental traps of hindsight and use history as the guardrail for an intelligent forecast.
Here goes nothing.
The PA profession will remain a bastion of male dominance in medicine. Like the graduates of early PA programs, the gender demographics will remain heavily skewed toward males, with a ratio of nearly 3:1. The early precedent of men dominating medicine, set by our physician counterparts, is too great to overcome; the PA profession will be forever considered a boys' club. “Scrubs plus gender” will become ubiquitous hospital slang for guessing a person's job title.
Southern states will become a PA stronghold. A no-brainer, really. From its birthplace in North Carolina, the profession will proliferate in the southern states, an area where inadequate access to care—especially among rural and impoverished populations—will lead to instant acceptance of PA practice. Expect the Deep South to lay the blueprint for PA legislation while the more “elitist” Northeast turns its nose up at the profession.
The PA profession will mostly attract youngsters. In 1980, nearly 70% of PAs were under age 35 years. If anything, that proportion should only grow larger. Expect PAs to go to medical school in droves or to move on to second or third or fourth careers when reality does not live up to the excitement of TV medical dramas. A lack of salary growth and a scarcity of academic, research, and administrative positions mean PAs won't stick it out through middle age.
The PA profession is unlikely to survive its first 30, much less 50, years of existence. Just do the math. PAs face an uphill legislative battle, due in part to resistance from nursing lobbies (and even from some physicians), at nearly every turn. In addition, the 1980 Graduate Medical Education National Advisory Committee report suggests an impending surplus of physicians in the United States (seriously, look it up). The fitness craze and technological advances means longer, healthier lives for all Americans. Physician salaries will plummet as they fight each other on the open market for the few remaining sick patients.
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