Major General Spurgeon Neel and the Army Physician Assistant: A Case Study of Policy Change

Perhaps the greatest modern medical policymaker was Major General MG Spurgeon Neel. Serving from 1943 to 1977, Neel is best known as the Father of DUST OFF or the Father of Aviation Medicine for his pioneering role in the creation of the doctrine of helicopter medical evacuation. One of Neels greatest strengths was his power of evidenced-based persuasion. He published more than 33 articles in the fields of flight, operational, and military medicine. He was passionate about his causes to be sure. Nonetheless, his support for them was based on rational analysis. Diverging from common mental models, the ideas contained in his writings included a supported set of instructions for an improved future. Most importantly, as a champion of change, MG Neel possessed the leadership skills to convince the establishment that his visions were incontrovertible. Almost all of Neels policies have withstood the test of time. One has become distorted. In 1973, Neel described the concept of the physician assistant PA to the Army. Whether the idea was his alone, that of his superior, or a consensus creation is unclear. What is definite is that it was MG Neel who provided the justification and voice behind the plan. His vision for the PA position was specific. As with other policies, he supported it with documented insight and analysis. In 1984, many years after MG Neel had left the Army, the PA position changed in a subtle but important way. This alteration occurred in the absence of a champion via a process that is best termed bureaucratic policy change. The purpose of this essay is to gain understanding into the processes by which high-level Army policy may develop and change. Using decisions related to the PA position, championed-based change will be compared with the bureaucratic model. To best understand these competing models, significant detail will be devoted to an in-depth understanding of the PA policy.