Edited Transcript
Interview with Thomas Dunn, PA-C
Interviewer Dr. Reginald D. Carter
April 24, 2012
Asheville, NC
TD: Thomas Dunn
RDC: Reginald Carter
RDC: Tom, you graduated from the Duke PA Program but I’m very interested in your life before going
to PA school. Could you give me a brief summary of where you grew up and what you did before you
entered the PA Program at Duke?
TD: Well, I grew up in Roxboro, North Carolina. I was the son of a tobacco farmer and graduated with
national honors from high school. I had the grades but didn’t have the funds to go to college so my best
opportunity, I thought, was to join the Navy. I was guaranteed a school with the Navy so I went into the
Navy in 1958 and went to hospital corpsmen school in Great Lakes. After I finished that I spent about
eighteen months with the Marines at Camp Lejeune, North Carolina and to get out of there, I asked for
another school and they sent me to the neuropsychiatry school in Philadelphia. After I graduated there, at
the top of the class, they sent me to Portsmouth, New Hampshire to work in the delivery room. That was
good utilization of my training (laughs). So, after I got out of service (I enjoyed the service), I worked as
hard the last day as I did my first day. There were no advancement opportunities that I could see because
all the billets were taken up by the Second War Veterans. And, so I got out, and I had applied at Chapel
Hill (the University of North Carolina). I was going to be a CPA. I had been accepted and I went to my
first day of school and, come to find out, they hadn’t processed the loan application, so I didn’t have the
funds to go. So, I said, well, if I can get my money back I’ll do something different. So, I went to work
at Duke in the catheterization laboratory after applying there.
RDC: So, you just went over to Duke and applied for a job, a clinical-oriented job, and they hired you in
the catheterization laboratory.
TD: That’s right.
RDC: Were you the first ex-military corpsmen to be hired by Duke at that time?
TD: No, Nelson Myers was already working in the catheterization laboratory. We had similar
backgrounds as corpsmen. He had gone through the cardiovascular training program at Bethesda, I think,
and he got out of service and went to work in the catheterization laboratory.
RDC: And, what types of things did you do in the catheterization laboratory at Duke in 1960?
TD: 1962. We learned to scrub, we learned to operate all the electronics, the Colson Densitometers, we
were doing cardiac outputs, and an analysis to get the calibrations to determine the studies that we had
done, and processing records.
RDC: So, was there much patient contact in those days, or was it mostly animal research?
TD: It was both. In those days, most of the money was devoted to animal research. So, we did a lot of
animals – pig, dog and alligator studies and, then, we also, in those days, were studying people who had
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IHHS. It’s a type of heart disease that we needed to learn more about. That was in the days of the old
computer programming. We had punch cards that we had to enter the data on. So, we would work all
day collecting the data and, at night, we would take work home with us as extra work to get ahead to enter
it in and do the preliminary work.
RDC: Now, you were in the cardiovascular laboratory but there were other ex-medical corpsmen being
hired for other units in medicine around Duke.
TD: Yeah, I forgot what it was called, but where John McQuery worked…
RDC: Dialysis Unit?
TD: Yeah, the dialysis unit and Charlie Mitchell…those were the main labs that I recall.
RDC: So, my understanding is that you were on the payroll. Do you remember, or recall, being called a
physician assistant even before the PA program started? Or being on the payroll as a physician assistant?
TD: Well, not before I finished school. Dr. Henry McIntosh was Chief of the Catheterization Laboratory
then. He allowed Nelson (Myers) and me to participate in the PA Program when it first started. If we had
free time, Nelson and I could both go to class and if we didn’t, one would go to class, keep notes and the
other one would get those notes that night and we would study together.
RDC: And, that’s when the PA Program was first established in 1965, three years after you were
employed at Duke. How did you find out about the Program and how did you get into the Program?
TD: Well, we were at Duke and we knew Jim Mau, who was the administrator (of the department of
medicine), and we talked to him frequently. We knew about the Program that was being planned and we
took a lot of the exams, I guess, to demonstrate our proficiency and if we were best suited for the
Program. There were probably eight or ten of us guys who were part-time students.
RDC: So, one group went fulltime – Ferrell, Germino, Scheele and Guffy while the rest of you went parttime So, you were really in the first class of PAs. You just graduated a year later and, there were, what maybe six or seven of you in that class, part-time. So, what was the curriculum like when you went
through Duke?
TD: Well, we had class work that we participated in first and, then, we had different clinical rotations.
One of our rotations was the emergency room. I also rotated in the endocrine clinic, and then, also in
neurology. We worked right along with the medical students and the residents who did the training. We
participated in the training that the residents were teaching the medical students.
RDC: So, you just blended right in with the ongoing teaching program?
TD: Right.
RDC: Did you encounter any resistance when you were a student from nursing or any other group?
TD: No, not really that I recall, but, I know there were some concerns that some of the nurses had toward
the PAs. Dr. Andreoli, was originally a nurse, who helped teach us and she smoothed out a lot of the
areas that were concerns.
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RDC: As I recall, Ruby Wilson, who later became the Dean (of the school of nursing), was also heavily
involved up in the dialysis unit. She got to know the medical corpsmen quite well. So, she helped a lot,
I’m sure. So, you’re getting ready to graduate in ‘68 and jobs were scarce in those days. You were a new
type of professional. So, what was going through your mind concerning work?
TD: Well, I knew the catheterization laboratory at Duke and many of the Fellows (house staff) who came
for training. Dr. Russell and Dr. Saunders, who were Fellows there, knew me and I had worked with
them on their research projects. And, so, when Dr. Russell came to Asheville to begin a cardiology
practice, he invited me to become a member of the Cardiologist Group. That was the summer of ’71 and
he called me up and offered me a job. I came to look, I think in September, and accepted the job in
December. I came to work on January 10th in ‘72.
RDC: So, between the time you graduated and took the job with Dr. Russell, did you stay at Duke or
were you out-of-cycle in graduation. Did you graduate in a different month?
TD: No, we graduated, it seems like it was in the fall of “65”, I think.
RDC: OK, or ’68?
TD: ‘68, the second class. So, we graduated in the fall and I continued to work in the catheterization
laboratory.
RDC: Ok, so you just continued what you were doing part-time and stayed on.
TD: At that time I was Director of the technical and nursing staff of the catheterization laboratory.
RDC: Oh, you became the Director of the Catheterization Laboratory’ staff.
TD: I had three years in at that time.
RDC: But, then, you were on the payroll as a physician assistant and were recognized as a physician
assistant - once you had graduated.
TD: Apparently, that was the way it was.
RDC: Ok., tell me about coming to help startup a cardiology practice in Asheville, NC. I guess Dr. Max
Mauney was the only cardiothoracic surgeon and Dr. Russell was the only cardiologist in town at that
time.
TD: Dr. Mauney and Dr. Keller were the cardio-thoracic surgeons and Dr. Russell was the only
cardiologist in town. So, it was an exciting time. It was a new period for everybody in town and we all
felt that we had something to offer the patients that were in the area.
RDC: How were you introduced to patients? Do you remember how that went?
TD: Well, Dr. Russell and I would round each morning together and he would introduce me to the
patients as his assistant. If there were specific needs, like treadmills or some type of test, he would
indicate to the patient that I would be the one seeing them in the Catheterization Laboratory or treadmill
area for further testing.
And, so, I never had any problems of being accepted by the patients or the staff.
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RDC: What about Mission Hospital and getting the hospital bylaws (staff privileges) amended for PAs.
Do you remember much about that or was it basically handled by the physicians and hospital
administrators?
TD: That was basically handled by Dr. Russell.
RDC: So there weren’t any problems getting staff privileges or dong procedures?
TD: Well, I remember once that Dr. Russell asked me to put in a line, a cut down line on a patient. And,
for some reason he was out that afternoon and the nurse called for one of the surgeons to come and put
the line in. So, he was disappointed and a little upset when he found out that we hadn’t put the line in our
own patient but that the nurse had gone above what he had left instructions to be done.
RDC: Was that a matter of contention (or concern) about nurses taking orders from PAs in those days?
Did you just worked it out by talking?
TD: Well, we worked it out by talking it over and I was never a very demanding person. I knew what
was best for the patient and offered the best and at times, you know, I don’t remember having any bad
relations with the nurses about the care that the patient was to under go.
RDC: How quickly did the practice grow? You started out in ’72 by, let’s say, in five years, where was
the practice at that point?
TD: Well, in ’72, Dr. Russell and I shared a catheterization laboratory with the Radiology Department
and it was about two years before Dr. Saunders came. He planned to come initially, but was drafted into
the Army. So he joined us in 73’ or 74’ and then each year after that we began to add a physician. I guess
every couple of years or so.
RDC: So, it grew very quickly?
TD: Yeah, it grew fairly quickly.
RDC: And now, you’re up to, I believe 12 physician assistants and how many physicians?
TD: I think there are 22 physicians.
RDC: Wow that is a lot of growth. Let’s go back to those early years and what you were allowed to do
and not to do. I know in the early days you could not prescribe medications at all – so how did you
handle that?
TD: Well, if there were any prescriptions that needed to be done, on rounds that morning, we would
earmark the patients that needed prescriptions and would get the doctor to write the prescriptions for
them.
RDC: So you were already at the point of basically knowing what the patient needed - so you would
write the order but had to wait for the doctor’s signature?
TD: I could write the order in the chart but the prescription or discharge note would have to be written
and signed by the doctor at that time.
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RDC: So you worked primarily in the catheterization laboratory, but did you also do follow up visits with
patients?
TDC: I was doing follow up visits; I was actually doing a lot of the procedures, Swan Gants line,
temporary pace makers, thoracentesis and pericardiocentesis.
RDC: Did that take much effort to get the Board of Medical Examiners to sign off on doing many of the
procedures? That is, a non-physician doing those kind of things?
TD: Well, when we started I was told that PAs, with the trust of their physician supervisor, could do
anything that he would allow them to do.
RDC: OK, so the physician had delegatory authority and the Board was satisfied as long as the physician
said “I stand responsible. My PA can do this.” They were acceptable. You don’t remember getting your
hands slapped or told “no, you can’t do that.”
TD: Well, we had one nurse that was here from California and for a period of time he seemed to dislike
most everything we did. He made a big issue (about what we did) and reported it to the Board of Medical
Examiners. Eventually, Dr. Russell, I and Bill Lang had to go to Raleigh to have a hearing with the
Board of Medical Examiners.
RDC: And, how did that go? Did they, after you presented your case accept what you were doing?
TD: Yes, yes, there were a lot of responsibilities that the Doctor assumed we could handle that apparently
the Board of Medical Examiners wanted to know more about and how we operated our practice. There
were no issues after that.
RDC: I’m sure that you have seen many changes over the years now that you’ve got forty years to look
back on this profession. I’ve talked to many pioneering PAs about this. When you graduated from Duke
did you have some sense of what your role as a PA would be or what you would like the role to be? At
that time, how did you see the PA role?
TD: Well, I was one of those young, interested people who would have liked to have been a doctor.
I didn’t have the means or finances to do that, so I made the most out of my experiences.
RDC: So, the more you could take on to do, the better you liked it.
TD: And, some of the doctors that I worked with there were the best in the world. They assisted me with
a lot in my life, getting me a head. And had confidence in what we could do.
RDC: By that, you mean that they were good teachers and they were good about allowing you to take
responsibility when you were capable of doing that.
TD: Right.
RDC: Do you remember the first time you were able to write a prescription under your own name?
And what that felt like?
TD: I don’t recall, not really.
RDC: Or had you been writing prescriptions all along and just not signing, so it was ….
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TD: Well, I had been writing them. And we would get the doctor to sign them. That was not a big deal.
RDC: So, once you were able to put your own name on the prescription, it was just routine…
TD: Yeah, it just simplified matters a lot – with the method to just find the doctor or get someone to sign
for the prescription so that the patient wouldn’t be held up and could get out of the hospital.
RDC: Could you imagine when you first graduated how much autonomy that you ended up having by the
time you ended your career as a PA?
TD: No, not really. Well, it was an opportunity that many people don’t have. A new profession and new
skills for unique people and, you had to really enjoy your work to do well at it.
RDC: Looking back at your career, and you’ve already mentioned some of these, what would you say are
the most positive things about a career as a PA, personally for you?
TD: Well, I think, for me, the satisfaction that we did things to help mankind. To help people get well is
an opportunity that most individuals don’t have. We understood the patient’s need from the time they
entered the hospital. When they would come in very sick and when they would leave in a healthier
manner that was uplifting for me.
RDC: Spending over forty years in cardiology and seeing all the advances during that time, must have
been exciting.
TD: Yes. When I first started, at Duke, there wasn’t anything such as coronary arteriography. We
developed the program there. We would go into the shop and manufacture, under a Bunsen burner and
sterile technique, the different shaped catheters necessary to get through the coronary artery during the
diagnostic procedures.
RDC: You made your own?
TD: Yes, we made our own.
RDC: No stints or anything of that…
TD: We used what was available, a period way before stints were used.
RDC: And radiologic technology was not overly advanced.
TD: No, because at the catheterization laboratory at Duke, we had three rooms, and we were separate
from the radiologists. We did all cardiologic procedures.
RDC: Now, when new physicians would join the group practice in Asheville, how were they introduced
to PAs if they hadn’t worked with them before?
TD: Well, that was sometimes a concern because some of the physicians who came had no idea or
knowledge of what the PAs were capable of doing. And, to be honest with you, and not bragging, I think
some of them were jealous of what my capabilities were.
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RDC: Well, if you’re a new doc and you work with someone (a non physician) who is more seasoned, it
makes you envious, I’m sure, but, it also must have inspired them to work harder to gain new skills.
TD: I think some of them actually tried to change some of the things we were doing.
RDC: But, I guess the senior partners, they did not want to go backwards.
TD: No, right.
RDC: In educating students, I know that not long after you set up the practice, you began taking students,
medical and PA students, is that right?
TD: Yeah, we had residents from Chapel Hill who would come and spend a month with us. Also, PA
students came from different programs. I trained the residents from Chapel Hill to do various techniques
in the catheterization laboratory, such as, putting in lines, cut downs, Swans Ganz catheters, pace makers,
all the different approaches such as jugular, subclavian and femoral vein access - all of those.
RDC: So, the residents are being taught to do these elaborate procedures by a PA. Now, that had to
register something in their minds (about the use of PAs or team delivered health care)?
TD: Well, I think I had the respect of most people who came. Not bragging, a lot of them knew what my
background was, what my capabilities were, and the physicians I worked for, they knew what I was
capable of doing.
RDC: So, these young residents, I’m sure you weren’t able to follow, but I would imagine one of the first
things they sought was a PA of their own once they got out to practice.
TD: We didn’t have any problems with them seeking the help of a PA.
RDC: That’s great! Any negatives about being a PA? Anything that you think back and say “gee…
TD: No, not really anything negative. Only if I had my time to do over again, I would have searched
harder to find the money to become a physician, because I think I could have been as good as anyone in
the country.
RDC: Uh, hum.
TD: But, the opportunities weren’t there when I was capable. I had one patient, Dr. Sam Walker, who
was a general surgeon here in Asheville. When he had his surgery, I took care of him. He came up to me
one day and said “son, you pick the school that you want to go to – medical school – and it’s yours.”
And, at that time, I was mid-to-late 30’s and I had been to school most of my life and I didn’t really want
to go back. I had a family, too. That was more than what I could imagine doing again.
RDC: But, the PA profession really gave you that opportunity that you wouldn’t have had, otherwise, to
do the things that you were able to do. One reason that we do oral histories is to get this information out
to the younger generation of PAs who are just beginning to practice. If you had any advice to pass on to a
person who has just begun their career as a PA, what would that be?
TD: I guess, to work hard and earn the respect of your patient and the people you work for and things
will work out.
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RDC: So, just stay focused on the job and the people.
TD: Right.
RDC: Is there anything that I’ve missed? I know this is a short interview but is there a question that I
should have asked you or an area that you would like to cover that we haven’t covered?
TD: I can’t think of anything, really. Those were the highlights – some of the most rewarding years of
my life. To all the people who gave me the opportunity from Duke, especially, Drs. McIntosh, Morris,
Kong, Russell and Saunders, I will always be indebted.
RDC: Yeah – the physicians – we wouldn’t be where we are today without the physicians. There’s no
doubt about that. We need to keep that partnership and that respect.
TD: Right, exactly.
RDC: Well, thank you for the interview and it’s been great to have been with you and getting some of
this foundational history.
TD: Thank you.
Final edits and approval by Thomas Dunn, June 1, 2012.
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