Physician Assistant Founder, Global Health Innovator, Peace Corps Medical Director, and Civil Rights Leader
Global health leader and recognized founder of the physician assistant (PA) profession, Richard A. Smith, MD, MPH, died March 10, at his home in Honolulu, Hawaii. He was 84.
In 1968, Dr. Smith created one of the nation’s first PA programs at the University of Washington (UW) to extend the medical care of physicians by training a new kind of clinician who could partner with a primary care doctor in medical practice. He used the term MEDEX (MEDical EXtension) to denote his systemic approach used to educate and place graduates in medically underserved communities.
After launching the first MEDEX program at UW, Dr. Smith helped replicate the MEDEX model at seven other universities throughout the United States to validate the program strategies and to broaden support among political and medical leaders. Dr. Smith spent another 20 years adapting the MEDEX concepts and strategies for developing nations.
An officer in the US Public Health Service (PHS) for 25 years, Dr. Smith is remembered for his groundbreaking roles as the second PHS medical officer to go abroad (Nigeria) with the Peace Corps (PC) in 1961. He later served as deputy medical director of the Peace Corps worldwide.
As Director of Field Operations for the Office of Equal Health Opportunity (OEHO) in 1966 under Surgeon General William Stewart, Dr. Smith helped to ensure desegregation of 7,000 American hospitals after the passage of the Civil Rights Act of 1964 and Medicare. President Lyndon Johnson asked Dr. Smith to desegregate the hospital in Lady Byrd Johnson’s hometown of Marshall, Texas, first, and to do it personally. OEHO’s desegregation campaign was described as “perhaps the most peaceful and successful civil rights effort in American history,” by American Legacy magazine in 2000.
While serving as Director of International Health Manpower Planning in the Office of the Surgeon General, Dr. Smith became the first African American and the youngest person appointed to official U.S. delegations for the World Health Assembly in Geneva in 1967, 1968, and 1970. For two decades, he continued to serve on human resource committees of the World Health Organization (WHO).
In 1968, Dr. Smith created the first MEDEX PA program at the University of Washington in Seattle to “extend the healing hands of overburdened physicians” in underserved rural communities of Eastern Washington. More than a training program for PAs, MEDEX was his global vision for introducing, developing, and deploying new mid-level medical professionals who could handle much of the basic and routine care that physicians provide.
Smith’s lifelong commitment to his vision was inspired at a church work-camp in the mountains of pre-Castro Cuba when he was 17. In a rural clinic, he assisted a “practical nurse” who was a daily lifeline for families between the few hours each week when an overworked doctor visited. Dr. Smith switched his college major from music to medicine, determined not only to become a doctor but also to “multiply my healing hands” by training others to extend care.
In 1973, Dr. Smith established The MEDEX Group in the John A. Burns School of Medicine at the University of Hawaii. Smith and his staff assisted eight countries on four continents to strengthen their national health programs through the training and management support of non-physician healthcare providers.
With his global health team Dr. Smith produced a 35-volume, 7,000 page MEDEX Primary Health Care Series in collaboration with governments of Micronesia, Guyana, Lesotho, Kenya, Costa Rico, Botswana, Liberia, and Pakistan. The MEDEX Series provided a systemic framework and resources for expanding medical care in underserved and low resourced countries. It has been translated in whole or part into 33 languages and used in over 88 countries. The United Nations Conference on Science and Technology for Development (UNCSTD) cited The MEDEX Primary Health Care Series as “one of the most promising technologies available for improving the delivery of basic health services.”
Nelson Mandala and the African National Congress brought Dr. Smith to South Africa in 1994 to assist in designing structure and policy for more equitable health care.
Dr. Smith together with Dr. Eugene Stead, Jr., at Duke University and Dr. Henry K. Silver at the University of Colorado are recognized as co-founders of the PA profession by the Physician Assistant History Society.
Richard Alfred Smith was born in Norwalk, Connecticut, on October 13, 1932. He is survived by his first wife of 18 years, Parbattee Spangler-Gangadhar, a Florida resident, and their sons: Dirk Smith, Rik Smith, and Erik Smith, all residents of the San Francisco Bay Area; and his second wife of 40 years, Lorna Carrier Smith, and their sons Blake Smith and Quintin Smith living in Honolulu, Hawaii. He has 9 grandchildren.
Memorial arrangements are pending. The family requests memorial donations be made to the Richard A. Smith MEDEX Scholarship Fund c/o the University of Washington Foundation, 1320 NE Campus Parkway, Seattle, WA 98105.
Reprinted with permission of the University of Washington Health Sciences and UW Medicine. If you’d like to read more, UW recently published this story about the life and career of Dr. Smith.