"Physicians' Assistant," "Medex," "Limited Physician," "Feldsher," "Officier de Santé," "Behadar," "Hakim"—there are at least 19 different terms for the same job according to a recent WHO questionnaire.1 Now that six of the first nine graduates of Dr. Silver's program are at work2,3 the term Child Health Associate can be added to the glossary. Previously, perhaps in jest, Dr. Silver had proposed still other titles: the "Syniatrist Associate" and the "Syniatrist Assistant."4 Dr. R. A. Smith, the promoter of Medex, has proposed still another list: "Flexner," "Kruser" and "Osler," to name a few.5 It is possible that before too long the American language alone will have produced more than the 19 terms, unearthed in the recent world survey, as well as a few trainees to match each term.All this semantic confusion does not even take into consideration newly coined terms that involve nursing: "Nurse Practitioner," "Nurse Associate," "Primex," etc. In spite of Dr. Silver's assertion to the contrary, and in spite of efforts by nursing leaders to preserve a nursing "identity,"6 it is very difficult to differentiate between job descriptions of the "Pediatric Nurse Associate" and the "Child Health Associate."Nevertheless, neither jest nor a dissection of the research "evidence" from Colorado will serve to dismiss Dr. Silver's advocacy and Dr. Greeb's testimonial.7 Dr. Ross' frank and thoughtful reflections add weight to the charge to consider their implications seriously.8 The fact is that, whether we like it or not, a very substantial effort is now underway in the United States to train "physician extenders" or personnel with primary caretaking responsibilities that ten years ago would have been considered physician responsibilities.
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