The first physician assistant program in the United States was at Duke University Medical Center. This program served as a model for other institutions to begin similar educational programs, and the profession has quickly become a major source of medical services throughout the country. Less well-known is the role of Duke University and North Carolina in the development of a unique regulatory system, which also became a national model. This system has been effective in protecting the public and the patient, and has had the flexibility to adapt to changing medical practice and changing standards. The process by which this regulatory system was developed was unique, and its unique characteristics are felt to have been a significant factor in its success. Duplication of these characteristics is recommended for those who wish to incorporate new medical occupations into the larger medical community.