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The MEDEX Northwest Physician Assistant Program was created at the University of Washington in 1968 as one of the nation's first physician assistant (PA) programs. A joint project of the Washington State Medical Association and the University of Washington School of Medicine, MEDEX was designed to meet the needs of overworked physicians in rural communities. As envisioned by MEDEX founder Dr. Richard A. Smith, "Physician Assistants were created by physicians, for physicians." Initially, all MEDEX students were former military corpsmen returning from Vietnam. Based on their extensive clinical experience, they were well accepted by doctors and their patients. Dr. Richard Smith was a former Peace Corps physician and leader of the federal project to desegregate the US hospital "system" as a requirement for Medicare reimbursement. Dr. Smith's founding principles for MEDEX included a collaborative model for community and practitioner involvement--the framework for the MEDEX Program throughout its 45-year history.