After reading a number of questions about acceptance into PA programs a prevailing theme has emerged.
Many international physicians stated that their interest in becoming PAs stems from dissatisfaction with the hours or volume of patients they are seeing in their own practices in their native countries.
So, what is my advice?
That you make an honest, soul-searching assessment of what it is you are seeking.
PAs are Not an MD Surrogate
If you have a prevailing feeling that your MD is a superior credential and that you will be functioning as an "MD Surrogate" in the US, then perhaps you don't fully understand the concept of a PA/supervising MD team.
Every good PA knows very well our limits in the scope of practice which have served us and our physician mentors very well for over 40 years.
We aren't, and never will be physicians!
Nor will you, if you practice as a PA within your scope of practice.
PAs Don't Always Have Regular, Predictable Hours?
You may also want to investigate why you believe that coming to the United States to become a PA will ensure that your hours will be regular, predictable and better than what you have now.
Your hours will depend completely on the medical practice or hospital which hires you.
Expecting that as a PA you will have it easier than you have it as an MD may be a false assumption.
Many PAs work very long, grueling hours in emergency rooms, critical care, hospitals, public health facilities, family health care, community clinics and countless other fields in addition to volunteer work on their own time.
The person who inquired about coming to a US PA program because PAs in Canada are still new and not well respected might do well to step back for perspective.
R.E.S PA-C T
PAs in the US are the single most serially tested group of medical providers in the world.
We are currently changing a decades-old requirement for national board certification exams every six years to maintain our treasured "C" on our credential, indicating board certification.
But if you look closely at the environment which mandated our test schedule it reveals that we have been regularly asked to "prove" our knowledge, skills, and trustworthiness for those same decades.
Each of us went through some version of facing the "newness" question about what is a PA and scrutiny and occasional rejection by physicians, nurses, and patients.
And most of us will tell you the struggle to prove ourselves is hard.
And at one time it may have been necessary.
But now, for most situations, when you join a medical practice, your patients already know what a PA is and how we function with their physicians.
In Canada, your PA profession, though in comparative infancy to the US, needs great people to choose it, build its competence and support its growth rather than abandon it and go to already proven territory.
If you believe in rigorous academic and clinical training then wouldn't you want to be in the vanguard in Canada demanding that rigor?
The Good With the Challenging
I treasure my life and work as a PA in California and Florida.
Anyone fortunate enough to come here as an immigrant looking for an opportunity to serve in the medical corps is warmly welcomed and will be honored by our ranks.
But when you choose this path to PA make sure you are seeing the good with the challenging and accepting that part of being in medical care.
Every place in the world demands a near-total commitment of time and the humility to be comfortable caring for impoverished people, people of every cultural and ethnic background, just as you are doing wherever you currently live.
Your challenges are the same as ours in that regard.
The United States PA programs are unparalleled in preparing a workforce to address the overwhelming problem of inadequate access to health care.
But we may not be a panacea for overworked, over-scheduled and feeling unappreciated, at times.
Sincerely, and with good wishes for your success,
- Martie Lynch BS, PA-C
The Long Road to Practice
Today's post comes to us via the comments section and was written by physician assistant Margie Lynch, PA-C.
I receive many comments and emails from internationally trained doctors looking for career options here in the United States.
In fact, as an undergraduate, while working in the campus health clinic, I had the privilege of being trained by a foreign medical doctor from India who had transitioned to a laboratory tech in the United States.
The truth is, in many instances, a foreign medical degree is non-transferable and the barriers to practice prevent many highly skilled, well-intentioned international providers from coming to the United States. And like the MD I worked with, their skills and training may go to waste. This is a shame sad there are many clinics and hospitals in the US that would benefit from culturally competent bilingual practitioners.
And like the MD I worked with, their skills and training may go to waste. This is a shame sad there are many clinics and hospitals in the US that would benefit from culturally competent bilingual practitioners.
This is a shame as there are many clinics and hospitals in the US that would benefit from culturally competent, highly skilled, bilingual practitioners.
International Barriers to Practice in the United States
According to this NY Times Article, the United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care. And that shortage has gotten exponentially worse since the passage of the affordable healthcare act in 2014.
For years the United States has been training too few doctors to meet its own needs, in part because of industry-set limits on the number of medical school slots available. Today about one in four physicians practicing in the United States were trained abroad, a figure that includes a substantial number of American citizens who could not get into medical school at home and studied in places like the Caribbean.
But immigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can actually practice here.
The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).
The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck.
That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.
The whole process can consume upward of a decade — for those lucky few who make it through.
Fighting Brain Drain
The counterargument for making it easier for foreign physicians to practice in the United States — aside from concerns about quality controls — is that doing so will draw more physicians from poor countries. These places often have paid for their doctors’ medical training with public funds, on the assumption that those doctors will stay.
According to one study, about one in 10 doctors trained in India have left that country, and the figure is close to one in three for Ghana. (Many of those moved to Europe or other developed nations other than the United States.)
No one knows exactly how many immigrant doctors are in the United States and not practicing, but some other data points provide a clue. Each year the Educational Commission for Foreign Medical Graduates, a private nonprofit, clears about 8,000 immigrant doctors (not including the American citizens who go to medical school abroad) to apply for the national residency match system. Normally about 3,000 of them successfully match to a residency slot, mostly filling less desired residencies in community hospitals, unpopular locations and in less lucrative specialties like primary care.
In the United States, some foreign doctors work as waiters or taxi drivers while they try to work through the licensing process.
The International Path to PA
Is PA a reasonable alternative to foreign-trained medical providers whose skills we desperately need here in the United States?
And just how many PA schools are eagerly opening their doors to these practitioners?
This, my friends, is a topic for another blog post.
Feel free to share your thoughts in the comments section down below.
-Stephen Pasquini PA-C
Are you or someone you know a foreign trained doctor or a medical provider looking to practice as a PA in the US? Here are some useful resources:
- Here is a wonderful resource on the topic from the ARC-PA (they accredit US PA programs and determine who may sit for the PANCE exam)
- Physician Assistant Forum - Foreign medical graduate
- Dose of PA - From International Student to Physician Assistant
- NY Times Article - Path to United States Practice Is Long Slog to Foreign Doctors