Meet The PA Pioneers of Israel: The Israeli Physician Assistant

This is part four of a nine-part miniseries by documentary filmmaker Adam Halbur on the PA model around the world.

The Test: PAs for Israel

Israel, the only Middle East country other than Saudi Arabia to attempt a physician assistant program, graduated its first trial cadre in 2017, retrained emergency medical technicians to fill shortages in hospital emergency rooms around the country.

• The Saudi program, begun in 2010 with faculty from George Washington, takes 28 months including military training.
• The Israeli program, run by the Ministry of Health’s Training and Development Department, does not have the military component; though service is mandatory for all citizens unless deferred, and the country is at odds with many of its neighbors, not to mention Palestinians who have been dispossessed of land and rights.

I was aware of this tension seeing soldiers with machine guns at train stations and guards manning metal detectors at the entrance to hospitals and bus stations. I wasn’t able to bring my tripod into one hospital for an interview.

Unbeknownst to me, I was even being watched while I filmed B-roll of passing ambulances. This man came up to me to ask what I was doing, and when I told him I was making a documentary on Israeli medicine, he thanked me and offered me a box of cookies. One could grow paranoid and question motives.

Israeli PA Master's Degree

However, Udi Gelbshtein, coordinator of the pilot at Sheba Medical Center, said that if all goes well, Israel hopes to train PAs in other specialties and perhaps start a master’s program.

“We are ready to do the next training. If we are going to have the 100 positions that we wanted to have in the emergency medicine department, we are not going to open the third one,” he explained. “I think that their success in the field will probably lead the university to start, you know, offer the program for a master’s degree.”

I arrived at Sheba just as Gelbshtein was supervising the inaugural written exam. I asked one student who had finished, Idan, what had brought him to this point:

I used to volunteer in MADA [Magen David Adom in Israel], which is an emergency ambulance. And a friend mine told me, ‘Let’s go and volunteer.’So I said, ‘OK, why not?’ So we started, we did this one-year course where you become an ambulance driver. And we started our training and we both went on this call and she saw a little blood and she lost consciousness, she fainted. And she stopped her volunteer [sic] and I stayed. And then I started working in that company and became a paramedic, instructor.

PAs are a "Natural Progression"

For Idan, who slowly worked his way up, the PA profession is a natural progression. “For paramedics here in Israel,” Gelbshtein said, “for many years there was like a glass ceiling above their head. And someone who did the paramedic training and spent three years in a university and, you know, practiced paramedicine for a few years, if they wanted to change careers, it was very difficult for them.

Some went to nursing, some went to other professions, you know, not even medicine, but this physician assistant program is now giving them another opportunity[iv] to continue in the same profession—in the same way they did for so many years and spent so much time—gives them the opportunity now to grow further and pursue something more challenging.”

Even With Years of Medical Experience, It's No Easy Task

Many of the PA candidates, most of them men, had been EMTs for about 15 years, but while they were very experienced in the field, some students expressed academic frustration.

“He passed and he passed of course,” one student said when I asked a group how they did on the test. Another replied in jest, 'I passed away' Gelbshtein said the program is tough and the students could do with more time to absorb the material.

“The students I can’t say suffered, but they trained very hard. Personally, I think that it’s not easy to do such extensive training within one year. It normally takes two and a half years,” he said defending his inaugural cadre. “And most of them have families, wife, kids, you know, even parents they need to take care of. So it’s not easy. It’s something that is very very demanding. So they deserve a big thank you, you know, for continuing and always studying and asking questions and everything.”

Improving Patient Outcomes

A few days later I caught up with Idan at the Wolfson Medical Center’s newly renovated ER where he told me his success story of adapting to his new PA role:

It was a 60, I think it was a 60-year-old patient who came here with stroke signs, came with an ambulance. And I started managing. I asked the secretary to hold the CT. I talked to the neurologist. I didn’t wait for someone to take him. I took him myself after doing the examination. And we went straight to CT, and I met the neurologist at the CT. And after doing the CT, we decided to take him straight to the stroke unit and give him treatment. In the evening, I got a nice call from the hospital which said there’s no neurological deficit.

Despite finding newfound fulfillment in seeing his patients recover in hospital, he was continuing to volunteer in the field as an EMT, for which he has a bug. And he indicated if a master’s program were instituted, he might go for it.

As Good as You Can, As Professionally as You Can

Idan, as most PA-like professionals I have met, are for the most part very realistic about the profession—it might be gainful employment for all, but for the successful, the drive to keep improving, to keep learning, is essential:

It’s like a routine, you come to work, you do what you need to do and you get a thank you from this and you get a thank you from that. This one or that one, it doesn’t matter. And you continue your day. At the end of the day, it’s work. You’re trying to do it as good as you can, as professionally as you can. And you study, you keep studying all the time. After you finish the work here, you go home and you read and you learn. I don’t think it ever ends.

At the time of the interview, Idan had passed the written test but was still waiting to do the practical, or OSCE (objective structured clinical examination), which he eventually passed, as well.

Will There be PAs in Palestine?

With all the camera and audio equipment I had to tote around, and the wearisomeness of passing through security checkpoints, I never went to the Palestinian territories. But I wondered during my time if Palestinians, who are in great need of medical services, especially in Gaza, would benefit directly from the Israel PA program. All indications were that it was for Israelis and does not pertain to the Occupied Territories. When asked if Palestinians would have PAs, Gelbshtein replied:

“I don’t see why not,” meaning, as I understood, they could train their own. Any benefit to Palestinians would be to those living and/or working within Israeli society needing emergency care. Perhaps this will change, that any PA programs would educate Israeli and Palestinian alike and that they would live together, perhaps as two states and hopefully as one nation, everyone with equal socio-economic rights.

Adam Halbur is a writer and teacher living in Tokyo, Japan. A short version of his film As Good As You Can, As Professionally As You Can premiered at the 11th annual conference of the International Academy of Physician Associate Educators. Watch the “American Cheese” segment of the longer version here. Watch a short of the 50th AAPA Conference with interviews from Ruth Ballweg and David Kuhns here. Halbur is entirely self-funded, so if you appreciate his work, please consider making a small contribution to his feature documentary on the Kenyan clinical officer.

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Resources and References

• Physician assistants in Saudi Arabia
• We are ready to do the next training
• Let's go volunteer
• Another opportunity
• I passed away
• It's not easy
• There's no neurological deficit
• It's a bug
• It's like a routine
• I don't see why not
• As good as you can
• The Test - PAs in Israel
• Support this work

Stephen Pasquini PA-C Physician Assistant

Stephen has been a family practice PA since 2004 and is the creator of The PA Life, Smarty PANCE Board Review, and PASchoolfinder websites. A National Health Service Corps Scholar and a graduate of The University of Medicine and Dentistry of NJ (Rutgers) PA Program and the University of Washington in Seattle, WA. Stephen's goal is to provide one-of-a-kind online resources for those interested in or practicing in the PA profession, to promote better access to healthcare for all, and to foster universal recognition/awareness of the PA profession. Read more about Stephen.

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