As of 2019, the adoption of PAs has spread globally across a variety of health systems and at least fifteen countries have been in various stages of expansion of PA-like medical workers (nonphysician clinicians) that function under the supervision of a doctor.
For a more complete and updated review of this topic please see my latest post: Physician Assistants (PAs) and Associates Around The World
- Canada Physician Assistants
- United Kingdom Physician Associates
- The Netherlands Physician Assistants
- Liberia Physician Assistants
- India Physician Associates
- Ghana PA Medical (Medical Assistant)
- South Africa Clinical Associates
- Australia Physician Assistants
- Saudi Arabia Assistant Physicians
- Germany Physician Assistants
- New Zealand Physician Associates
- Afghanistan Physician Assistants
- Israel Physician Assistants
- Bulgaria Physician Assistants
- Ireland Physician Associates
Many of these countries have American-trained PAs working as expatriates, and most are developing educational programs that produce a health care provider functioning as an addition to the doctor.
Each country has made it's PA a distinct entity, with cultural and educational influences shaping their roles. Common denominators of these PAs are: they function as semi-autonomous clinicians under the direct supervision of a doctor and have roles that tend to complement those of the doctor.
Historical observations suggest the development of the PA profession in different countries tends to follow a similar path and that lessons learned from these nations may be useful in further expansion of the profession.
Those countries mentioned above are just some of the countries that have recently recognized the progress of PAs and have developed their own PA programs. Yet, assistants to doctors and prototypes of PAs are not new.
Eastern European countries such as Russia and Ukraine; Asian countries such as China and Malaysia; much of Oceania (eg, Australia, New Guinea, Micronesia, Melanesia, and Polynesia); as well as parts of Africa and South America have employed medical aides for decades.
Even in the United States, the Alaskan Community Health Aides project, inaugurated during World War II and continuing today, produces what can be referred to as prototype PAs.
Common Denominators
Excluding the Netherlands, every country falls short of the desired 3/1,000 doctor-to-population ratio that is recommended by the World Health Organization (WHO). All use English in the classroom, although for the Netherlands, English is a secondary language. Table 1 shows the population and doctor-to-population ratios of these countries, as well as those of the United States for comparison.
Canada, Australia, South Africa, have remote and/or widely separated and sparse populations. In some countries, the size or dispersal of rural populations presents formidable challenges to health care delivery.
Educational Development
Education programs have developed in different ways and by different means in the nations described here. The established PA programs in these countries range from 2 to 3 years in length, with a didactic component followed by a clinical component.
Please see my full article with a breakdown of practice and education requirements in each of the above countries: Physician Assistants (PAs) and Associates Around The World
You can also download and view a beautiful infographic of this comparison here.
Resources: The Globalization of Physician Assistant's (PDF)
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Felicity Ntori says
April 22, 2019 at 2:55 pmI am Physician Assistant in Ghana can I apply and practice outside Ghana? What are the procedures?
Stephen Pasquini PA-C says
April 23, 2019 at 3:16 pmHi, Felicity,
From the standpoint of the ARC-PA, individuals educated as physicians or physician assistants outside of the United States are not treated any differently than any other prospective PA student. To practice as a PA in the United States one must graduate from an ARC-PA accredited program and be certified by the NCCPA. If interested in applying to a PA program, such individuals should contact the PAEA for information on specific programs.
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): http://www.arc-pa.org/frequently-asked-questions/non-us-health-care-professionals/
Before you can work in the US, you must contact the Commission on Graduates of Foreign Nursing Schools (CGFNS International) to complete a visa screening program which, in part, will determine if your education was equivalent to that from a US PA Program. If your education is equivalent, you are eligible for a certificate that you can submit with your visa application to the US State Department. The State Department’s approval of your occupational visa may help you enter the U.S. but you are still not eligible to work as a PA in the U.S.
To become a PA in the United States, individuals must also attend and graduate from an ARC-PA–accredited entry-level PA program and pass the Physician Assistant National Certifying Exam (PANCE) administered by the National Commission on Certifying of Physician Assistants (NCCPA).
For information on PA programs contact the Physician Assistant Education Association (PAEA): https://paeaonline.org/ and the directory of PA programs here: http://directory.paeaonline.org/
Eligibility criteria for taking the Physician Assistant National Certifying Exam (PANCE) are available on the NCCPA web site: http://www.nccpa.net/
Additional information on practicing as a PA in the US can be found at the American Academy of Physician Assistants’ (AAPA) website: https://www.aapa.org/
To determine if an individual state allows non-US educated physicians to practice as PAs without additional education and national certification, you would have to contact the licensing bodies of the specific states.
To find PA programs that accept International students:
I would start by searching the PAEA directory website and click the box “Accept int’l applicants.” Currently, there are 138 programs that accept international students. From there you need to narrow down further based on requirements. I would then use my PA program picker table. You can narrow your search even further using all your variables: https://www.thepalife.com/pa-program-picker/
Then, follow the links to the PA program websites and reach out to them personally. They will be able to guide you better than I since every program is a bit different. If you have any questions afterward just shoot me a reply.
Stephen Pasquini PA-C
http://www.thepalife.com
http://www.smartypance.com
Kruesi says
January 4, 2019 at 2:56 pmHello!
I am planning on going to PA school in 2020, and have recently been thinking about trying to train outside of the US. I love Australia and have looked into their PA schools, but I am wondering if I could talk to someone about the benefits/problems with going to school outside of the US. If I go to school in Australia and then decide to come back to the US to work, is that a simple process?
Thank you,
Kruesi
Timothy Benac says
March 8, 2019 at 6:55 amI finished PA school in 2004, have lived and worked in Canada, as well as the US.
I have also lived in the UK as my wife is British, but I wasn’t working as a PA during that period.
Short answer don’t train in Australia if you want to return, you probably won’t get to sit for NCCPA examination. This article is very misleading. In Ontario, which is where two of the four Canadian programs are, PAs are not even a registered profession, so that means you have little to no legal standing and just about anyone can be employed as a “PA.” There are little available jobs as there is no reimbursement for services from the province.
Theresa says
December 7, 2018 at 9:02 amAny new updates on PAs practicing internationally? Specifically Australia or New Zealand? I haven’t found much…
Thanks!
Stephen Pasquini PA-C says
December 12, 2018 at 8:57 amIronically Theresa, I just published a post expanding greatly on this topic and in it there is information on both Australia and New Zealand: https://www.thepalife.com/physician-assistants-pas-and-associates-around-the-world/
Hope that helps!
Stephen
florentia metta says
November 2, 2018 at 8:33 pmhow can I found PA school that accept foreigner students?
Stephen Pasquini PA-C says
November 11, 2018 at 8:19 amHi Florentina,
To practice as a PA in the United States one must graduate from an ARC-PA accredited program and be certified by the NCCPA. If interested in applying to a PA program, such individuals should contact the PAEA for information on specific programs.
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): http://www.arc-pa.org/frequently-asked-questions/non-us-health-care-professionals/
Before you can work in the US, you must contact the Commission on Graduates of Foreign Nursing Schools (CGFNS International) to complete a visa screening program which, in part, will determine if your education was equivalent to that from a US PA Program. If your education is equivalent, you are eligible for a certificate that you can submit with your visa application to the US State Department. The State Department’s approval of your occupational visa may help you enter the U.S. but you are still not eligible to work as a PA in the U.S.
To become a PA in the United States, individuals must also attend and graduate from an ARC-PA–accredited entry-level PA program and pass the Physician Assistant National Certifying Exam (PANCE) administered by the National Commission on Certifying of Physician Assistants (NCCPA).
For information on PA programs contact the Physician Assistant Education Association (PAEA): https://paeaonline.org/ and the directory of PA programs here: http://directory.paeaonline.org/
Eligibility criteria for taking the Physician Assistant National Certifying Exam (PANCE) are available on the NCCPA web site: http://www.nccpa.net/
Additional information on practicing as a PA in the US can be found at the American Academy of Physician Assistants’ (AAPA) website: https://www.aapa.org/
To determine if an individual state allows non-US educated physicians to practice as PAs without additional education and national certification, you would have to contact the licensing bodies of the specific states.
To find PA programs that accept International students:
I would start by searching the PAEA directory website and click the box “Accept int’l applicants.” Currently, there are 138 programs that accept international students. From there you need to narrow down further based on requirements. I would then use my PA program picker table. You can narrow your search even further using all your variables: https://www.thepalife.com/pa-program-picker/
Then, follow the links to the PA program websites and reach out to them personally. They will be able to guide you better than I since every program is a bit different. If you have any questions afterward just shoot me a reply.
Stephen
Rebecca Vu says
April 27, 2018 at 9:21 amHi Stephen,
I was wondering if you had any information on international clinical rotations or resources to find placements for 4 weeks?
Respectfully,
Rebecca Vu
Stephen Pasquini PA-C says
November 11, 2018 at 8:20 amHi Rebecca, you can search through academic programs and clinical rotations at https://www.pasforglobalhealth.com/
You have to be a member to browse their full database.
Stephen
Kristan says
November 17, 2012 at 2:59 pmI worked in New Zealand, another country that is looking at the PA model to bridge the medical provider shortage. I participated in a one year pilot in a busy surgical service, and they are currently trialing a 2 year primary care role with 6 US-trained PAs.
I stumbled across your website while web-searching “globalization of PA.” I am interested in promoting global health and am also a member of PAGH (PAs for global health). I have yet to formalize my path on how I want to help promote this, so I am searching the web.
Thank you for blogging, for providing a forum for PAs, healthy living, issues in health care in the US and abroad.
Cheers,
Kristan
Stephen says
November 19, 2012 at 12:01 amHi Kristan,
It is a small world. I just got off a conference call with PAGH (I am on the board as their new web chair). I am in the process of building a new web site at pasforglobalhealth.com . I think I may have bit off more than I could chew with this one, but like you I am passionate about promoting global health, especially as Physician Assistants!
I have heard of this pilot program in New Zealand and I think it is fascinating that you had a chance to participate in it. I would love to hear about your experience! If you are at all interested in writing about your experience let me know. I would love to feature an article about it here, on our PAGH web site and publish it to our newsletter. I know a lot of other PA’s who would be very interested to learn about your work there as well.
Stephen