As of 2020, 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.
Several titles are in use for this important healthcare cadre including physician assistants, physician associates, clinical associates, clinical officers, medical licentiates, and assistant medical officers, to name a few.
Countries with PAs or PA-like medical workers
- 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
For a more detailed review of this topic please see: Physician Assistants (PAs) and Associates Around The World
Many of these countries have American-trained PAs working as expatriates, and many are developing educational programs that produce a healthcare provider functioning as an extension to the traditional medical doctor.
Each country has made it's PA a well-defined entity, with cultural and educational influences shaping their roles. A common theme among these PAs is that they function with some degree of autonomy, work under the supervision of a physician, and have roles that complement those of the physician.
The global development of the PA profession tends to follow a similar path and the lessons learned from the pioneers of PA education abroad will help with further expansion of the PA profession. Experience has proven that such processes always take longer than estimated.
The countries mentioned in this article are just some of the countries that have acknowledged 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 (Russian feldschers); Asian countries such as China and Malaysia (Chinese barefoot doctors); 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 remaining today, provided what can be referred to as prototype PAs.
Common Denominators
The World Health Organization (WHO) has promulgated a desirable doctor-population ratio as 1:1,000 and a minimum threshold of 4.45 physicians, nurses, and midwives per 1,000 population as a part of its WHO Global Strategy on HRH, necessary to achieve universal health coverage.
Yet, over 44% of WHO Member States reported less than one physician per 1,000 population, and over 26% report to have less than 0.3 per 1,000 population.
The following table shows the population and doctor-to-population ratios of several of these countries, as well as those of the United States for comparison.
Among others, Canada, Australia, and South Africa have remote and/or widely distributed populations. In many countries, the size and seclusion of its rural populations present difficult challenges to successful healthcare delivery.
Population and Number of Doctors and PAs
| Population | # of PAs | # of MDs | Dr./pop ration | |
| United States | 328 million | 125,500 | 752,400 | 2.6 |
| Australia | 24.9 million | 40 | 47,875 | 3.6 |
| Canada | 37.5 million | 650 | 91,375 | 2.3 |
| United Kingdom | 66.65 million | 700 | 297,007 | 2.8 |
| Netherlands | 17.28 million | 1231 | 56,000 | 3.9 |
| South Africa | 57.78 million | 920 | 27,432 | 0.9 |
| Taiwan | 23.78 million | 0 | 47,000 | 1.9 |
| Germany | 83.02 million | 100 | 392,402 | 4.2 |
| India | 1.35 billion | 1,100 | 840,130 | 1.4 |
Source: WHO medical doctors per 10,000
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.
Physician Assistant Education Programs in Select Countries
PA Models in Different Parts of the World
PAs come in many different "flavors." There are physician assistants, physician associates, clinical associates, clinical officers, medical licentiates, and assistant medical officers, to name a few.
| Practitioner | Countries |
| Physician Assistant | United States, Liberia, India, Canada, Netherlands, Australia, Israel |
| Physician Associate | United Kingdom, Ireland |
| Clinical Officer | Kenya |
| Medical Licentiate | Zambia |
| Health Officer | Ethiopia |
| Clinical Associate | South Africa |
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)
- WHO Global Health Observatory
- Where PAs and Physician Associates Can Work Internationally
- International Academy of Physician Associate Educators
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I am currenty applying for PA programs right now after living in Spain for the last year! I was wondering if you have any advice about if it would make more to go the Nursing route (NP/BSN/RN/etc.) rather than the PA route since I know I do want to end up moving back to Europe eventually? Do you think the PA role will expand more within the next 5-10 years or are there just more opportunites as a nurse? Would love to hear your thoughts!
Hi Holly! That’s great that you’re considering a career in healthcare. It’s a rewarding field with many opportunities.
As for your question, it’s difficult to say for sure whether the PA role will expand more within the next 5-10 years or if there will be more opportunities as a nurse. The healthcare landscape is constantly changing, so it’s hard to predict what the future holds.
However, I can tell you that both PAs and nurses are in high demand, and both professions offer a variety of career options. So, you can’t really go wrong with either choice.
If you’re interested in working in Europe, I would recommend doing some research to see which profession is more in demand in the countries you’re interested in moving to. You can also reach out to PAs and nurses who are already working in Europe to get their insights.
Also, while deciding between RN and PA may seem like a black-and-white decision, it is not exactly. You could choose to go the RN route and then go back to school to complete your APN training and work as a nurse practitioner if you want to widen your scope – a path many of my coworkers chose. So while doing your research you may want to see what countries accept nurse practitioners as well. This may give you the best of both worlds.
I hope this helps, and I wish you the best of luck. I’m happy to help if you have additional questions.
Stephen Pasquini PA-C
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Hi,
I was wondering if you think the PA profession will grow in other countries like Spain, Italy, France, etc.?
Thank you!
This is a great question! My answer is yes, although I doubt to the degree that it is growing in the US only because the pathway to becoming an MD in Europe is much more streamlined and cost-effective. The time and costs of becoming an MD in the USA are tremendous factors driving the exponential growth of the PA profession. This, coupled with the high reimbursement rates and lower cost to employ a PA… well, it just makes sense here in the USA. The economics are different in Europe – both as a practicing clinician and as a student. I would love to hear your thoughts!
Stephen
i have a granddaughter has been turned down twice she is a graduate of elon college.a normal girl without tatooes nose rings not on drugs what is the problem?
she also has good grades
Hi Dariana! The PA school application process is more competitive than ever. Not to toot our own horn or to “lure” you into purchasing something that you don’t need, given the situation, I would recommend a consultation with Kelley Rutter, who was not only the most successful PA school applicant I have ever met but also one of our Pre-PA consultants. Since the CASPA application is a sum of all that has brought your granddaughter to this point, it is tough to determine what is holding an applicant back without assessing the entirety of their application. It is likely a combination of things, and her application may need a bit of TLC to get more attention from the PA school ADCOMs, who are drowning in applications. If she is interested, you can learn more about our consulting services here: https://www.thepalife.com/pre-pa-consulting/
I’m a practicing PA in Ohio (otolaryngology) currently, but I’m interested in information regarding leaving the country to practice in other countries, specifically how one would find resources, jobs and relocation assistance. Thanks
Hi Deborah, here is an article breaking down many of the places PAs can work internationally. Some of these countries have only developed programs and some were running pilot programs which have since been discontinued but it may be a good place to start: https://www.thepalife.com/physician-assistants-pas-and-associates-around-the-world/
I know several PAs who are currently working in the UK and Ireland as well as several in New Zealand and Canada. It’s wonderful to see the profession expanding beyond US borders. You will have to let us all know what you find and when/where you go.
Stephen
I am Physician Assistant in Ghana can I apply and practice outside Ghana? What are the procedures?
Hi, 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
Im about finishing my PA studies in Ghana and would love to work in Austria pr Canada or USA. I would also want to do a top up in medicine with time if im able to get a job there.
Can you help with information?
Hi, Amanda,
From the standpoint of the ARC-PA, individuals educated as physicians 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
Hi,
Im Amanda, PA student in Ghana. Were you able to work in the US yet as a PA per the information given?
Hope to hear from you.
Hello!
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
I 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.
Any new updates on PAs practicing internationally? Specifically Australia or New Zealand? I haven’t found much…
Thanks!
Ironically 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
how can I found PA school that accept foreigner students?
Hi 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
Hi Stephen,
I was wondering if you had any information on international clinical rotations or resources to find placements for 4 weeks?
Respectfully,
Rebecca Vu
Hi 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
I 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
Hi 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