Friday, April 18, 2014

International Physician Assistants

International Physician Assistants
Updated: 08/06/2015

Whether you are a recently graduated PA, a seasoned PA looking for a fresh career outside the US border, or a pre-PA looking into international opportunities after graduation, you’ve come to the right place. In this post, you’ll find everything you’ll need from physician assistant (PA) schools in other countries to international resources for job listings, to organizations uniting international PAs! As AAPA’s 2013-2015 Strategic Plan does not include any efforts or services associated with international PA practice, it will become increasingly difficult for PAs to learn about changes developing outside the US. If you have any resources or comments to add to this posting, please leave them in the comments below and I’d be happy to include any and all changes or additions.

First, I’ll direct your attention to AAPAs “International Practice” page, which offers information about international licensure, liability coverage, transporting medical supplies, and ethical practice. They also have a FAQ and Guidelines for Working Internationally, which you might find useful. Other resources were previously available, but have been removed from the site. One example was AAPAs “Before You Go--Preparing for International Practice” which included passport information, visa information, insurance, immunizations, physician supervision, guidelines for working internationally, and much more! AAPA also used to have another resource titled International Employment and Training, where you could stay up-to-date on the most current status of employment challenges faced internationally by PAs. Write to AAPA at and let them know if you feel materials like this are necessary and needed in the PA community.

International PA Caucuses involved in the delivery of international healthcare are:

Non-AAPA resources involved in the delivery of international healthcare are:
  • Physician assistants
  • Clinical officers
  • Medical assistants
In the Spring of 2012, the Afghan National Army (ANA) implemented a physician assistant (PA) program which inspired the Paktya Provincial Reconstruction Team (PRT) to work with the Government of the Islamic Republic of Afghanistan (GIRoA) officials and transition the program to the civilian sector. PAs are a new concept in Afghanistan. Candidates must be at least 18 years old and a high school graduate. They take entrance exams to be accepted into the program. Read more about the program here.

There have been two conferences on PAs in Australia. Representatives from the Health Innovation Advisory Subcommittee attended the 2007 AAPA conference. A demonstration project was held in 2008. PAs are now allowed to work in Queensland Australia as of late 2013. The largest problem facing PAs seems to be job placement after graduation. Most Australian PA graduates remain in their previous occupational titles as they await new opportunities for formal employment as physician assistants. While the private sector is a possibility, generating enough revenue (for salary) is challenging. The government offers limited opportunity for PAs at the moment.  

As part of the “New roles in context of Workforce Reform South Australian Health Care Plan 2007-2016”, the government of South Australia launched a South Australia Health PA trial. This program recruits US PAs to work for one year in three clinical settings: surgery and anesthesia, peri-operative medicine, and pediatrics. Positive outcomes have been reported in terms of patient and professional acceptance and quality of care. AAPA suggests contacting U.S. agencies such as the State Department, U.S. AID, the Peace Corps or corporations such as Raytheon and Shell Oil for employment.
PACED - information, communication, and resources for PAs in Australia

PA Programs
The University of Queensland PA Program - while UQ has suspended its program, it has indicated that it may re-open the program if national registration of graduates is likely and if employers indicate that positions will be available
James Cook University PA Program - three-year bachelor’s program in the rural tropical north
Edith Cowan University PA Program - two-year master’s program

Interestingly, Australian PA graduates and students bring almost 15 years of experience to the workforce prior to entering PA programs. Incredible considering it is 5 times the current average in the US!

Canada’s confederation consists of 10 provinces and 3 territories that each have jurisdiction of its administration and regulation of its health professionals, including PAs. 4 of the 10 provinces allow PAs to practice.

PAs have existed in the Canadian Forces (military) for since 1984 and are trained by the Canadian Forces Health Services Training Centre in Borden, Ontario. The placement on rotation of military PAs in civilian health care establishments generated interest in use of PAs in civilian sector. Two provinces (Manitoba and Ontario) have developed civilian training programs. The specific schools are the University of Manitoba, McMaster University, and the University of Toronto, in partnership with the Northern Ontario School of Medicine and the Michener Institute for Applied Health Sciences. Representatives have attended AAPA conferences. The Certified Canadian Physician Assistant (CCPA) is recognized as the national standard designation, however, certification is not required in all provinces to practice.

Physician assistants in Canada can make a starting salary of $90,000 and are required to be certified and registered with the College of Physicians and Surgeons of Alberta. PAs are currently practicing across Canada in the Canadian Armed Forces and are working in the public health care system in the provinces of Manitoba, Ontario, New Brunswick and Alberta. PAs are regulated in Manitoba and New Brunswick by the respective provincial college of physicians and surgeons. In both Ontario and Alberta, the profession is not regulated. However, the Ontario Minister of Health has recommended that a mandatory registry be established which would be governed by the College of Physicians and Surgeons of Ontario. In Alberta a voluntary registry has been established for PAs under the College of Physicians and Surgeons of Alberta. PAs are permitted to practice, by way of delegation, under the provincial Medical Act. There are currently upwards of 400 PAs practicing in Canada.

The four PA programs in Canada are accredited by the Canadian Medical Association’s Conjoint Accreditation Services. The 3 civilian university programs are 2 undergraduate programs located in Ontario and a master’s degree program at the University of Manitoba. All programs are 24-25 months long with the number of seats determined by the provincial government.

HealthForceOntario - jobs and resources for working PAs in Ontario - A place for PA and NP students in Canada

PA Programs
University of Manitoba - two-year master’s program
McMaster University - bachelor’s program
University Toronto PA Consortium - bachelor’s program
University of Western Ontario - no longer has a program

Although some locations may offer opportunities for rotations or volunteering in China as students, permanent work in China as physician assistants is not currently allowed as a PA is not recognized as a licensed profession in China. China does have “assistant doctors” that are licensed healthcare workers and graduate from three-year medical training institutions.
Shanghai United Family Hospital - for clinical rotations

NuPhysicia - hires PAs to work in Egypt on behalf of the DoD
  • $78,000 salary
  • 1-year renewable contract
  • 183 work days/year

Health officers are trained in universities. All hold bachelor's degrees and therefore can progress to master's level training and education e.g. in emergency surgery.

Germany does have physician assistant programs available, but the role of the PA is still new and there is not yet a representative national professional or academic organization representing them.  
PA Programs
Duale Hochschule Karlsruhe Physician Assistant Program
Mattias-Hochschule Rheine University of Applied Sciences Physician Assistant Program
Steinbeis University of Berlin Physician Assistance Program

In Ghana, physician assistant (PA) refers to 3 branches of healthcare professionals trained in the medical model to practice medicine or dentistry. PA-Medical is a medical assistant (MA), or a physician assistant analog. PA-Dental is a community oral health officer and PA-Anesthesia is known as a nurse anesthetist. Ghana has only 3,500 physicians and dentists, and 2,500 Medical Assistants (MAs) (PA analog) for the care of its 24.2 million people. This very limited supply of health care providers contributes to poor access to care and population health in the country.

MAs in Ghana provide over 70% of the population’s primary health care. "Educating for Service” is the motto for the College of Health and Well-being  in Kintampo and its graduates live by it. MAs are trained there. On average they care for 90-150 patients per day, primarily in rural clinic settings, but also in large regional hospitals. The school and MA profession celebrated its 40th anniversary in 2009. 90% of PAs are licensed by the Medical and Dental Council of Ghana, the regulatory body for medical and dental health professionals. 7 schools train PAs in Ghana and 7 schools are applying for accreditation to start programs.

Interestingly, the PA-medical profession was previously dominated by males, but is now acquiring more females (50%).

The College of Health and Well-being Kintampo (formerly Rural Health Training School) - 18 month program; trains professional nurses on the medical model to care for rural and underserved populations
Central University - train physician assistants and grant a B.Sc.
Presbyterian University College - train physician assistants and grant a B.Sc.

Physician assistants have been in India since 1994, when there were only 3 graduates. Today there are nearly 1,300 PAs and 1,200 students pursuing PA education. However, PAs are not yet licensed in India.

In the beginning, PAs were trained by private cardiovascular surgeons in Chennai, Tami Nadu state as an experiment. These PAs left and followed cardiologists and surgeons who wished to take them to their other facilities in India. PA graduates were wanted because they were experienced and had more exposure than newly graduated medical students. Today, 47 PA programs in India exist with collaboration from 10 universities. 46 of those are located in southern India (Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu). Candidates are required to have prior health care experience as a nurse or another allied health profession. Only one PA program is organized by the government, the Tamil Nadu Dr. MGR Medical University in Chennai. It is a 3-year graduate program.

Today, PAs work in cardiology, cardiovascular surgery, general medicine and surgery, trauma, orthopedics, obstetrics and gynecology, oncology, and emergency medicine. Unfortunately, PA programs in India have no formalized program curriculum, but IAPA continues to press the government to recognize the profession and to take necessary approaches to solve this problem.

India still needs many PAs in the north. They also need the government of India to recognize and license their practice, in addition to introducing PA programs at medical colleges across the country. The government has proposed a 3-year baccalaureate degree in community health to curb the shortage of physicians in India in addition to a rural medical assistant 3-year medical training program in Chhattisgarh.

Comprehensive Health Services, Inc. - The Medical Services Support in Iraq (MSSI) Program Manager establishes a clinically safe and professionally managed healthcare environment and provides primary health care as well as resuscitative surgical care in accordance with U.S. or equivalent medical standards on a 24-hour basis, 365 days of the year to Chief of Mission (COM) personnel U.S. Embassy Baghdad, serving a population of approximately 14,000 adults.

Military Civilian Blog - posts PA jobs in Iraq and middle east

In 2009, the Israeli Medical Association (physician organization) stated its opposition to the PA profession in a white paper, instead supporting the use of pre-existing physician counterparts. This opposition was matched in 2010 by a report by the Israel Ministry of Health’s Healthcare Workforce Committee, which recommended investigating PAs, NPs, and the like, with an expectation that these providers would increase the quality of care and productivity of the clinic/hospital to “free up time for the physician.”

As of July 2013, the Israel Ministry of Health has in principle decided to accept physician’s assistants (PAs) as a fully fledged medical profession. According to the committee, the PAs will start by working in hospitals, especially in fields in which there is a severe shortage of physicians – anesthesiology, emergency medicine, surgery, internal medicine and pathology. Extra training and lab work will be required for pathologists and other similar fields.

There is a catch, though. These PAs will be recruited from pre-existing cohorts of health professionals. For example, the pathology PA applicants (the first cohort) will be prior laboratory workers or foreign medical school graduates who did not pass their licensing examination. According to Dr. Berkowitz et al., these new PAs will be “paramedics” that are given additional training and education to fulfill their new role. This is similar to the American model for PA programs.

Training in Kenya is under the Ministry of Health through the Clinical Officers Council (COC), which sets the syllabus and accredits training institutions. The Kenya Medical Training College (KMTC), also under the Ministry of Health, has campuses all over the country and trains the majority of clinical officers. Unlike other countries, clinical officers (physician assistants) in Kenya are a constitutionally recognised profession. They are required to sign legal documents such as medical certificates, death certificates, forms etc. and to present medical evidence in a court of law eg. in cases of rape and assault..

The training is rigorous and follows a compressed medical model. The first year is dedicated to learning the basic sciences, some experience in a diagnostic medical laboratory, nursing and clinical skills. The second year focuses on the clinical subjects whereas the third year is spent almost entirely rotating in every department of a teaching hospital where they attend ward rounds, clerk patients and present cases, perform deliveries and as first assistants in major surgical operations. They also attend clinical meetings and write prescriptions which at this stage must be countersigned by a supervising clinician.

Registration after three years of training, students sit for the national final qualifying examination (FQE) which is administered by the Clinical Officers Council. Those who trained outside the country sit a separate paper exam. On passing the FQE they are expected to apply for provisional registration by the Clinical Officers Council before proceeding for internship in accredited hospitals. The internship lasts one year and involves three-month supervised rotations in the major clinical departments namely casualty, medicine, paediatrics, surgery, obstetrics and gynecology.

Career advancement Qualified clinical officers with three years experience qualify to enroll for a Higher National Diploma at KMTC which leads to a specialist qualification in various specialty fields.

The Tubman National Institute of Medical Arts (TNIMA) was established in 1945. In 1965 the physician assistant programme was established as a joint venture between the Liberian government, WHO and UNICEF. Initially it was a one year course but currently it is a three year diploma course accredited by the Liberia National Physician Assistant Association (LINPAA) and the Liberia Medical and Dental Association Board. In order to legally practice medicine as a PA one must sit and pass a state exam administered by the medical board.

Clinical officers train for three years and undergo one year internship whereas Medical assistants train for two years and undergo one year internship. Medical assistants can then enrol for a 18 month up-grading course to become Clinical officers. The upgrading course takes place at Malamulo and Malawi College of Health Sciences.

In this country the Clinical officers have almost entirely replaced doctors who are in short supply or based in the urban areas. They are trained to carry out all the routine functions of a doctor at a district hospital hence are able to perform routine surgical and Obstetric Operations such as Caesarean Sections, Hysterectomies, Orthopedic care, Burr holes, Lumbar Punctures, and other important Life saving Surgical procedures.

Tecnicos de cirurgia are experienced Clinical officers (Tecnicos de medicina) who undergo further residential training in surgery under senior surgeons lasting two years at Maputo Central Hospital and one year internship at a provincial Hospital. They are trained to carry out emergency surgery, obstetrics and traumatology and are deployed to the district hospitals where they are usually the sole surgeons.

The first four physician assistants in the Netherlands were introduced in 2001. Since then, they have grown to more than 1,000 PAs, pushing out between 150-200 graduates each year. Interestingly, this is one country that did not develop the PA out of a lack of physicians or decreased access to healthcare.

The model is a bit different: it is a work study model that is tied to one specialty. This means that the PA students work (are employed) under a “supervising physician” throughout the entire program. This not only allows for great teaching opportunity, but assures students of a job afterward.  

PAs work mainly in surgical specialties with education funded by the Ministry of Healthcare and the Ministry of Education. Representatives have attended AAPA conferences and made consultative visits to US PA programs, AAPA, PAEA. There are 5 PA programs in the Netherlands, located in Nijmegen, Utrecht, Amsterdam, Groningen, and Rotterdam.

PA Programs - all are 30 month Master’s programs requiring a healthcare related bachelor’s degree and at least 2 years of clinical work experience in the healthcare setting

New Zealand
New Zealand is interesting because it’s healthcare system is divided into 20 district health boards, with the number of hospitals in each district based on population.

New Zealand found interest in PAs in 2000, but seriously implemented its interest in 2009 when it tasked Health Workforce NZ with starting its first demonstration project of PAs.

In 2010, the four District Health Boards in the Northern Region of New Zealand (Auckland District Health Board (ADHB), Counties Manukau District Health Board (CMDHB), Waitemata District Health Board (WDHB) and Northland District Health Board (NDHB)), in collaboration with the University of Auckland Faculty of Medical and Health Sciences, are proposed to undertake a pilot study of the Physician Assistant (PA) role. Physician Assistants, referred to as physician associates in New Zealand, are not currently part of the health workforce in New Zealand.

The overall purpose of the “pilot of pilots” project was to determine whether the PA scope of practice, as practiced by PAs trained under the US medical model and working under the delegation of a registered medical practitioner, had a role to play in the future of health services in New Zealand (NZ). The scope of practice for PAs in New Zealand would be different and initially narrower than that in the United States, but it was expected that it would evolve during the pilot as understanding of the opportunities of the PA role in the New Zealand setting were clarified.

As a first step, it was proposed to start with a small pilot in surgery at CMDHB in South Auckland. The pilot was in the department of general surgery. Two US trained PAs were brought to NZ to work at CMDHB for a period of twelve months, commencing in 2010. Their work and communication skills enabled for a successful pilot, paving the way for the current “New Zealand PA Pilot Project” which began in late 2012.

The initial demonstration showed that physician associates can fill gaps in service delivery and contribute to improving patient outcomes. Current New Zealand employers are keen to retain their physician associates and take on more. Seven PAs were a part of this project serving sites on the North and South Islands.

As of 2014, there are 6 physician assistants working in family practice settings on the North Island, 4 in the Hamilton area, and 2 in Tokorua (rural area). A seventh PA works in the ED near the southern tip of the South Island. The largest question for New Zealand PAs is how to implement this pilot success into a regulated healthcare profession that will having a lasting impact on the NZ healthcare system. Until then, PAs await the day the Ministry of Health approves them as a regulated profession, provides them prescribing rights, and the day they develop PA training programs.

More information can be found here.
Note: during the demonstrations, physician associates cannot prescribe.

Puerto Rico
Known in Puerto Rico as “Asociados Médicos,” Puerto Rico is the only U.S. territory that has no law to authorize physician assistant practice. To date, very little movement has occurred on the legislation introduced in 2009 by Representative Carlos Mendez Nuñez that would work to change this by licensing PAs and nurse practitioners to provide health services currently provided only by medical doctors on the island. Aside from two public hearings held on the bill in early January of 2010, no substitute bill akin to the AAPA’s Model State Legislation for Physician Assistants has been introduced or any other action taken on the part of the Puerto Rico Legislature.

Chatham University PA Program - as of August 2010, Chatham University PA Program has partnered with Universidad Metropolitana and the VA Caribbean Health System to launch the first ever PA program in San Juan, Puerto Rico.

Rwanda re-opened its clinical officer program in 2012 after the various medical training programs were all brought under the umbrella of the University of Rwanda.

Saudi Arabia
Saudi Arabia introduced universal healthcare in 2005. Since then, they are facing shortages and maldistribution of the current providers.

Saudi Arabia introduced its first Assistant Physician (Physician Assistant) program in September of 2010 when the Ministry of Defense decided to train young Saudis interested in healthcare. The program was established with aid from George Washington University Medical Faculty and Associates. The program was founded at the Prince Sultan Military College of Health Sciences, in Dhahran, Saudi Arabia.

Candidates must have at least a bachelor’s degree in applied sciences, be proficient in English (courses are taught in English), and competence in reading, writing, speaking, and listening skills (TOEFL score >500 or IELTS > 5.5). The 28-month long program started with 46 students and will lead to the granting of Masters degree in applied health science. The program currently has a staff of three. The didactic curriculum is year-round, while the clinical rotations in the second year of study are located at military hospitals and affiliated institutions. Students rotate in emergency medicine, general surgery, orthopedic surgery, internal medicine, psychiatry, field medicine and family medicine. Additionally, students must also commit to serve in the military for 5 years after graduation. For licensure, graduates must pass a comprehensive examination including clinical and oral exams. After completing a 6-month internship in emergency medicine under a supervising physician, then graduate may then serve as a military medical officer (first lieutenant) in the Ministry of Defense’s medical service division.

Since inception, 15 graduates have completed the program and 7 candidates are on rotations. Current challenges are recognition by the Ministry of Higher Education and the Ministry of Health Specialists.  

PA Program
Prince Sultan Military College of Health Sciences - Assistant Physician Master’s Program

South Africa
Clinical associates are a category of healthcare providers found in South Africa. They assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician.

Clinical associates must work under the continuous supervision of a “registered medical practitioner” (physician), but that doesn’t mean the physician must be physically present with them. Clinical associates complete a 3-year bachelor’s degree in clinical medical practice. They must then register with the Medical and Dentists Professions Board of the Health Professions Council of South Africa. In 2008, the first 23 clinical associates of Walter Sisulu University graduated. The University of the Witwatersrand (Johannesburg) and the University of Pretoria followed suit in 2009, with 25 and 56 clinical associate graduates. Almost all graduates have found jobs in district hospitals (rural areas), with a few working for non-governmental organizations.

Peace Corps South Africa - for more information, see the Peace Corps section below

Clinical Associate Programs
University of Witwatersrand - teamed up with Emory University
University of Pretoria - teamed up with Arcadia University
Walter Sisulu University - teamed up with the University of Colorado, although relations are winding down
University of Limpopo - never began a program, although there were plans before leadership changed

After a devastating civil war that left much of the southern part of this country in ruins a delicate peace agreement was reached which resulted in the creation of a semi-autonomous state. The resultant impact on healthcare will be felt for years to come. Due to the shortage of health workers AMREF pioneered the training of clinical officers in this region by setting up Maridi National Health Training Institute.

Since the mid 1980s, Taiwan has experimented with a PA-like model of care. The Taiwan Medical Association and organized nursing resisted this model in 2004 and legislation to legalize the PA profession was defeated. All PAs in Taiwan became nurse practitioners and assumed roles spanning nursing and medicine.

Training in Tanzania is under the ministry of health. There are numerous clinical officer training schools and programs last three year. Internship is not required for registration. Experienced clinical officers may enroll for an advanced diploma in clinical medicine which takes two years to complete. This qualification is regarded as equivalent to a first degree in medicine by universities in the country. The graduates are then known as Assistant Medical Officers. A further two years training leads to a specialist qualification in anaesthesia, medicine, surgery and radiology etc.

Training in Uganda is under the ministry of education and takes place in clinical officer training schools. Programs last three years.Kampala International University offers a Bachelor of Science degree in clinical medicine and community health. High school graduates take four-and-a-half years to complete this degree while practicing clinical officers take three years.

United Kingdom & Scotland
The role of Physician Associate (PA) has been established in the United Kingdom since 2005. The role evolved from the position of Physician Assistant, developed in the USA in the 1960s. In 2012 the profession voted to change the name of Physician Assistant to Physician Associate, to distinguish themselves from another role within the NHS, with the same name. At present, there is no regulatory body for PAs, such as the General Medical Council (GMC) for doctors. The only current method of regulation within the professional body is membership to the Managed Voluntary Register (MVR) for Physician Associates. Physician Associates in the United Kingdom are required to re-certify every 5–6 years and maintain up-to-date practice through attendance of training accumulating CPD hours (Continuous professional Development), which need to be completed on an annual basis. Current challenges to PAs in the UK include a lack of legal regulation governing their activity. As a result, they are unable to prescribe or order radiographs. Most PAs worked in family practice in the early days, but now physician associates are being recruited into internal medicine and emergency medicine. Physician associates now work in a wide range of specialties including forensic psychiatry, pediatric ICU, trauma, and orthopedics. Demand has outpaced the current supply of physician associate services available with UK medical schools considering opening new programs in the future. An estimated 20 programs are needed and 10 universities are exploring new programs. If statutory regulation is put in place, physician associates are sure to advance in the UK. As far as acceptance, there are mixed feelings abroad from clinicians and employers alike.  

UK Association of Physician Associates - has job listings from England and Scotland
Physician Associate Recruitment Solutions - jobs for physician associates in England
NHS Scotland Recruitment - Scotlands job listing

PA Programs
St. George’s University London - two-year postgraduate diploma
University of Birmingham - two-year postgraduate diploma
University of Hertfordshire - program closed
Wolverhampton University - program closed
University of Aberdeen - two-year postgraduate diploma

U.S. Virgin Islands & Guam, American Samoa, etc.
PAs have reported working on many U.S. virgin islands including, but not limited to, Guam, American Samoa, Saipan, Tinian, St. Thomas, St. Croix.

Express Care Guam - hires physician assistants
Juan F. Luis Hospital and Medical Center - hires physician assistants

PA Program
Barry University at St. Croix - faculty teaches from Miami shores via interactive video conferencing

Zambia trains clinical officers and medical licentiates at Chainama and has been doing so for nearly 20 years.

University of Zambia - Chainama College of Health Sciences

Peace Corps
Medical Contractors (PCMCs) - also known as Peace Corps Medical Officers (PCMOs); primary health care providers for Peace Corps Volunteers and trainees overseas.
  • Eligibility is contracted through the headquarters’ office and is limited to licensed and nationally certified PAs.
  • Knowledge of French is desired.
  • Recruiting is continuous, so there are no closing dates. For more information visit.

U.S. State Department
  • Applicants must be American citizens
  • Must be at least 20 years old to apply (21-60 years old to be appointed)
  • Ineligible to reapply until one year after the application date of prior announcements, provided an open vacancy
  • Must check the website for current open periods (when they are hiring)
  • Salary: $76,219-$111,930
As a State Department FSHP you are sent where needed. People fluent in many foreign languages can be assigned to a country/region with a completely language unknown to them. You don't dictate where you go, especially as a healthcare practitioner.

Remote Medical International
Remote Medical International is seeking qualified PAs for international remote area duty work. Placements range from tropical islands to the Arctic. If selected as a provider with RMI, you will work with a variety of industries providing medical care and rescue services all over the world as part of a high-performance team of Project Managers, Medical Directors, and others. It is highly likely you will also be involved in a wide variety of operations including technical rescue, maritime, or medevac by aircraft. Although the job is glamorous, it is also very strenuous and demanding. You may find yourself on remote Pacific island, in a tent in Antarctica, or following a film crew in Africa. You will most likely work on a 3 month rotations. Short-term deployments are also very common and range from several days to several months.

Physician Assistants in Australia, JAAPA July 2014
Physician Assistants in Israel, JAAPA December 2014
Physician Assistants in the Netherlands, JAAPA September 2014
Physician Assistants in New Zealand, JAAPA November 2014
Physician Assistants in Saudi Arabia, JAAPA August 2014
Physician Assistants in Canada, JAAPA March 2014
Physician Assistants in India: Triumphs and Tribulations, JAAPA April 2014
Physician Assistants in South Africa, JAAPA June 2014
Physician Associates in the United Kingdom, JAAPA February 2015
Physician Assistants in Taiwan,  JAAPA March 2015
Physician Assistants in Ghana, JAAPA April 2015

Haiti, JAAPA July 2015


  1. This information is fascinating. I always knew PAs were practicing abroad and going on medical missions, but had no idea of the broad opportunities available and all of the different levels of providers in other countries.

    Thank you for providing this valuable resource.

    I am hoping for an opportunity to become involved in the development of PA education in China. This will prove, I am sure, to provide needed links to information I can use to that end.

    Anonymous, MPAS, PA-C, GTA

    1. Thanks! Keep me updated on where you go next. I update this article from time to time so check back for more information in the future.

    2. Hi ! I am Annie.I have completed diploma in medical assistant.I want to get higher degree into it.can you help me ? How can I?

    3. How about PAs practicing in Vietnam? Or any international program located in SE Asia?

  2. hey paul can you tell me about physician assistants in middle east? like dubai? do they allow foreign trained PAs to work there? what is their policy?

    1. To be honest, I don't know the answer to your question. I get most of my information from PA profession or JAAPA articles of people who write about working in the countries they do. If you have a question, you should reach out to PAs for global health and ask them. They might know.

  3. This is an incredible amount of information and I cannot begin to thank you for taking the time to post it. Thank you.

  4. Can you provide any more information for guidelines/regulations for US certified PAs in Ethiopia?

    1. Sorry Bob. I only have the information available because of writers at JAAPA. If that information becomes available, I would be more than happy to post it here. I do update this blog post quite often, so check back. Thanks for reading.

  5. Hey Paul thanks for all the info! I wanted to know if you have any info whether a PA degree is recongnized in Pakistan? Thank you

    1. Hi Zainab,

      Unfortunately, I do not know the answer to your question. You might try posting this question on or emailing the editor of JAAPA letting them know you are interested in information about PAs in Pakistan. They are an abundant source of knowledge.

  6. The info here is fabulous and thank you SO much for sharing!

  7. If you were to get your PA license internationally, say you go to Africa for school, would you have the same PA license if you were to come back to the states? Or would you have to go through schooling again?

    1. No. To practice as a PA in the US, you must have completed a US accredited PA program and become nationally certified by NCCPA.

  8. I am also curious as to the above question. Would becoming a PA in the UK, Netherlands or Germany allow you to also practice in the US?

    1. Hi Maurie, unfortunately, no. To practice as a PA in the US, you must have completed a US accredited PA program and become nationally certified by NCCPA.

  9. Also interested in credibility in the US if you attended a PA program in the UK and wanted to return to the States to practice. Or vice versa, if you went to a PA program in the US and then decided to move to the UK, would you be able to practice?

    1. Hi anonymous, unfortunately, no. To practice as a PA in the US, you must have completed a US accredited PA program and become nationally certified by NCCPA. If you were certified as a PA in the US, I believe the UK allows US trained PAs to work there. I hope that makes sense.

  10. Highly informative and valuable information you have shared in this post with all of us who are seeking medical opportunities at international scale. Can you provide more information regarding the GMC responsible officer and what are the pre-requisites of the role? Or where can I find more infor about it?

    1. Hi David,

      Try contacting Editorial Board member Harrison Reed, MMSc, PA-C of JAAPA. He might be able to put you in contact with someone who knows more.

  11. Hi, I lived in China for a few years and I knew a couple PAs that were working there (specifically in Kunming.) They told me that China just considered them basic physicians (There are 3 levels of physicians in China, as you mentioned the 1st is a 3-year degree, somewhat similar to PA).

    1. Thanks for sharing that Audrey. Glad to know that PAs are even ABLE to work in China. I look forward to hearing more about them in the years to come.

  12. Hey Paul,

    I recently got married, my wife is from Germany, she was certified and working as a PA.
    Now that she is in the United States I am lost to what I have to accomplish to help her obtain employment here as a PA.

    If you can help me that would be great, or direction to the first few steps would be fantastic.

    Thank you

    1. Hi,
      I believe she would need to be licensed by NCCPA first (our national licensing board). If she hasn't yet, she'd need to attend an accredited PA program and take the PANCE. Then, she would apply for her state licensure, etc.

  13. It's great to know that PAs are involved internationally! I am wondering if countries that are not in North America accept international PAs. For example, I am a Canadian PA and am interested in working in Australia, would that be an option?

    1. Hi unknown,

      I'm not sure about the answer to your question. I would try contacting Editorial Board member Harrison Reed, MMSc, PA-C of JAAPA. He might be able to put you in contact with someone who knows more.

  14. I am about to graduate from undergrad with a bachelors in Health Sciences. I have the health care experience but a relatively low science gpa, I have always wanted to study abroad (I studied in Madrid for a semester in undergrad) and I have looked into a few of the programs you posted for MPAS (just to update your article: Edith Cowan in Australia looks to be no longer a program and University of Manitoba is only available to Canadian citizens or permanent residents). I am wondering if you have heard of any U.S. students getting accepted into any MPAS programs in the netherlands or U.K.? I would like to apply to international masters programs (I understand that means I would have to work and live in that country after I get licensed).
    Thank you!

    1. Hi Linde,
      I personally have not heard of students getting into PA programs in the netherlands or UK. If you are truly interested, try emailing those programs or asking in the PhysicianAssistantForum under the international PA category.

      Otherwise, try contacting Editorial Board member Harrison Reed, MMSc, PA-C of JAAPA. He might be able to put you in contact with someone who knows more.

  15. Replies
    1. Hi Melissa,

      I have not heard of PAs working in France, but if you're interested in finding out more information, I would inquire at

      Good luck and let me know if you find anything out!

  16. Any information you have on PA professions in these countries and their scope of practice? Maybe some salary reports for those countries? I know I can probably look it up but just curious if you know. I'm almost through PA school and am very interested in working abroad as a PA. Also curious about if we are certified through PANCE, how do we go about being certified in another country? different boards?

    1. Hi Lauren,

      I don't know the specifics about being certified in other countries as a PA, but as far as I have read, most American certified PAs are able to work in other countries with a U.S. national certification. As far as scope of practice and salary, I don't think you'll find much besides anecdotal information online.
      I would refer anyone to PAs for Global Health for possible leads/contacts.

  17. Hello,

    I am Canadian and would like to become a PA and practice here in Canada. I am wondering if I can attend school in the UK or anywhere other than US/CAN and come back to Canada. Could I challenge the certified exam? I am just wondering what my options are as we only have 3 schools here in Canada.

    Thank you ,


    1. Hi Elizabeth,

      I believe most PAs who train in the U.S. are able to work in countries such as Canada. I'm not entirely sure if that holds true for the UK. I think in Canada, an additional licensure exam is required to work as a PA, but I would double check with the canadian physician assistant group. If I was you, and wanted options to work in Canada or UK after PA school, I would try to go to a US or Canadian school prior.

  18. Hello Mr.Gonzales,
    I'm an international student studying in USA. I will graduate from high school this year. I would love to study PA in colleges.
    Can international students get the license and practice as PA in USA?


    Alyssa Le

    1. Hi Alyssa,

      Yes, this is possible. Please see my blog post on

  19. Hello,
    Does Indian PA are allowed to work in Canada?

    1. Hi Anonymous,

      I have no earthly idea. I would ask

  20. Hi, this is some great information. I am currently a practicing PA in the USA and am probably going to move out of the country if Donald Trump becomes president. How do I find out what my options are? I would like to move somewhere warmer but would certainly consider Canada if I had to. I am more than willing to take whatever test I need to take to get licensed elsewhere, but would obviously prefer not to go through school again.

    1. Hi Beth, Great question! See the Canadian Association of Physician Assistants Q&A page for more info:

  21. Hi, I have family in Guatemala and was considering going to school there. Would I be able to study there and get a national license in the US or would I have to attend an accredited PA program all over again in the US to able to work in America ? Would it just be cheaper studying in America and leaving it at that ? I really want to study abroad but also be able to work in the US. Any advice would be greatly appreciated. Also are national license accepted everywhere? Do you have to pay to get a national license? I apologize for all the questions I just like to be well informed before getting into anything.

    Thank you (:

    1. Hi Amandita,

      You would need to attend an accredited PA program in the U.S. and sit for the PANCE before you could practice in the U.S. This is a requirement of nearly all employers in the U.S. If you want to work here, they want you to be credentialed here. The reverse is not always true - some american trained PAs travel to other countries and work there using their U.S. licensure or obtaining new licensure through the country which they work (i.e. the UK).

      Yes, you have to pay for a national license. Check out NCCPAs website for more info.

  22. Hi, I am an American citizen. I currently am in India completing my 12th grade studies. What are the steps that I should take in order to go into a PA programme from India?

    1. Hi,
      Since you're still in high school, I would look at bachelor or pre-professional PA programs in the U.S. You can read this blog post:

  23. Eey, I'm a paramedic in NYC and in Israel. I did the PA program in Israel and I'm cert there. What do i need to do or can do in order to practice as a PA here in the US. I want to move back here now


    2. You'll have to take the PANCE and attend an accredited PA program before becoming a PA in the U.S. This is the law and cannot be worked around.

  24. Hi, Paul. How awesome of you to answer all these questions.
    My question: I am a PA-C in the USA and want to move to an African country to help provide basic medical care and/or teach. Is there an African country that would allow me to work there without having to attend a program all over again?

  25. I just graduated with a bachelors in science. I need to get clinical hands on experience in order to apply to PA school. I would like to do this abroad do you have any suggestions for volunteer opportunities to get these hours?

  26. Hey Paul! Thank you for the awesome information!
    I had a quick question, however. After I join one of the UK programs as the Physician's Associate, what is the process (and challenges) to come back to work in the US. Are there some kind of boards like in Medical School?

    1. Still have to attend a US accredited PA program and take the PANCE to work in the US as a PA, unfortunately.

  27. Hi Paul,

    I was just wondering if you knew the difference between a Clinical Associate and a Clinical Officer in South Africa. It says "Unlike nurses and physician assistants, a clinical officer is an independent practitioner who is trained in the medical model to practice the full scope of medicine and provides routine care in general medicine or within a medical specialty such as anesthesia and carries out treatment that is outside the nurses' scope. A clinical officer usually oversees a health center or a district hospital and is part of the medical team in bigger hospitals where one may head a department or work under a senior clinical officer or a physician." Is that not like a PA, if not a doctor itself? Just curious as to how that and a Clinical Associate differ.

    Kind regards,

    1. 1) PAs don't typically administer anesthesia, esp in the US
      2) PAs aren't allowed to practice with independent clinical judgement (i.e. without the consent of a physician)... I'm assuming that's what "full scope" infers
      3) Very few PAs oversee health centers or hospitals (have administrative roles), but it is becoming more prevalent

  28. Hello Paul.
    I am a PA currently practicing in US. I am interested to know if I would be able to practice as PA in Switzerland.

    Thank you

  29. Hello this is great information,

    I was wondering if it would be possible to be a PA in Colombia (South America).

    Thank you for your post!

  30. I currently live in American and I'm going to PA school soon. I would like to move to South Africa one day. Do you know if it is hard to get licensed in SA? Would I have to take a few classes or maybe an exam to get certified there?

  31. physician assistant should be scrapped. there should be just doctors and nurses. nurse practitioner too should be scrapped

  32. can tell me about PA in pakistan

  33. If I got to school in Hawaii would I still be able to work in the U.S ?

  34. Paul,
    I hold the title of being the first practicing Physician Assistant in the country of China. I practiced for six months there in 2011, in Hangzhou. The country is saturated with physicians, who make scant salaries as it is. The role of assistant doctors, as you mentioned, is actually a stepping stone for individuals to become full-fledged physicians and is not a static profession in and of itself. China also uses "barefoot doctors" in the rural areas, but the education and regulation of these, is not standardized. It will be a very long time before a PA profession is born there.

  35. i need to know whether a graduate of physician assistant from India find job abroad as physician assistant

  36. Hi Paul, do you or anyone else know of any Graduate PA programs that are taught in english, perhaps an american university, but in Spain? I studied abroad in Madrid and would love to go back for graduate school. Thanks!

  37. Hi,
    I am meera , an indian physician assistant have got 6 years of experience,currently i am doing my pg in Australia ,my question is how can I work as pa in Aus or how I calculate my credits ,any subdivisions .thank you

  38. Hi,
    I am meera , an indian physician assistant have got 6 years of experience,currently i am doing my pg in Australia ,my question is how can I work as pa in Aus or how I calculate my credits ,any subdivisions .thank you

  39. Unfortunately, Barry University closed it's St. Croix Campus after Hurricanes Maria and Irma in 2017. Physician Assistants are still employed in the US Virgin Islands.
    Bill Demshok, PA-C, MS
    Barry Univeristy

  40. Hi, my name is Jordan and I am getting ready to go to PA school. I am curious if there are any programs that you know of that would allow me to work in the US as well as other countries? I am wondering if there are programs to where I could work abroad in underserved countries for a time period, and come back to the US on a rotational basis??

  41. Do you know of any programs that allow PA's to work in underserved countries and in the US on a rotational basis?

  42. Hi, I just wanted to point out that currently (2018) the AAPA no longer has an international presence due to lack of interest and has instead decided to focus on the USA only.

  43. Hello, I'd like to know whether PAs can find employment in Bangkok, Thailand?


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