Saturday, February 14, 2015

From International Student to Physician Assistant

From International Student to Physician Assistant
Updated: 07/08/2016
You may be an international medical graduate (IMG), a caribbean medical student, or a student from a foreign country (outside the United States) wanting to attend physician assistant (PA) school. While it may seem daunting at first, do not be frightened by the lengthy application process or by the worrisome anecdotal stories you may read about online.

You will need to prepare your materials before throwing an application together. Many international students and international medical graduates see medical school residency matching as a barrier to becoming a licensed provider in the United States, which is why they choose to become physician assistants.

Physician assistants can still practice medicine, but they are not required to complete a residency, which may be very difficult to acquire when there is already such a shortage. In today’s society, many IMGs do not have the upper hand in residency matching over U.S. candidates. In 2007, the National Resident Matching Program (NRMP) published data on “who gets residencies.” Only 25% of residencies went to Non-US Citizens and Graduates of International Schools. IMG compete with American medical students (4th year students) and many students from India who place scores for USMLE step 1 and 2 in the 99th percentile. In 2012, 48,507 students applied for match in the U.S. and 24,034 residencies were available. 65.4% of those 24,034 residencies went to American graduates. Many reasons why IMG do not get accepted to U.S. residencies include: unexplained gaps in training or gaps between graduation and time of application, incomplete USMLE steps or low scores on USMLE exams.

If this is why you want to become a physician assistant, I highly advise you to consider other routes or careers. This is not what the PA profession is for - it is not “easier” to get into PA school or a considered a “cop-out.” If you have heard this, you were told incorrectly. The Medical Society of the State of New York offers guidance for IMGs to obtain residency in New York State. In addition, NYIT College of Osteopathic Medicine offers a bridge program for IMG to become doctors of osteopathic medicine called Emigre Physician Program (EPP).

PA programs can be just as competitive as U.S. medical schools. If you are truly interested in becoming a PA and understand the role of a PA, then I invite you to bring your knowledge and experience to the profession. The journey to becoming a PA is also not an easy one. You will be competing with thousands of other U.S. pre-PA applicants with a plethora of knowledge, volunteer work, patient care, and shadowing experience from all over. It’s no wonder it is so difficult for international students to gain acceptance to PA programs! PA programs have to ensure that you are in it for the right reasons and that you truly understand what becoming a PA is all about. Make sure you do your homework and know exactly what you are getting yourself into before you commit.

Most Frequently Asked Questions:
I am a foreign medical graduate. What are the first steps I need to take to become a PA in the U.S.?
Please visit AAPA’s website on Becoming a PA.

I am a foreign medical graduate. Can I get a PA license with my medical degree?
Answer: No. Texas, and every other state law, requires graduation from an accredited PA program for eligibility.
Medical school is much more difficult than PA school, so why can’t I (the unmatched MD) practice as a PA even though I didn’t pass my USMLE?
PACdan put this in great words “because you did not go to school for it.” The "difficulty" of the PANCE vs. the USMLE is not the concern, rather it is the eligibility to take the exam and practice as a PA. The eligibility to take the PANCE requires one to graduate from an accredited PA program. What if PA graduates took the material they were missing from medical school (about one year's worth) and the USMLEs and did well, should they be allowed to gain residency and practice as a physician? Everything is equal at that point. If your answer is no; then the reverse should also be no. There are training modalities unique to PA programs that prepare one to be a PA, and not a physician; the reverse holds true as well.
Do I have any advantage since I am already a physician in my home country?
No. Holding a foreign medical degree does not give you any advantage when applying to PA schools no matter how long you have practiced.

I am a foreign medical graduate - what are my chances of getting accepted to a U.S. PA program?
As an international medical graduate, you must realize that you are competing against thousands of qualified U.S. pre-PA students with hundreds to thousands of hours of clinical experience obtained within the United States and abroad. In addition, they have U.S. coursework, excellent GRE scores, and outstanding volunteer and shadowing experience as well. If a PA program is going to accept you, you will need to demonstrate to them that you are worthy of a spot in their program just like everyone else. You do not get an upper hand just because you graduated from a medical school in another country. If a PA program is going to train you to become a licensed physician assistant, they need to make sure you will actually become a PA and not utilize their program’s training to take the USMLE exams to help you obtain a residency. If you think for one second that any PA program hasn’t already considered you might be doing this - you are highly mistaken. Almost all PA programs require interviews so that they can determine your intentions and decide if you truly understand the role of a physician assistant and that you have true aspirations to become one.
I am a foreign medical graduate. How can I calculate my GPA from my “scores” since we do not receive letter grades in my country? Will my credit hours be accepted in the U.S.?
Answer: The best answer to this question is - it varies. The PA program’s you plan to apply to will have to evaluate your coursework on an individual basis. Most programs will probably consider your coursework as “electives” since they were not taken within the U.S. For example, Texas requires academic work taken at foreign colleges/universities, or preparatory schools to be excluded from GPA calculations for admission to graduate or post-baccalaureate professional school. However, undergraduate foreign coursework that appears as transfer credit on the transcript of a regionally accredited U.S. college will count toward GPA. Lump sum credit with no specific course or hour identification will not be accepted. Foreign coursework will generally not count toward satisfying any of the required courses/pre-requisites for PA school. A baccalaureate degree is sometimes required for admission and must be from an accredited U.S. or Canadian institution.

Please consult CASPA via their Instructions and FAQ. If you still cannot find answers to your question, call CASPA (617-612-2080) or email for more information.

How long are my TOEFL scores good for?
Generally, 2 years.

I completed my foreign medical degree clinical hours (year 3 or 4) in the United States. Can I count these as direct patient care experience?
Probably not. But you should check with the PA programs you plan to apply to to make sure. Clerkship hours are probably a better route for healthcare experience hours.
PA schools require healthcare experience - how can I get healthcare experience as a foreign medical graduate?
Clerkships and observerships seem to be better routes for IMG. They consist of a didactic and clinical phase and are prevalent in places like Chicago and New York. However, they may require visas. Visit the International Affairs website for UT Southwestern for more information.

Do PA programs “waive” any of the prerequisite requirements or didactic coursework since I hold a foreign medical degree?
No. I think it is safe to say that nearly all PA programs require you to complete the rpogram in its entirety.

I do not have permanent residency in the U.S. Will this be a problem in PA school?
Some of the factors that could help decide on applying to a particular state are the visa requirements of some medical boards or other requirements like fingerprinting or direct verification of credentials, which usually take a lot of time. The State Medical Board typically issues an unrestricted license to practice medicine only to U.S. citizens and permanent residents. Applicants on non-immigrant visas can only apply for limited license to practice medicine and only in qualified medically underserved areas/health professional shortage areas.

Are there any PA programs known to accept more foreign medical graduates more than others?

How can I obtain a F-1 (Student) Visa?
Getting accepted to a U.S. accredited PA program will help to kickstart the process of getting your F-1 Visa, which is also known as the “student” Visa. This will allow you to study in a PA program, but will not allow you to work. It is good for 4 years.
  • Once accepted, get in contact with your financial advisor, financial services department, international department, or registrar at the school you are applying to. These people will help you figure out where you need to send your Visa information.
  • Obtain all required documents needed yourself. This may include transcripts or other forms. Do not expect the international department to do everything for you.
  • Figure out if your country of residence offers student loans through the government or state/providence. For example, Canada offers student loans and provincial student loans.
  • Find your own private loans as soon as you can. Remember, as an international student on a F-1 visa, you are required to pay tuition yourself and are not allowed to apply for financial aid (FAFSA). Banks are a good source for loans.

Are there other ways around the F-1 Visa?
Yes, you can get married to a U.S. Citizen and obtain a green card (for permanent residency)
  • MAVNI (Military Accessions Vital to the National Interest) - allows legal non citizens with in demand skills to joint the Army in exchange for expedited US citizenship; move from non immigrant Visa or asylee/refugee/temporary protected status directly to citizenship, especially if you speak more than one language
    • Must legally reside in the US more than 2 years prior to joining the Army
  • Optional Practical Training (OPT) visas are used as “visa extenders” for students. With this visa, you are able to find job placement up to 12 months after graduating from a PA program and are less expensive than a H1-B visa.
    • If the student chooses to engage in pre-completion OPT, he or she may not work more than 20 hours per week while school is in session, but may work full-time during his or her annual vacation and other times when the school is not in session. If a student engages in pre-completion OPT, the student’s eligible period of  post-completion OPT will be reduced by 1 month for every 2 months of part-time pre-completion OPT that is worked when he or she graduates
    • STEM Extensions: may extend your OPT 17-24 months if you graduate with a qualified Science, Technology, Engineering or Mathematics (STEM) degree, and are currently in an approved post-completion OPT period
  • Canadian and Mexican citizens are able to enter the U.S. temporarily for professional business activities on a TN visa as part of the North American Free Trade Agreement (NAFTA) - however, a PA is not considered a “specialty occupation” under this visa. Thus, PAs would not be eligible for a TN visa.
  • The H1-B Visa is usually required for employment in the US as a PA upon graduation. PAs are considered a specialty occupation for this type of visa. For more information, visit the U.S. Citizenship and Immigration Services website. For simple information regarding the different types of visas available, visit the International Affairs website for UT Southwestern.

What are the difficulties in obtaining a H1-B Visa?
  • Timing is everything. There is a quota each year for the number of H1-B Visas that are given. The quota periods begin in April and end in October of the same year. You will need to be a competitive applicant for one of these visas as “spots” are known to be filled within weeks of opening dates of the application. You generally file for a H1-B visa in April and your “start” date of employment will be in October of that year. This may not go over well with an employer who wants to hire sooner.
  • Cost. Costs affiliated with H1-B visas can be in the thousands. Employers may require you to cover these costs.
  • Finding an Employer. Certain employers, such as non-profits and teaching hospitals affiliated with universities, are H1-B quota exempt. This means you are able to apply for a H1-B visa quickly with a start date that is not subject to quota caps.

Are there ways to help me obtain my H1-B Visa?
Yes. Become a competitive candidate while in PA school. Hire a legal representative or immigration lawyer, such as those at VisaPro. Pay the $1,000 premium to expedite processing to get your visa within 2 weeks of sending in your application.

I was accepted to a U.S. PA program, but I do not know the first steps for coming to the United States. What should I do first?
Visit the International Affairs website for UT Southwestern for information. The left hand side of the page has links for what to do before you arrive, bringing your family, day care and school information, ELS courses, finances, and tips for life in the U.S.

CASPA as an International PA Student
Below is some information CASPA asks you about that may be important if you are an international applicant or medical graduate. I have listed this particular information to draw your attention to these fields when filling out your CASPA application. Probably of most importance is the text in red, which I think most students will find helpful to know well in advance before applying.
  • Materials Under Another Name - If you are sending any documentation to CASPA where your name is listed differently than it appears on your application, you MUST COMPLETE THIS SECTION . Failure to complete this section can prevent important documents from being matched to your application.
    • Examples: maiden names, nicknames, “westernized names” which many international applicants may have, alternate punctuation (your name has an apostrophe or hyphen in it), alternate spacing (your name has 1 or 2 spaces, etc.), known misspellings (if a document contains a misspelling, ex. Gonzales and Gonzalez)
  • Demographic Information
    • Citizenship status - Select your status as a U.S. citizen, temporary resident, permanent resident, or non-resident. If you are a temporary resident please indicate your Visa status.
    • Languages - Physician Assistant students interact with patients from many backgrounds. Indicate any language(s) other than English in which you feel comfortable conversing.
    • Residency Claim - Select the U.S. state and list the county in which you currently claim residency.
    • Birth Information - Enter your birth date, in the format MM/DD/YYYY. For example, “01” would be listed for the month of January. Also indicate the state/Canadian province, county, and country of your birth. If you were born outside of the U.S./Canada, please select “No State.”
    • Secondary (high school) Data - Enter the name of the high school you graduated from and the city where it was located. Select the appropriate state or Canadian province and your year of graduation from the drop-down menu. If you attended high school outside of the U.S./Canada, please select “No State.” If you did not graduate from high school and instead passed the GED exam, please input “GED” for the high school name and the city where you sat for the exam.
  • Ethnicity, Race, and Background - Physician Assistant programs fully recognize the importance of diversity in their student body and in the physician assistant workforce. Accordingly, programs strongly encourage applications from persons from all socioeconomic, racial, ethnic, religious, and educational backgrounds and persons from groups underrepresented in health care. Please select any and all of the options in this section which you feel best apply to you. Please note that this section is used for statistical purposes only.
  • Academic History
    • Institutions Attended
      • U.S. State or Canadian Territory Schools - Click on the state or territory in which the school is located to select the college from our database. If your school is NOT listed, select “NOT LISTED US INSTITUTION” or “NOT LISTED CANADIAN INSTITUTION.” Note: French-speaking Canadian schools must be reported as a foreign institution.
      • Foreign Schools - Select “NON-US/CANADIAN (FOREIGN) INSTITUTION.”
      • Caribbean Medical School Students - ALL Caribbean medical schools, including but not limited to Ross University, American University of Antigua, and St. Matthew’s School of Medicine, are considered FOREIGN institutions. There is no Caribbean Medical School which has U.S. regional accreditation, even if the school has offices in the U.S. and graduates may become licensed in the U.S.  Please read the “FOREIGN OR FRENCH CANADIAN TRANSCRIPTS” section of our FAQ and follow those instructions for reporting your coursework.
  • CASPA Coursework Entry Service - CASPA now offers all applicants the option to have coursework professionally entered on their behalf by their specialists for an additional fee. CASPA coursework entry staff is available to enter U.S. undergraduate, graduate, post-baccalaureate, and doctorate coursework. Given the nature of professional, non-U.S./foreign, and planned/in-progress coursework, this work is not eligible for coursework entry and must be entered by the applicant.
    • Once your coursework entry is complete, you will receive a notification. It is your responsibility to review the coursework entry for accuracy and approve the entry. If you find any issues with your coursework entry, please submit the issues in writing to the CASPA  email address: Wait for corrections to be approved and made before approving your coursework entry. Once you have approved the coursework entry, complete and submit your application. Your application will continue with normal verification.
  • Transcripts
    • U.S. AND ENGLISH CANADIAN TRANSCRIPTS ARE REQUIRED to be sent to CASPA from all institutions you received college-level credit from, including credits earned as a high school student or those transferred to other institutions. CASPA cannot process your application without receiving all of your transcripts.
    • DO NOT SEND FOREIGN OR FRENCH CANADIAN TRANSCRIPTS. CASPA will NOT accept these documents and they will be destroyed. Please see the “Foreign and French Canadian Transcripts” section of our instructions for how to document foreign or French Canadian work.
    • DO NOT SEND FOREIGN TRANSCRIPTS. CASPA does NOT accept ANY foreign transcripts, including those printed in English. Do NOT send foreign transcripts to CASPA, as they will be discarded.
    • DO  NOT SEND TRANSLATED FOREIGN TRANSCRIPTS. CASPA does NOT accept foreign documents translated into English as this documentation is insufficient. Only an evaluation for U.S. equivalency will be accepted.
    • Canadian Students - Canadian schools that provide English transcripts are NOT considered foreign. Please see the U.S./Canadian Transcripts section for how to report your work. Original transcripts from these schools must be sent to CASPA, even if your PA program does not accept Canadian transcripts. CASPA will NOT accept foreign evaluations from Canadian schools WHICH PROVIDE TRANSCRIPTS IN ENGLISH.
      • Canadian schools which have transcripts issued in French are considered FOREIGN and must be reported like any other foreign school. Evaluations for these schools should be sent to CASPA. CASPA will NOT accept original Canadian transcripts which are written in French.
    • Caribbean Medical School Students - ALL Caribbean medical schools  are considered FOREIGN institutions, even if they have offices in the U.S. or allow U.S. licensing. No Caribbean school has regional U.S. accreditation and cannot be considered a U.S. Institution. Common Caribbean medical schools include but are not limited to: Ross University, St. Matthew’s School of Medicine, and the American University of Antigua. Please list your Caribbean Medical School as a foreign institution and do NOT send Caribbean Medical School transcripts to CASPA as they will be discarded.  You should instead determine if your PA programs will require a foreign evaluation, which may be sent to CASPA, or if your PA programs will accept the original Caribbean transcript mailed directly to the PA program.
  • How to Document Foreign Coursework - If you attended a foreign school or earned your degree outside of the United States, CASPA does not require any documentation, but most PA programs DO. The majority of PA programs require that you have your foreign coursework submitted to an evaluation service for a course-by-course U.S. equivalency report.  This report should then be sent to CASPA directly from the evaluation service. Contact the foreign transcript evaluation service as early as possible. The services may take several weeks to process your foreign transcript once it is received.
  • Foreign Coursework Evaluation Service - Below is a list of the most common services used by CASPA applicants for the translation and review of foreign transcripts. Please note that this list is not all-inclusive and CASPA does not recommend or endorse any particular service. You should check with your designated programs for final approval on which service you should use as it may be different than those on this list.
    • CASPA will send your course evaluation to the schools that you have designated. Please note that if you have ONLY foreign coursework, there will be no GPA calculated.
    • Under no circumstances can CASPA forward your foreign transcript to a third party, including returning it to you if you sent it to them accidentally. Any foreign transcripts received by CASPA will be discarded.
  • Official TOEFL Scores - Official TOEFL Scores should be mailed to CASPA in paper format. They must be original copies of the test and sent to CASPA directly from ETS. CASPA can NOT accept photocopied, faxed, or electronic TOEFL scores. If you are unsure what the TOEFL is about, please visit the website for more information:
  • Please mail all official TOEFL scores to:
P.O. Box 9108
Watertown, MA 02471
    • CASPA does not hold applications awaiting your TOEFL scores. Once these scores are received, your schools can view them online. Please note that the programs to which you are applying may want these scores by a certain date. You should make sure these are received by any deadline provided by the PA programs themselves.

Important Tips for International PA Students
  1. Retake Prerequisite Coursework in the United States. Retaking coursework in the U.S. can actually help you as an international student. Some PA programs may consider you as a U.S. applicant instead of an international applicant if you have completed enough U.S. coursework. This can help your chances of acceptance and enhance your knowledge prior to matriculation.
  2. Very Few Spots Are Available to International Students. Typically only 1-2 spots per PA program are offered to international students. This means that you have to be well-rounded and very competitive in all aspects of your application to be considered. The number might also depend on class size of the PA program.  
  3. 131 PA programs Currently Accept International Applicants. According to the PAEA Program Directory, 131 U.S. PA programs nationwide will accept international students. This number will continue to grow, so your chances are exceedingly better year after year.
  4. Your Type of Visa Matters. No, not your credit card. While in school you will most likely have an F-1 Visa and PA programs realize that you may not be able to work right after completion of your PA program. When you graduate from your program, you have 60 days to secure employment while on a F-1 visa. Many students find employers willing to hire them while on rotations and the employer will often initiate the H1-B visa process for you. If this does not work for you, you can still apply for the Optional Practical Training (OPT) visa 90 days prior to your graduation date and up to 60 days after. If you receive the OPT visa, you have a 12 month extension on your F-1 visa to secure a job to sponsor you with a H1-B visa. With an H1-B visa, you may apply for permanent residency. Many students find it difficult to find employers willing to sponsor them for a H1-B (working) visa and others report that many PAs must commit to working in underserved areas since employers “have to prove they are unable to hire a suitable American candidate.” This may be very difficult or very simple depending on how qualified the other applicants are for the position you apply for. This is a risk some PA programs are not willing to take and will not undergo training of an international applicant who will not potentially be able to provide medical care like a U.S. citizen would. The H1-B visa is employer specific and you must apply for a new one if you switch employers. Some students are also on H-visas, temporary work visas, prior to beginning PA school to acquire health care experience.
  5. Work Permits Are Not Needed For Rotations. Since you do not receive any payment or salary/compensation during PA rotations like medical students do, no visa or permit is required during the PA clinical year(s).
  6. You May Not Apply to FAFSA with a F-1 Visa. Students on a F-1 visa are required to pay the school the full cost of education by repaying the school system for the full, unsubsidized, per capita cost of providing the education to him or her.
  7. Your Attitude Matters. When applying to PA school it is important to realize that you will most likely interview with your program of choice, granted you are offered an interview. Thinking that you are in some way above every other applicant because you hold a medical degree from another country is not the attitude you want to portray in your interview. You need to be humble and understand why you want to become a PA and realize that you are an applicant just like anyone else.



  1. I am really happy after reading this blog, this is too good and nice information. Thanks for sharing!


  2. thank you paul for such in depth information regarding the program, truly appreciate your work.

    i am a bangladeshi and i have completed my M.B.B.S. plus 1 year of internship in bangladesh from a reputed medical college.
    i did my schooling in Bahrain, in an Indian School under the CBSE board(indian curriculum)(10+2) which is equivalent to A levels, during which we had chemistry both organic and general in great depth.

    i have a few queries which i hope you would me kind enough to clarify...

    1) with such a background and without a citizenship or permanent residency, will i be able to apply to any PA program?

    2)if i have my transcripts reviewed my a foreign transcript evaluation service like WES, will i be required to retake courses like chemistry, anatomy, physiology etc. to apply(if thEY meet the requirements?)?

    3)what about my GPA? how do i get to calculate that? is it possible that if i get my transcripts evaluated by WES, they can give me an equivalent GPA and calculate my credits?

    4)during medical school, we have had clinical rotations since the 3rd year uptil 5th year and i have also completed my internship..would this be counted as my health care experience?

    5)does it matter if i go to a PA program which is less in demand and on provisional accredation since i already have good medical knowledge?

    6) if i apply to universities which have dual degrees like Emory etc. , ( MPH+PA) will that be a disadvantage in terms of missing out PA classes during MPH classes or are they well co ordinated?

    7) if someone has given USMLE prior to applying for a PA program, is that going to be a disadvantage for getting accepted? can PA programs actually find out if one has taken USMLE or applied for residency, if one doesnt personally mention?

    8) will working as an Honourary Medical Officer or a paid Medical Officer be counted as health care experience?

    9)can someone work as a PA, and then take USMLEs and apply for residency and become a MD?
    it will be wonderful if you could help me

    1. Hi Rawnak,

      1) Without a citizenship or permanent residency - I do not think PA programs will accept you. You need some type of residency status to be able to attend a program because what would be the point of accepting someone who would not be able to work here afterwards? I think you should really read the article before asking a question like this because I clearly outlined it in the article.

      2) Even if you do have your foreign transcripts evaluated, there is no guarantee that they will transfer to US coursework. Schools will approve your coursework on a case-by-case basis - meaning you would need to check with the programs you plan to apply to in order to see if your coursework meets their standards or not. If they do not, you will have to retake US courses.

      3) As far as GPA goes, I'm not entirely sure, but I don't think they would calculate an undergraduate GPA for you. When you enter/have your transcript evaluation sent to CASPA (application service) your courses would be entered online and it would be calculated at that time. However, be aware that they will not enter your coursework for you. It is up to you to figure out how to enter your own coursework on CASPA.

      4) I think your rotations were probably great experience, but programs will want to see that you have had US experience. Our healthcare systems are entirely different and PAs may be utilized in different ways in each country. They may consider your experience, but I would not count on it as being your primary source of experience. You should call the programs you plan to apply to and ask them yourself.

      5) Provisional accreditation is often given to newer programs that have not yet graduated their first class of students or that are starting up a program and have not had a site visit yet by ARC-PA. It does not mean they are "in less demand" or less popular. I do not think that it would be any easier to get into one of these programs. All programs are competitive and accept top students at each. Remember - just because you attended medical school in another country does not improve your chances of acceptance or make you appear any more bright than any PA applicant. PA applicants do not choose the PA route because they aren't as intelligent. You should know this by now.

      6) It sounds to me like you have quite a bit more of research to do yourself. MPH + PA dual programs are built so that you can take coursework from both areas - not necessarily to take away PA coursework so that you can replace it with public health coursework. You should know what they truly are before you make a decision to even apply to one.

      7) It sounds to me like you have experience with taking the USMLE yourself and you have probably applied for residency but didn't get in? PA programs get that a lot from students just like yourself. It makes it 10 times harder for you to get into a program. They know your plan - you want to use PA school to help you study for the USMLE so you can take the exam and perform well. Many people like you come through our application process, which is why I wrote this article. You would need to first show the admissions committee that you know what a PA is and then prove to them that you are actually in the program to become a PA and not utilize their resources to become an MD or DO in the US.

      8) If your experience was done in another country, it may or may not count toward your healthcare experience requirements. Even if it does count, they will want you to have shadowed a US physician assistant and have experience in the US medical field.

      9) See my response to question 7. It is obvious that this is your intention. You do not need to apply to a PA school because you won't get in. I can guarantee it. They will see right through you.

  3. and could you also tell me about legal issues regarding a docotr with a medical license practicing as a PA ( like malpractice issues etc.)

  4. thank you paul for your wonderful advices.could you kindly clarify just one more situation..

    suppose an FMG,passes USMLE 1,2(CK, CS), does observership/externship in US, gets matched in a residency, COMPLETES residency(lets say internal medicine), and THEN wishes to practice as a tht possible? or does he have to go to PA school and pass PANCE?or diirectly work as a PA , as he himself is a Physician?

    so basically my question is can an MD, after completing residency (in US), work as a PA ?

  5. Hello It is so helpful !! I have a question for you. I have foreign bachelor's degree in health care but not med school. So I'm thinking go to community college to be med assistant or studying by myself and get certified for HCE . Do you think it's good start ? which one would be better..? Thank you !!

    1. I think going to community college and becoming certified would be a good base for you, but also consider that your foreign bachelors degree may not be accepted by PA schools. If that is the case, you may want to go to an undergraduate university in the US to obtain a bachelor's or associate's degree first.

  6. Hi Paul
    This blog was very helpful
    I have a few questions that i hope you can help me with
    I have a foreign degree in Clinical Laboratory Science but I am very interested in the PA program. I primarily did this as my undergraduate study because I entered college at 16 and i honestly did not know what I was doing, I just know I wanted to help save lives. I have graduated, 5 years later, a lot smarter than i was, but now I have a specific bachelors degree in a field that although I enjoy, its honestly not my passion because it hardly deals with direct patient care, which is what i am most interested in. I started researching on healthcare careers when I moved to the U.S, because back home the only career in healthcare that was dominant was medicine, and although I admire doctors and what they do, I would prefer to do a Masters degree, because apart from healthcare and patient interaction, I would also love to explore the education line. Long story short, I read extensively about the PA program and, it felt like a perfect fit for me, still does. I am currently enrolled in community college and retaking all the prerequisites needed for pa school even though i already took them before while taking my bachelor's degree, I just completed a phlebotomy certification, to enable me work in the healthcare field here in the U.S and I am a permanent resident of the U.S. Question is, what else would you advise me to do, do I need to do more, am I on the right track or do you honestly think I'm wasting my time. Any tips will be appreciated because I tried talking to my school counselor and she wasn't much help. Thank you.

    1. offers pre-PA assessments, which can help you determine if you are on the right path (GPA, GRE scores, healthcare experience, etc.).

  7. hi, this bogo was nice. But I have A question.

    I am attending my BA in biology in US (Queens college,New york).
    I was thinking to go for PA school for 2 years after my 4 year bachelor degree.
    So i was curious to know will it be easy for e get a H1B visa as a PA?
    What are the factors that support my question and what are the chances for it?


    1. Hi Himanshu,

      I don't know too much about Visas, so I would consult an international office at your university for more information.

  8. So, if i attended a carib med school, I shouldn't report it on the CASPA?

    1. I don't think I ever mentioned this and if I did, please disregard it. Reporting your schooling on CASPA is up to you. Let me be clear - I think you should report your caribbean education. You should report any and all education because background checks will bring it up. You should prepare yourself for interviews because you'll be asked about your education choices and why you are choosing PA school. I think applying as a foreign medical graduate makes applying much more difficult because it is hard to convince an admissions committee that you do not have ulterior motives to use PA school as Segway into U.S. medical schools.

  9. Dear Mr. Gonzales,
    First of all, I want you to know how happy I was to finally be able to find such great sources to help me becoming a PA. Your advices talk of the truth and the real world situation I've never heard of.
    I'm currently an international student from Vietnam studying my junior year in high school in Nebraska. I've known of the preofession 2 years ago and it has been my dream since then to become a PA. I've been trying to take hard courses and prerequsites science courses since I have the opportunity to study here. I have a few questions and it would mean the world to me if you can help me out even just a litlle bit:
    1/ What inspires you to become a PA?
    2/ How does a day in a life of a PA looks like? What am I expecting working as a PA?
    3/ What courses/ prerequsites should I focus on as a high school student/ undergrat to provide me the best education background for this profession?
    4/ What is the expected starting salary? ( for international and US citizens)
    5/ What is the expected average salary after 10 years? ( for international and US citizens)
    6/ What are the best and worst things you've ever encountered/experienced being a PA?
    7/ I'm currently in a F1 visa. Does that affect my chances for colleges and PA programs?
    8/ What are the best colleges for PA profession would you suggest an international student to consider? ( the cost, scholarships, international student services and opportities for grad school)
    9/ What are the best grad school for PA program would you suggest an international student to consider?
    10/ If it is really that hard for an F1 graduate PA student to get a job right after school, what would you advise international students to do to either acquire an H1-B visa or do to not be unemloyed?
    11/ What minors would you suggest PA students to consider?
    12/ What are the limitations and difficulties for a PA grad student after graduating when finding a job have? ( limited areas? limited license? limited salary compared to native- born applicants?)
    Please consider all these questions for international student as I'm still under F1 visa although I'm studying high school in the US.
    I'm lost ad scared because I realize there's a huge gap between my dream and what I can do with my life to support myself and my family. In the end, what's the point of years of enduring and harsh education if I can't find a job that will support me in life?
    Please be as real and practical as much as you can and please feel free to question me anything you'd like.
    Again, thank you so so much!

    1. Hi An Ha Lan,

      I am going to refer you to Savannah Perry, PA-C. She actually offers a service to pre-PA students for questions such as yours. I would start there first and if you have any additional questions that may be more specific, please try posting here again. Thanks :

      Also, you can use code: DoseOfPA for discount on services

  10. Hi Mr. Gonzalez.

    Thank you for the great site. I'm considering pursuing a BScPA at the University of Toronto or McMaster University, both in Canada. Do you know if American schools can hire and provide working visas for Canadians with this degree?

    1. I believe some American employers may hire Canadian PA school graduates, but I believe most employers will want you to have completed the PANCE (national certifying exam) and to sit for this exam, you must have completed an accredited US PA program. There are some states that may not have this requirement. I would refer you to for more information on State regulations for practicing PAs.

  11. Hi Paul,
    I completed my bachelors in Physical Therapy in India in 2007 and my MS in Exercise and Sport Science From Iowa State University in 2010. Since Jan'2010 I have been working as physical Therapist in US, working very closely with MD, PAs in acute care and acure rehab setting. I want to pursue PA program as I feel I can contribute more towards patient care in various setting given my backgrnd as a PT along with PA.
    I don't have my prereq from US although i have way more clinical exp and a Masters deg from US univ. Will my application be considered ? I don't mind giving GRE again but doing coursework like Anatomy again is just a waste of money and time I feel. Do let me know what your thoughts are on my situation. I have not come across any PT ( let alone international) who has gone and pursued PA program.
    Thanks for your time,

    1. Hey Arjun,

      Sorry for the delayed response. I thought I had already replied to this. First off, congrats on your accolades. You have some really great experience and accomplishments.

      Unfortunately, there is no bypassing the rules that are set in place. Foreign graduates encounter this all of the time and, I agree, it is frustrating. Truth be told, most programs aren't going to consider your application unless you retake your courses here in the US. But it's not always about where you have taken them - sometimes its about how long ago you took them. There is a 10 year maximum (that's when your courses expire). We're not quite there yet, so you may have a chance, but I would email or call PA programs you want to apply to and ask. There are and have been physical therapists who have entered the PA route, albeit there aren't many, but they are out there.

  12. dear paul
    Thank you so much for the wonderful advice and information, in my case, I am a foreign medical graduate and have been in the US for the past 8 years, I am US citizen , honestly , I have been searching so many Rn schools to be back to Medical field but unfortunately that is not too worthy to spend 2 plus years, so I have been looking for a PA school to accept all my statues of education, so if you please tell me what schools are more flexible to accept my MD and match me to enroll to one of their classes ? and how long is the PA program ?

    1. Hi Omar,

      I don't know of any PA programs that "are more flexible" with foreign medical graduates. I can direct you to the PAEA directory and you can check things out from there.

      Good luck!

  13. Hi,
    I went to a foreign medical school in the caribbean for one semester and decided not to pursue it any further, as I did not pass first semester. I am planning on applying to PA school this cycle but I am afraid of how my dropping out to not repeat and failing a semester would look. Also my transcripts are basically empty from this school, there are no credits or GPA, it was P/NP.

    Any advice would be helpful. I don't know if I should even report it.


    1. Not trying to be rude, but if you didn't pass a semester in medical school (even if it was caribbean), what makes you think you'll do well in PA school? The courses aren't any easier and most PA programs take courses with the medical students.

      Not trying to discourage you - I really just want you to think about what you're doing here. It could be a very expensive road for you to start PA school only to find out it's too challenging. That's exactly what PA admissions committees are going to think. As far as reporting your past experience - I would just be honest about it. There's no reason to lie about your past. Assume the worst - they find out and you didn't report it - do you think they'd pick you then? What would you say?

  14. I am studying physician assistant in India. I want to do my higher studies abroad. What is the procedure. Can u advice me

  15. Hi Paul! Thanks for sharing this extensive info on the PA program!
    I am a UST BS Medical technology graduate here in the Philippines, I believe I did well during my college days so I really got good grades... I really want to pursue PA program but I lack the volunteer hours... and they told me to do some shadowing hours to make my profile more competitive.. But I am not sure how to do his since I'm still here in the Philippines... Any advice as to how I can shadow a PA?

    I was also thinking of enrolling first in a Community College which offers a Medical Assistant Associate degree program to complete my volunteer hours since being a Medical Technologist here, I have no direct patient care experience really.... But then, I am worried that after completing the Associates degree, no one would hire me (no one would sponsor for a working visa) and I will end up not being able to complete my volunteer hours.(Can I apply for an OPT instead? Can I Use OPT for Medical Assisting?)

    Any thoughts regarding my problem?
    I am planning to go to Pacific University in Oregon

    1. You can't shadow American PAs without coming to America. I would start with figuring out when you'll be in the US and try to schedule a shadowing experience or two while you're here. You can volunteer in your own country.

      Enrolling in a medical assistant program doesn't get you volunteer hours - those count as hours to become a medical assistant or "training hours" and they cannot be counted as anything but that. You need to volunteer at outside events (fundraisers, health fair, homeless shelters, etc.)

      Not being sponsored after obtaining your degree as an MA is a possibility - especially considering how expensive it is to sponsor someone. Maybe you should be ready to pay for those fees yourself? Save up before coming here. I'm not sure about applying OPT for medical assistant, but I would guess the answer would be no. These are all great questions that I encourage you to figure out beforehand. Formulate a plan and then proceed.

    2. Hello again Paul! Thank you so much for the advice!

  16. Very informative site. I am an employer willing to sponsor the H1B visa and/or GC process for a PA. How can I find applicants in need of this?

    1. Hi unknown,

      I would say look above! ^^ I know there are multiple people who inquire about this. If you want, post your contact information here so potential applicants can find you.

  17. This comment has been removed by a blog administrator.

  18. hey! I am highly interested in getting to PA program; due family circumstaces I was unable to match and will not be going through match ever again. What is the best way to address in Personal statement about why I will be going to PA after completing MD degree? I have emailed few programs; but was told they will not consider me as I have MD degree.

  19. Hi Paul,
    Such an awesome blog to read about PA program.
    Am Radhika from India who completed BA PA and Masters in Public health and i have a good score. I work as a PA in a hospital in India for 8 yrs.
    Now am interested to do Masters in PA. So just started to get some info's about US schools who are providing PA programs for PA student. I wanted to know if my plan is good to ahead and can I get a good school and a job after my masters is completed (since am an international student). Please advise.

  20. Thanks for sharing such detailed information on this topic and answering the FAQ's.

  21. can I apply for the PA program if I have a degree on dietetics from a foreign school?

  22. Hi Paul!

    I’m an international student who went to high school in the US. I’m a high school senior, and I’ll be graduating this year. I’m interested in working with people, the science of medicine, and the art of healing. Since I’m not bound to anything yet, I’m evaluating all my options before I commit.
    I have applied and been accepted to a few combined med and PA programs, and to some good schools in the midwest. I’m currently on my dad’s H visa.
    What would you recommend is the safest path to get a job in healthcare(PA or Physician)? Do you think it’s better to be on F vs H visa in order to have the best internship opportunities? Is it a good idea to consider MAVNI? What about employment with the UN or Partners in Health or something similar in global health? Anything else that can help?

    I really appreciate the info you put out there!
    Thanks for the motivation and inspiration! :)


  23. Hi Paul,
    There is very comprehensive information available at your blog for IMGs going to be PA. I also come in same category. I completed my med school overseas, after that I passed USMLE 1,2 and 3 but did not get residency match. 2 years ago, I settled in United States after getting married. Now I would like to pursue my career as a PA. I am 35 years old and I feel PA fits well for me at this point and in long run in terms of keeping balance in my responsibilities of professional and personal life.
    I have 1000+ hours volunteer US clinical experience and research as well in United States.
    Do you think i am good for this program?
    Is there any other options that is good for foreign doctors here in USA beside PA?
    Do you think PA program route helps IMG doctors to plug themselves in into residency programs at any way?

  24. Hello,
    I am foreign medical graduate with GPA 3.88 evaluated from WES currently US citizen working as Triage nurse and overshadowing PA. I plan to take the prerequisite from community college. Completed MPH on USA...... I just want to know what are the chances for me applying to PA program since I have so low GRE scores?
    Any suggestions for the schools that do not require GRE?

    I have a dream to serve people in the health care however, MPH alone with my foreign medical degree is not sufficient and got attracted to the PA program.

  25. Hello I have done my dentistry from India . But I want to do pa in usa and doesn't want to pursue dds because of many reasons.liking about the pa profession and the cost associated with dds .
    So is the possibility I can get in to pa program though I have done scribe in India in hospital
    Thank you

  26. It seems as though things are changing as several states are taking measures to help MD's get licensing as a PA. Missouri seems to be one of the states with the most broad advantages thus far.

  27. You actually make it seem so easy with your presentation but I find this
    matter to be actually something that I think I would never understand.
    It seems too complex and extremely broad for me.
    I'm looking forward for your next post, I will try to get the
    hang of it!

  28. Hello. I am an IMG, 40 years old, I am starting that process but somebody told me that I should try to do something else because by the time I finish all the schooling I am going to be massively in debt and I wont be able to pay before my 70"s. is that true? Thank you for your help.

  29. Scenario: A friend of mine, passed usmles and ECFMG certified but did not get match into residency(doctor). She wants to practice as a Physicina Assistant.
    1. How to verify my credentials? How long will it take and what are the next steps?
    2. She completed Bachelor degree in medicine outside USA. Should she apply for Bachelor or Master degree in PA?

  30. Hello Paul,
    I sincerely thank you for the extensive information on becoming a Physician Assistant. I got to know a lot about it. Will you please help me with one more information. I want to know if Canada universities offering PA programs like the University of Manitoba accepts International students into their program. Or, if not, any other country besides USA which offers PA programs for international students too. I am thinking, studying for PA programs elsewhere in the world will allow us to work as one too soon after graduation. All this considering the H1B visa situation. Please let me know.

    1. Hi Arum, there are lots of factors that play into your specific scenario. I don't feel confident enough to give you an answer. I do not know of individual international programs outside the US that accept international students with an H1B Visa. I would message the staff at University of Manitoba and other PA programs throughout the world you are interested in attending and let them know about your specific situation and see what info they can offer.

  31. Hi Paul,

    Thank you very much for your insight into getting into PA programs as an international student. I am currently a senior at Boston University studying pre-medical sciences. I was born and raised in Japan, went to an international school for most of my life, and then moved to Boston for my undergraduate studies. I obtained my EMT certification in Massachusetts last year and plan to work as an EMT with my OPT starting this summer after I graduate. I have clinical research experience in neurorehabilitation at my school and observation hours at St. Luke's International Hospital in Tokyo (2 months), Beth Israel Deaconess Medical Center in Boston (2 months), and St Vincent's International Hospital in Sydney (2 months), where I assisted doctors with basic clinical procedures. My dream is to become a Physician Assistant in the United States, however, I do not hold a US citizenship. I understand that as an international medical student it is difficult to be considered by PA programs. Does this still hold true for non-US citizens who have a solid 4-year bachelor's degree in a US institution and have enough clinical work experience in the United States and other countries? I'm sorry if you have touched upon this subject in your article. I wasn't sure if you were speaking specifically for students who have obtained a medical degree in a foreign country or also for non-US citizens who have been studying in a US undergraduate program.

    Thank you very much.

    1. I think that's a great question to which I don't believe there is a quick or easy answer. I think the fact that you hold a degree from the U.S. and lots of experience you seem like a pretty well rounded candidate. I think other factors that play a huge role are your GPA and GRE scores (if applicable). If you plan to apply to PA programs, message them regarding your citizen status and see what they recommend. I would imagine you'd need to become a U.S. citizen, because I am pretty sure most licensure requirements-require you to be one or hold a green card, etc.


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