International Progress of the American Physician Assistant Model of Education and Medical Practice.

Purpose: The purpose of this research study was to document the expansion of physician assistants (PAs) outside of the United States. International expansion provides a natural experiment for comparison of the progress of developing PA models, experiences of emerging workforce enterprises, and how countries new to the PA concept have incorporated it into their health care communities. Methodology: A 10-question survey instrument focused on the topics of PA education and practice was developed and used for interviewing a primary informant from each researched country that was reported by the American Academy of Physician Assistants to have PA activity. These countries include: Canada, England, Scotland, the Netherlands, Australia, Taiwan, Papua New Guinea, South Africa, Nigeria, and Mozambique. The primary contact then provided researchers with a second and possibly third contact who were surveyed as well. The survey was administered to 23 informants either in person, by telephone, or via e-mail between May 2006 and September 2006. Results: From both the literature and informant interviews, the authors found that physician shortage was the most common denominator for all the researched countries that have established the PA profession or were interested in doing so. Most of the countries surveyed are working in roughly the same direction: working to introduce the PA in some form, to license or credential them, and to deploy them with a purpose of serving the best needs of it citizens. In terms of an educational and practice model, each country has adapted its own structure from the U.S. model to accommodate its unique needs. Both Taiwan and the Netherlands, unlike the U.S., combine the clinical and didactic curricula. Although the UK has the most comparable educational model to the U.S., Canada's model of practice most represents the U.S. in practice settings, credentialing method, and policy for foreign-trained PAs working. Differences exist mainly in that each country adapted the PA model of practice to best suit its needs within range of the limitations set by its government. Conclusion: Many countries outside the U.S. have decided to incorporate the PA profession into their own health care model in order to experience benefits. Through this study, several implications can be drawn. First, it is imperative to have government and doctor support and recognition when incorporating the physician assistant model, from both an educational and clinical standpoint, into an existing health care model. Secondly, each program would benefit from being associated with a pre-existing and successful medical school. Thirdly, each country must define the role and the level of autonomy that the PA will have in that country. Lastly, public acceptance and awareness of the profession is vital to the success of this new profession. Despite obvious similarities and differences of the profession from country to country, it is apparent that the PA profession is making worldwide advancements.

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