The global PA movement

In an article for JAAPA's October 1992 Silver Anniversary Edition, former AAPA President William Marquardt reflected on the first quarter-century of our profession and shared a vision for our future. “Physician assistants will be worldwide leaders,” he wrote, “vital to providing care and improving medical care to all people.” In the same issue, Jack Liskin, former PA program director at the University of Southern California, also offered predictions: “The world has become a global village in which we know almost instantly what everyone else is doing and realize that events in one place will have an effect everywhere else.” Liskin hoped that our burgeoning profession would take time to reflect on its past and critically examine our future. As we move closer to the profession's 50th anniversary we are struck by these authors' observations, especially when considering how our profession has evolved domestically and worldwide. The American PA movement continues to gain momentum. There are nearly 100,000 certified physician assistants, PA programs across the country are expanding, and new programs are being started. Our movement also appears to be a catalyst for a global PA movement. Countries worldwide clearly face many of the same problems and challenges in supporting health and caring for the sick. In Liskin's global village, the PA model is being embraced and cultivated to increase access to care, grow safety nets, lower costs, and address medical provider shortages. Beginning this month, JAAPA will investigate the global PA phenomenon and offer commentary and brief reports from clinical and academic leaders who will describe current challenges and opportunities, share a vision for the future, and discuss practice innovations unique to their countries. In this issue of JAAPA, Ian Jones writes about the evolution of the PA movement in Canada. Closely tied to the military at its beginnings in 1999, the PA model in Canada continues to move steadily into the civilian sector to address unmet medical needs and access to care barriers created, in part, by Canada's vast rural areas and maldistribution of healthcare resources. In the months ahead, we will hear from leaders elsewhere, including India, Australia, South Africa, and the Netherlands. Demand has driven growth of the PA movement in the Netherlands, which has passed its first decade, with the Dutch government urging the development of the PA model and integration of training programs into its country's universities. The government support has paved the way for greater autonomy among Dutch PAs, who facilitate task realignment from an overly burdened physician workforce. Parallels between the PA movements in these countries and the United States are clear, such as the military roots of the profession. The United States is supporting this global PA movement through the success of our PA model as well as with consultative, diplomatic efforts by numerous American PA leaders working beyond our borders. Perhaps the vision described by Marquardt in 1992 opened doors for this global movement and is now actively being realized. Echoing some of the sentiments shared by Liskin, we offer a few key questions. Which trends and innovations in the PA profession outside the United States are distinct and may inspire advancements in the PA profession in America? Which strategies are countries outside the United States using to optimize the PA profession in ways that are bringing about measurable improvements in healthcare access, quality, and cost? How can PAs in America support and contribute to the continued growth of the PA profession around the world? How can active involvement and increased awareness in this global movement make us better clinicians, advocates, and leaders? Liskin also wrote, “For tomorrow's PAs, such awareness will mean fully awakening to the world outside our practices.” He worried that our increased success and autonomy, and probably our increased diversity across practice settings and specialties, had the potential to make us less sympathetic to the needs of others. We propose that as our profession nears its 50th anniversary, there is no better way to reconnect with our roots or consider our future than to raise our awareness of the global PA movement. Understanding the distinctive trends and innovations occurring beyond our borders might just offer us fertile ground for envisioning the next 50 years of the PA profession at home.

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