The expatriate PA

FigureIn recent years, expatriate physician associates (PAs) have become increasingly visible to observers of international medical labor.1 Although this trend is only partially documented and not widely acknowledged, it signals a growing transformation in healthcare service delivery, with the PA serving as a transferable skilled health professional. THE GROWING TREND OF PA EMIGRATION There is an ongoing trend entailing emigration of American-trained PAs to Canada, New Zealand, and the United Kingdom (UK). American PAs have also found positions in Australia, South Africa, Israel, Liberia, Ireland, Germany, and the Netherlands. This migration is not exclusive to Americans, as PAs from the UK and Canada have also moved to New Zealand. According to estimates from colleagues abroad, at least 35 American PAs reside and work in Canada. Unlike physicians and nurses, the reverse flow for PAs is obstructed because licensure, which is granted exclusively by states, requires graduation from an ARC-PA-accredited program (a qualification for sitting the American PA National Certifying Examination). REASONS FOR RELOCATION The motivations for PAs to move abroad are varied. One common reason is marriage or having a lifestyle partner who is a national of the host country. For instance, an American PA married to a Canadian, New Zealander, or British national might relocate to their partner's home country. Some American PAs have moved to the UK, Israel, and South Africa to take up educational roles or help establish new PA programs.2,3 An American-trained PA has returned home to the Netherlands to work in primary care.4 National issues may play a role in the decision to emigrate. Some PAs have cited the quality of life in their new country as a primary motivator for relocation. Political factors, such as reproductive rights and confidence in changing US laws and regulations, have driven others to seek employment offshore. For some, raising a family in an environment with less partisan extremism or gun violence has been a significant factor in the decision to relocate. One American PA, for example, emigrated after their European spouse was denied American citizenship. Individuals who leave for political reasons are known as émigrés. THE PA MOVEMENT IN NEW ZEALAND New Zealand has become a prominent destination for PAs, attracting interest from the UK, Canada, and the United States. As of 2025, at least 50 PAs participate in the early New Zealand PA movement. The political culture in New Zealand, which includes nonnuclear policies, gun control, diverse cultures, and universal healthcare, resonates with many expatriate PAs and reinforces their decision to relocate. Additionally, some PAs find the wages and benefits in New Zealand more appealing than those in their home countries, like the UK and Canada. Based on personal observations, no country offers higher PA salaries than the United States, suggesting that sociopolitical factors may surmount financial considerations.5 OTHER EXAMPLES OF PA EMIGRATION Some PAs who choose to emigrate are married to business professionals assigned to work abroad. In these cases, the American PA may find employment in a country early in its PA movement, such as Germany. For instance, American PAs may accompany their spouses on assignments in Germany or be stationed by the Department of Defense or Department of State in Afghanistan, Africa, or Latin America. Peace Corps PAs serve as medical officers on temporary assignments that typically last 2 to 5 years. One PA worked with Médecins Sans Frontières in Djibouti, Somaliland, Afghanistan, and Pakistan. Various humanitarian medical care organizations, such as the US Public Health Service and several religious organizations, temporarily relocate PAs. Although these PAs are not classified as expatriates due to their temporary placements, they serve as professional role models in their host countries, generating interest in the profession. CONCLUSION The emigration of PAs is a growing global trend that necessitates attention and documentation as a strategy for skilled medical labor. Similar to the relocation of American physicians and nurses abroad, the PA movement represents the export of an overlooked medical workforce model. Understanding the reasons behind this movement can be a cornerstone for recognizing PAs' capabilities in global healthcare service delivery. As this relocation trend evolves, gathering more details and documentation on the experiences of expatriate and émigré PAs will help to achieve a comprehensive understanding of this shift in the global healthcare workforce.

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