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Education: Higher Education

The Physician Assistant Profession: Reflections on Its Past, Present, and Future

Class 6: The Global Expansion of the Physician Assistant “Concept”


In 2011, the World Health Organizations Global Health Workforce Alliance reported that more than 1 billion people (one-seventh of the world’s population) have never seen a formally trained health care provider. UNICEF and the World Health Organization estimate that in 2014, 10 million mothers, full-term unborn infants, newborns, and children died and that 5 million more people died from HIV infection, tuberculosis, or malaria. The great majority of these deaths were readily preventable or treatable. Basic and essential surgical care is unavailable to the great majority of people living in low-income countries, contributing to the deaths of another 17 million people. The emergence of chronic diseases in low-income countries (primarily hypertension and other cardiovascular conditions, diabetes, and mental health disorders) and the health needs of the elderly will create a growing demand for primary care providers that cannot be met only by physicians and highly educated nurses.

In 2015, the estimated global shortage of physicians and nurses has reached more than 4.6 million. There will be a rapidly growing demand for many types of health care providers, including physician assistants (PAs). However, given the shortage of physicians in most low-income settings, medical care will increasingly be provided by other members of the health team, and community health workers will become important providers of medical care at community health posts and in homes. Community-based primary care provided outside of formal health facilities will need to be fully developed in low-income settings in order to achieve the United Nation’s sustainable development goal of universal access to health care by 2035. The eventual achievement of “health for all” will require the full development of health teams as envisioned in 1978 at the International Conference for Primary Health Care.

Suggested class outline:

  1. PA programs are spreading to other countries (the PA profession is now established in Canada, Great Britain, The Netherlands, Germany, Australia, South Africa, Saudi Arabia, Liberia, India and Ghana)
  2. U.S.-trained PAs are working overseas in a variety of roles. PAs work or volunteer internationally with medical missions groups, corporations, non-governmental organizations, military programs, and disaster relief groups. U.S.-trained PAs have also been employed in pilot projects sponsored by ministries of health to demonstrate the potential of PAs to address country-specific goals and priorities
  3. Training programs similar to PA training programs are now present in low-income countries, spreading the concept, the training, and the utilization of other similar health care providers
  4. Achieving “health for all” will require PAs and other similar health care providers, who are recognized as quality providers of primary care services domestically and globally
Class Resources
Core resources
Supplemental resources
  • Couper, I. D., and J. F. Hugo. “Addressing the Shortage of Health Professionals in South Africa Through the Development of a New Cadre of Health Worker: The Creation of Clinical Associates.” Rural and Remote Health 14, no. 3 (August 16, 2014): 2874.
  • Freund, T., et al. “Skill Mix, Roles and Remuneration in the Primary Care Workforce: Who Are the Healthcare Professionals in the Primary Care Teams Across the World?” International Journal of Nursing Studies 52, no. 3 (2015): 727–743. doi:10.1016/j.ijnurstu.2014.11.014.
  • Hooker, R. S. “Globalizing Physician Assistant Education.” The Journal of Physician Assistant Education 26, no. 3 (2015): 111–112. doi:10.1097/JPA.0000000000000029.
  • Hooker, R. S., and L. Kuilma. “Physician Assistant Education: Five Countries.” The Journal of Physician Assistant Education 22, no. 1 (2011): 53–58.
  • Kuilman, L., G. Sundar, and K. M. Cherian. “Physician Assistant Education in India.” Journal of Physician Assistant Education 23, no. 3 (2012): 56–59.
Discussion Questions
  1. What other types of health care providers might emerge to expand health care coverage to everyone?
  2. Will the PA concept continue to gain steam in other countries around the world? What are the necessary and sufficient conditions that permit the introduction and development of the PA concept in a country’s health system?
  3. Should PAs and similar clinicians provide essential and basic surgical and mental health services where such services would otherwise not be available?
  4. How will we know when health for all has been achieved?
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