Global Applicability of Physician Assistants by sammyc2007

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									Global Applicability of Physician Assistants
Christine Legler PA-C, DHSc
Association of Physician Assistant Programs International Affairs Committee

Co-authors – IAC Committee
• • • • • • • Marie L. Bensulock, PA-C, MS Patricia A. Castillo, MS, PA-C Wilton Kennedy, III, MMS, PA-C Kathy Jane Pedersen, PA-C, MPAS Kirsten Thomsen, PA-C Justine Strand, MPH, PA-C Marie-Michèle Léger, MPH, PA-C

Development of the physician assistant profession in the US
• 1960s - Shortage and maldistribution of primary care physicians in United States • Many rural and underserved communities were without health care services • New category of health care worker conceived to expand delivery of quality medical care • First physician assistant program began at Duke University in 1965 with four Navy corpsmen

Non-physician clinician models
• • • • Feldshers: Russia, Eastern Europe (1600-present) Officier de santé: France (1803-1892) Barefoot doctor: China (1966-present) Community health technician: Columbia, Mexico, Peru, Guyana (1970’s) • Clinical Officer: Kenya (1960’s – present) • Physician assistant: United States, Canada (1965present) • Nurse practitioner: United States, Canada, Great Britain (1966-Present)

What is a physician assistant?
• Health care professional licensed to practice medicine with physician supervision • Exercise autonomy in medical decision making • Provide a broad range of diagnostic and therapeutic services • PA education is competency-based using the medical model designed to complement physician training

Physician-physician assistant team
• Physician assistants are legally regulated in all states to practice medicine as delegated by and with the supervision of a physician • Physician-PA team relationship enhances the delivery of high-quality health care • PAs work in a variety of clinical settings including rural clinics, medical group practices, community health centers and hospitals

International interest in the PA profession
• Development of a new health profession often initiated in response to the identification of an unmet health workforce need • Rapidly evolving interest in the development of PAtype programs by many other countries • Recent development of PA Programs in England, Canada, and the Netherlands • South Africa and Ghana are in the planning process to begin programs in next few years • Expansion of international clinical rotation placements for PA Students • Increase in number of PAs interested in practicing in a international setting

United Kingdom
• Difficulty in recruiting general practitioners • Tipton Care Organization joined Great Bridge Partnership to recruit two PAs from the US (2002) • Pilot program has 14 PAs working in several primary care trusts (2004) • January 2004 - “Physician Assistants: A Solution to Workforce Development?” conference at University of Birmingham
• Use of PAs in the UK • Development of PA educational model in the UK

• September 2004 - First PA style course began at the University Wolverhampton • September 2005 – Another University plans to start a second PA Program

• Country faced with increased number of patients, aging population with multi-system illnesses and rising costs of health care • 2001 - First PA program began Health Academy of Utrecht • 2003 - Second PA program at the University Arnhem/Nijmegen • 2003 - Programs accredited by the Dutch Flemish Organization with one national curriculum • 2004 - Recognition by the Department of Education and Science

• PA type health professional integral part of the Canadian Military for over 30 years • May 2003 - Canadian Medical Association (CMA) approved PA profession as a “designated health care profession” • 2003 - Province of Manitoba approved licensure for U.S. trained PAs to work in in that province • 2003 to present - U.S. trained PAs hired to work at hospital in Cardiovascular surgery in Manitoba • August 2004 - CMA provided provisional accreditation to the Canadian Forces Medical Services PA Program • Fall 2004 - University Medical School in Winnipeg began feasibility study on the development of a civilian PA program

South Africa
• Country faced with a shortage of health care workers especially in rural areas, Physicians leaving to practice in other countries • Winter 2003 - South African government approves PA concept • March 2004 - “The Launch of the Medical Assistant Programme”
• Sponsored by Health Ministry for government officials, physicians, nurses, educators and other health leaders • AAPA and PA program representatives discussed the PA model • Presentations on Tanzania and Kenya Medical Assistant role

• Proposal to start a pilot PA program in 2006 with the assistance of a South African graduate of the Emory PA Program

• Shortage of physicians especially in rural areas • Significant numbers of physicians leave Ghana to practice in other countries • Preliminary approval from the Ghana Minister of Health and Education to start a PA program • January 2004 - Presentation by U.S. PA Educator on PA model to Faculty and Community Leaders at Cape Coast University • Fall 2005 – Visit by President from University in Accra to GWU PA program

Republic of China and Taiwan
• Mainland China - Beijing, Shanghai, Wenzhou (2002 - 2005)
• Several consultative visits and conference presentations on the PA model • Wenzhou Medical College hosts PA students

• Taiwan
• Delegation of U.S. physician assistants invited to Fooyin University as consultants (2004) • Fooyin University has established three locations to train a PA type provider (2005)

Steps to creating a new health profession
1. Determine the type of health professional needed to provide care for the underserved communities 2. Identify key individuals from the medical community, government, ministry of health and others interested in the development of a new health professional 3. Review health professional training programs from other countries, such the PA model in the US, to determine applicability

• In the United States, the Physician Assistant model has been proven to be a cost-effective way to train a quality primary care provider • Physician Assistant education is efficient and flexible • High degree of acceptance of the Physician Assistant role by patients and other health care providers • Internationally, the model can be easily adapted to the specific health needs of many nations

For more information: Physician Assistant Organizations
 Association of Physician Assistant Programs (APAP)  American Academy of Physician Assistants (AAPA)  Physician Assistants for Global Health (PAGH)
 National Commission on Certification of the Physician Assistants (NCCPA)

 Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)

Thank You! Questions?

journey of a thousand miles begins with a single step.” Confucius

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