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International PA Timeline

Explore the development and expansion of PAs and similar health-care professions around the globe!

Prior to the development of the PA profession during the mid-1960s in the US, similar models of healthcare workers existed in other countries. Today, the PA profession and comparable healthcare roles continue to expand internationally.

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1960s

1965

Liberia

The first Liberian Health Assistant/PA Program is established in Africa through a collaboration of the Ministry of Health and Social Welfare, the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF).

1965
1969

Ghana

The first Ghana PAs are trained through the Ministry of Health established Rural Health Training School at Kintampo.

1969

1970s

1975

Liberia 

Liberia’s physician assistant program’s curriculum is revised to be comparable to PA programs elsewhere in the world. Training is extended to three years from one and students are now required to have a high school diploma.

1975

1980s

1984

Canada

The Canadian Forces Medical Services School at Borden, Ontario graduates its first class of physician assistants; the first formally trained PAs in Canada.

1984

1990s

1992

India

The first PA program starts in India under the direction of Dr. K. M. Cherian, a renowned cardiac surgeon.

 

Image: Nalla Swanpna, cardiology PA in India, talks to patient, 2017. Photo courtesy of Adam Halbur.

1992
1999

Canada

Manitoba passes the Clinical Associate Act which allow PAs and international medical graduates to practice within the country as clinical assistants.

1999

2000s

2001

The Netherlands

The PA Role is introduced in the The Netherlands at the University of Applied Sciences in Utrecht.

2001
2002

Canada

The Canadian Military transitions former medical training program to PA curriculum.

2002
2002

South Africa

PAs are first considered by the South African National Health Council.

2002
2002-2004

Taiwan

Fooyin University in Taiwan operates as a “US model” PA Program. The program closes in 2004 when its accreditation is denied by the Ministry of Education and a Medical Care Act for PA Practice fails to pass.

2002-2004
2003

Canada

The Canadian Medical Association agrees to accredit Canadian PA Programs. The Canadian Medical Association recognizes the PA Profession as a designated health profession, eligible for the CMA accreditation.

2003
2003

The Netherlands

A second PA Program opens at University of Applied Sciences in Nijmegen.

Image: The first graduating class

2003
2003

The United Kingdom

Two US PAs are recruited to work in primary care practices in the UK. The number would increase to 26 by the end of the year. These PAs would go on to start the United Kingdom Association of Physician Assistants (UKAPA).

2003
2004

Canada

The first Canadian PA Program is accredited (Canadian Forces).

2004
2005

Ghana

The first two Bachelor PA programs are initiated at Cape Coast University and Central University College.

2005
2005

The United Kingdom

The UK Association of Physician Associates (UKAPA) is founded.

2005
2005

The Netherlands

Three more MPA programs are opened at: Inholland Graduate School in Amsterdam, Hanze University of Applied Sciences in Groningen, and Rotterdam University of Applied Sciences.

2005
2005

Germany

The first German PA program opens its doors at Steinbeis University in Berlin. Two other programs soon follow at Baden-Wuerttemberg Collaborative State University in Karlsruhe, and Mathias Hochschule Rheine University of Applied Sciences.

2005
2005

South Africa

In January the National Department of Health Task Team initiates the development of a clinical associate programme and 3-year bachelor degree. In August, the Family of Medicine Education Consortium develops national curriculum, scope of practice, job description, roles and responsibilities of clinical associates.

2005
2005

Canada

The first Canadian Certification Exam is offered by the Physician Assistant Certification Council of Canada.

Image: Tom Ashman (left) is considered the “father” of the Canadian PA movement.

2005
2006-2008

The United Kingdom

Twenty PAs are recruited for a PA pilot in Scotland.

2006-2008
2007

Canada

Ontario opens PA pilot program in Emergency Medicine for PAs and International Medical Graduates.

2007
2007

Ghana

The Ghana Medical Assistant role – originally created in 1969 to provide primary care in rural Ghana – is transitioned into a more typical PA program at Kintampo Rural Health Training Center. Originally designed to train experienced nurses in expanded roles, the Kintampo program opens its doors to other students, including high school graduates.

2007
2008

South Africa

Walter Sisulu University and University of Pretoria start their first cohort of clinical associate students.

2008
2008

Canada

The University of Manitoba and McMasters University PA programs open. They are the first Canadian civilian PA programs.

2008
2008

The United Kingdom

University of Wolverhampton and University of Birmingham open their programs with cohorts of ten students. The UK Association of PAs holds their first annual conference.

2008
2008

South Africa

PAs are formally introduced by the Health Ministry as a means to address chronic health workforce shortages, especially in rural and otherwise underserved areas of the country.

2008
2009

Canada

The Manitoba Practice Act is amended to allow physician assistants to use the title PA. The College of Physicians and Surgeons of New Brunswick amends the New Brunswick Medical Act (1981) to include PAs.

2009
2009

Poland

A pilot PA program starts in Zabrze, Poland. The program lasts 18 months and is focused on surgical training. Five students complete the training, with three continuing to work as PAs in surgery and two returning to their previous occupations as EMTs.

2009
2009

South Africa

The university of Witwatersrand starts their first cohort of students.

2009
2009-2010

Australia

Two Australian states – South Australia and Queensland – complete their one year PA pilots designed to show off the potential of PAs in surgical and pediatric roles (South Australia) and primary care (Queensland). Image: University of Queensland School of Medicine.
2009-2010

2010s

2010

Canada

The Consortium for PA Education opens – a partnership with the University of Toronto School of Medicine, the Michner Institute for Allied Health Programs, and Thunder Bay School of Medicine. It is the fourth civilian PA program to open in Canada.
2010
2010

The Netherlands

Dutch PAs now number 1,000.

2010
2010

The United Kingdom

The PA Managed Voluntary Register (PAMVR) is created by the UKAPA to help regulate the PA profession in the UK due to the lack of national legislation.

2010
2010

Saudi Arabia

The first PA program opens in the Middle East, offered by the Medical Services Directorate of Ministry of Defense and Aviation in the Kingdom of Saudi Arabia. It is launched at the Prince Sultan Military College of Health Professionals in Dharhan in partnership with George Washington University Medical Faculty Associates in the Department of Emergency Medicine.

2010
2010

Afghanistan

The NATO training mission in Afghanistan develops a PA course. The primary goals of this program are to both increase the overall numbers of clinicians and to improve the skill levels of the clinicians in the Afghan National Army.

2010
2010

South Africa

The National Department of Health approves clinical associate job description, roles and responsibilities.

2010
2010

Ghana

The Ghana Medical and Dental Council sets standards for the training and regulation of practice for PAs. It also creates a registry for all PAs in the country.

2010
2011

Australia

The Australian College of Rural and Remote Medicine (ACRRM) became the first major health care professions organization to champion the PA model with a formal policy statement. The Rural Doctors Association of Australia also endorsed this policy.

2011
2011

South Africa

The first cohorts of PAs graduate from the South African PA programs and are now working in rural district hospitals.

2011
2011

United Kingdom

Birmingham and Wolverhampton PA programs close. A new PA program opens at the University of Aberdeen in Scotland.

2011
2011

Canada

The Consortium of PA Education/University of Toronto graduates its first class in June.
2011
2012

India

The first published scholarly article about PAs in India reveals a workforce of approximately 1,000 clinicians trained as PAs. Of those clinically practicing, almost all work in cardiac surgery.

2012
2012

The Netherlands

PAs are enabled by law to practice medicine autonomously, albeit in collaboration with a medical doctor at all time.

2012
2012

Australia

The University of Queensland’s PA program closes after education two cohorts. The reasons for closure include a lack of support from the institution and competing priorities with in the School of Medicine. The second PA program in Queensland opens at James Cook University in Townsville with an emphasis on education PAs for rural and geographically distant communities.

Image: First graduating class of James Cook University.

2012
2013

 

The United Kingdom

UK PAs agree to change their name to Physician Associate.

2013
2013

Saudi Arabia

The first class of Saudi Arabian PA graduates with the title Assistant Physicians due to a translation issue with the title Physician Assistant.

2013
2013

New Zealand

New Zealand’s Health Workforce in the Ministry of Health sponsors a two-year pilot in primary care (6 PAs) and rural emergency medicine (1 PA).

2013
2014-2015

Liberia

14 Liberian PAs die for the Ebola epidemic.

2014-2015
2014

Bulgaria

The first two Bulgarian PA programs (Trakia University, Stara Zagora and Faculty of Public Health, Sofia) are developed building on a long tradition of the historic utilization of Feldshers in their country. The four-year Bachelor’s degree programs are based on the United States PA curriculum.

2014
2014

The United Kingdom

The Birmingham and Wolverhampton PA programs are reopened. Health Education England hosts the Birmingham Conference, “PAs in the Workforce” as the national government begins to formally support of the growth in the numbers of PAs and the expansion of PA programs. UKAPA is restructured and integrated into the infrastructure of the Royal College of Physicians and then renamed the Faculty of Physician Associates.

2014
2014

The Netherlands

Dutch PAs host their first international conference in Amsterdam.

2014
2014

New Zealand

The New Zealand PA Society is established and endorses the term “Physician Associate”.

2014
2015

India

The first International Conference on PAs in India, sponsored by the Indian Association of Physician Assistants, brings international PA leaders to participate, speak, and learn more about the Indian PA movement. The conference is help Amrita Hospital in Kochi, India. The first volume of a new PA journal for India is published in conjunction with the conference.

 Image: Dr. Prathapan Nair(left), principal of Amrita School of Medicine and Dr. Prem Nair, Medical Director of the School of Medicine.

2015
2015

 

The United Kingdom

The National Health Service announces a PA expansion project designed to recruit US PAs into the UK health system to expand the number of PAs and to also demonstrate the new and expanded roles of PAs in several areas of the UK. The Faculty of Physician Associates (FPA) is created and replaces the UKAPA.

2015
2015

Liberia

US Public Health Service sends 20 US PAs to Liberia to provide treatment for Liberian health workers (including PAs) infected with the Ebola virus.

 

Image: Liberian educated PA, Alvin P. Davis, Ebola survivor. Photo courtesy of Lt. Michael Muni, USPHS.

2015
2015

 

Germany

The three original PA programs remain open, although the Mathias Hochschule Rheine is restructured and moved to the Praxis Hochschule University of Applied Sciences. Five other programs are opened, including the University of Medical Center Hamburg-Eppendorf, Fresenius University of Applied Sciences in Frankfurt am Main, the State Academy Plauen, Fresenius University of Applied Sciences in Munich, and Fliedner University of applied Science in Dusseldorf.

2015
2015

Australia

The Australian Society of Physician Assistants endorses the term “Physician Associate”.

2015
2015

New Zealand

Health Workforce New Zealand releases the evaluation of the two-year pilot contracted out to the health research firm, Synergia. US-trained PAs are approved to work in the country under the supervision of a physician. They do not have prescribing rights.

2015
2015

Ireland

With the goal of achieving improved service delivery and better continuity of care, the Department of Health in Ireland approves a two-year pilot project with four expatriate PAs – 3 Canadians and 1 American – employed in surgical sub-specialties in Dublin.

2015
2015

Ghana

There are now seven schools in Ghana that are training PAs. The country now has 2,500 practicing PAs, 72% of which are PAs-Medical. (PAs in Ghana fall into three categories: PA-Medical, PA-Dental, and PA-Anesthesia).

2015
2016

Canada

Canadian military PAs transition from their status as senior enlisted non-commissioned members and warrant officers to the newly identified officer occupation within the Canadian Armed Forces.

2016
2016

South Africa

The Health Minister approves the Clinical Associate Scope of Practice.

2016
2016

Ireland

The first Irish PA training program based in Dublin, the Royal College of Surgeons, awards a 24-month Master of Science in Physician Associate Studies degree. The Irish Society of Physician Assistants is also established.

2016
2016

Israel

Israel’s Ministry of Health Training Department develops the first PA program at Tel HaShomer’s Sheba Medical Center. The program focuses on emergency medicine.

2016
2016

The United Kingdom

The First Annual Summit for PA Educators held in Worchester, UK is held. The Summit supports the professional development and networking needs of new PA program leaders and faculty.

2016
2016

Bulgaria

“PA” is now included on the register of regulated professions in Bulgaria.

2016
2017

Northern Ireland

Ulster University opens first PA Program in country with a focus on rural practice and placements.

2017
2017

Ireland

The Ministry of Health’s human resource arm, the Health Service Executive, announces it is backing the development of the PA career in Ireland.

2017
2017

The United Kingdom

PA programs now number 28 in response to the National Health Service’s call for 1,000 primary care PAs by 2020.

2017
2018
2018

India

The Union Cabinet of India approves the formation of the Allied and Healthcare Professionals Bill which calls for the regulation and standardization of education and services provided by allied and healthcare professionals. This bill applies to Indian physician assistants as well.

2018
2018

Germany

Germany’s seven universities found the “German University Association Physician Assistant” (DHPA eV). Image: Founding of the German University Association Physician Assistant.
2018
2019

 

United Kingdom

In July, physician associates were officially recognized by the The UK government when the Department of Health and Social Care’s (DHSC) General Medical Council announced that they would be in charge of the licensing of the profession.

2019
2019

Israel

The first Annual Conference for Physician Assistants in Israel took place at Sheba Medical Center in Tel Hashomer. The same year, the Israeli Physician Assistant Association (IPAA) is created.

2019
2019

Poland

The first symposium is held to discuss the feasibility of the PA profession in Poland.

2019
2019

The United Kingdom

The General Medical Council (GMC) becomes the regulator of the PA profession.

2019
2020

Ireland

The Irish Society of PAs hosts the first Irish PA National Examination (IPANE) in January.

2020
2020

Israel

Israel utilizes PAs to help fight the COVID-19 pandemic.

2020
2020

Myanmar

The first class of six PAs graduates in Myanmar after five-year training program.

2020
2020

New Zealand

American PAs working in New Zealand help control COVID-19 infections.

2020

2020s

2021

Germany

The number of PAs in Germany exceeds 1,000 and the number of PA students exceeds 2,000. The first German PA program at the Master’s level starts at the Fliedner University of Applied Sciences in Düsseldorf; more are in preparation.

2021
2021

India

The National Commission for Allied and Healthcare Professions Bill, 2020 is passed on March 24, 2021. The bill states that the PA profession is officially recognized by the Indian government.

2021
2022

Germany

The German University Association Physician Assistant welcomes its 25th member and continues to represent all universities with PA degree programs in Germany.

2022

Resources

Canadian Association of Physician Assistants

For a more comprehensive look at the history of Canadian physician assistants, visit the Canadian Association of Physician Assistants’ website.

IFPACS organization

A short video introducing the IFPACS organization and its student members. IFPACS is an international PA student group.

History of Ghana PAs

Information on the history of Ghana PAs was taken from the 2015 JAAPA article: Physician Assistants in Ghana.

PA Profession in Poland

Information on the PA profession in Poland was taken from the 2020 JAAPA article: Poland and Physician Assistants.