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.
1960s
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).
Ghana
The first Ghana PAs are trained through the Ministry of Health established Rural Health Training School at Kintampo.
1970s
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.
1980s
Canada
The Canadian Forces Medical Services School at Borden, Ontario graduates its first class of physician assistants; the first formally trained PAs in Canada.
1990s
India
IndiaThe 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.
Canada
Manitoba passes the Clinical Associate Act which allow PAs and international medical graduates to practice within the country as clinical assistants.
2000s
The Netherlands
The PA Role is introduced in the The Netherlands at the University of Applied Sciences in Utrecht.
Canada
The Canadian Military transitions former medical training program to PA curriculum.
South Africa
PAs are first considered by the South African National Health Council.
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.
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.
The Netherlands
The NetherlandsA second PA Program opens at University of Applied Sciences in Nijmegen.
Image: The first graduating class
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).
Canada
The first Canadian PA Program is accredited (Canadian Forces).
Ghana
The first two Bachelor PA programs are initiated at Cape Coast University and Central University College.
The United Kingdom
The UK Association of Physician Associates (UKAPA) is founded.
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.
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.
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.
Canada
CanadaThe 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.
The United Kingdom
Twenty PAs are recruited for a PA pilot in Scotland.
Canada
Ontario opens PA pilot program in Emergency Medicine for PAs and International Medical Graduates.
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.
South Africa
Walter Sisulu University and University of Pretoria start their first cohort of clinical associate students.
Canada
The University of Manitoba and McMasters University PA programs open. They are the first Canadian civilian PA programs.
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.
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.
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.
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.
South Africa
The university of Witwatersrand starts their first cohort of students.
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. 
Australia2010s
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.The Netherlands
Dutch PAs now number 1,000.
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.
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.
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.
South Africa
The National Department of Health approves clinical associate job description, roles and responsibilities.
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.
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.
South Africa
The first cohorts of PAs graduate from the South African PA programs and are now working in rural district hospitals.
United Kingdom
Birmingham and Wolverhampton PA programs close. A new PA program opens at the University of Aberdeen in Scotland.
Canada
The Consortium of PA Education/University of Toronto graduates its first class in June.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.
The Netherlands
PAs are enabled by law to practice medicine autonomously, albeit in collaboration with a medical doctor at all time.
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.
The United Kingdom
UK PAs agree to change their name to Physician Associate.
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.
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).
Liberia
14 Liberian PAs die for the Ebola epidemic.
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.
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.
The Netherlands
Dutch PAs host their first international conference in Amsterdam.
New Zealand
The New Zealand PA Society is established and endorses the term “Physician Associate”.
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.
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.
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.
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.
Australia
The Australian Society of Physician Assistants endorses the term “Physician Associate”.
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.
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.
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).
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.
South Africa
The Health Minister approves the Clinical Associate Scope of Practice.
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.
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.
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.
Bulgaria
“PA” is now included on the register of regulated professions in Bulgaria.
Northern Ireland
Ulster University opens first PA Program in country with a focus on rural practice and placements.
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.
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.
Ireland
The first Irish-trained PAs graduate from the Royal College of Surgeons in Ireland (RCSI).
Image: First graduating class of Ireland.
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.
Germany
Germany’s seven universities found the “German University Association Physician Assistant” (DHPA eV). Image: Founding of the German University Association Physician Assistant.
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.
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.
Poland
The first symposium is held to discuss the feasibility of the PA profession in Poland.
The United Kingdom
The General Medical Council (GMC) becomes the regulator of the PA profession.
Ireland
The Irish Society of PAs hosts the first Irish PA National Examination (IPANE) in January.
Israel
IsraelIsrael utilizes PAs to help fight the COVID-19 pandemic.
Myanmar
The first class of six PAs graduates in Myanmar after five-year training program.
New Zealand
American PAs working in New Zealand help control COVID-19 infections.
2020s
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.
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.
Germany
The German University Association Physician Assistant welcomes its 25th member and continues to represent all universities with PA degree programs in Germany.
United Kingdom
The House of Lords approves Anaesthesia Associates and Physician Associates (AAPA) Order 2024 which makes the General Medical Council the regulator for physician associates and anesthesia associates. The Order also makes “physician associate” and “anaesthesia associate” protected titles within the UK.
Canada
PAs are authorized for the first time to work in British Columbia hospital as part of a one-year pilot program.
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.
