physician assistant physician assistant a physician assistant or physician associate (pa) is a type of healthcare professional. while these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. depending on location, pas practice semi-autonomously under the supervision of a physician, or autonomously performing a subset of medical services classically provided by physicians. not to be confused with assistant physician. the educational model was initially based upon the accelerated training of physicians in the united states during the shortage of qualified medical providers during world war ii. since then, the use of pas has spread to at least 16 countries around the world. in the us, pas may diagnose illnesses, develop and manage treatment plans, prescribe medications, and serve as a principal healthcare provider. in many states pas are required to have a direct agreement with a physician. in the uk, pas were introduced in 2003. they support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician. they cannot prescribe medications nor request ionising radiation investigations (e.g. x-ray). pas are widely used in canada. the model began during the korean war and transitioned to the present concept in 2002. skills and scope of privileges are similar to those in the us. nomenclature the occupational title of physician assistant and physician associate originated in the united states in 1967 at duke university. the role has been adopted in the us, canada, uk and ireland, each with their own nomenclature. the role has been adopted in the us, canada, united kingdom, republic of ireland, netherlands, australia, new zealand, india, israel, poland, bulgaria, myanmar, switzerland, liberia, ghana, and by analogous names throughout africa, each with their own nomenclature and education structure. jurisdictiontitleabbreviationtestcertifying authority united statesphysician associate (was physician assistant)pa-cphysician associate national certification examnational commission on certification of physician associates with accompanying state-level certification. canadacanadian certified physician assistantccpaentry to practice examinationphysician assistant certification council of canada with accompanying provincial certification united kingdomphysician associatepa-rphysician associate national certification examinationroyal college of physicians republic of irelandphysician associatepanonenone kenyaclinical officercoclinical officers licensing examinationclinical officers council south africaclinical associate malaysiaassistant medical officermalaysia medical assistant board (lembaga pembantu perubatan malaysia) chinaassistant doctor papua new guineahealth extension officer former soviet unionfeldsher israelphysician assistantpa-r services physician assistants or associates may: conduct patient interviews and take medical histories conduct physical examinations order and interpret diagnostic tests and exams (in some countries) diagnose illnesses formulate treatment plans coordinate and manage care perform medical procedures prescribe medications (in some countries) conduct clinical research provide patient counselling offer advice on preventative health care first assist in surgery workplaces physician assistants or associates train to work in settings such as hospitals, clinics and other types of health facilities, or virtually via telemedicine. pas are commonly found working in teaching and research as well as hospital administration and other clinical environments. pas may practice in primary care or medical specialties, including emergency medicine, surgery and cardiology. training physician assistant (or associate) education is shorter than a medical degree required to become a physician. it also typically does not involve residency training, although this is increasingly offered in a variety of specialties. renewal of certification is usually required every few years, varying by jurisdiction. history in 1961 charles hudson recommended that the american medical association create new medical provider certifications. eugene a. stead of the duke university medical center assembled the first class of physician assistants in 1965, composed of four former us navy hospital corpsmen. he based the curriculum of the pa program on his first-hand knowledge of the fast-track training of medical doctors during world war ii. two other physicians, richard smith at the university of washington, and hu myers at alderson-broaddus college launched their own programs in the mid-late 1960s. j. willis hurst started the emory university physician assistant program in 1967. the liberian model of pas was a curriculum intended for graduates to work in areas absent of physicians as physician substitutes. advisors for this program included unicef, american physicians and agnes n. dagbe, ms, rn, a liberian nurse educated in the us. additional training was in the ussr. the liberian government inaugurated the program in 1965 with dagbe as pa program. beginning in january 1971, the us army produced eight classes of physician assistants, at 30 students per class, through the academy of health sciences, brooke medical center (academically accredited by baylor university). in 2017, approximately 68% of physician assistants in the united states identified as women and approximately 32% identified as men. the profession expanded globally. it can now be found in afghanistan, australia, canada, germany, ghana, india, israel, liberia, the netherlands, new zealand, saudi arabia, and the united kingdom. as a profession physician assistants have greatly influenced the theory and conceptualization of socially accountable health professional education. jurisdictions australia in 2011, health workforce australia began developing the role of physician assistant throughout the country culminating with registration and a pa program based out of james cook university. despite all initial indicators showing that the new profession would be successfully integrated into the health care system, in 2013 it was reported that the progress had floundered resulting in the majority of pas in australia being unemployed. canada as of october 2018, there are approximately 800 physician assistants working in healthcare settings in canada. the first formally trained physician assistants graduated in 1984 from the canadian forces medical services school at borden, ontario. the canadian medical association (cma) recognized physician assistants as a health professional in 2003. physician assistants are able to perform medical functions such as ordering tests, diagnosing diseases, prescribing medications, treating patients, educating patients and performing various medical and surgical procedures. physician assistants are labeled under the federal government national occupational classification code 3124: allied primary health practitioners. education and certification (canada) the first civilian physician assistant education programs were launched in 2008 at the university of manitoba and mcmaster university. in 2010, a third civilian program was launched by the consortium of physician assistant education (university of toronto, northern ontario school of medicine, and the michener institute). admission to the physician assistant program in all three of the university programs across canada are highly competitive with grades, education, interviews, professional experience, credentials, personal statements and testing considered in the candidate selection process. approximately 15 seats at the university of manitoba are available yearly while the two other programs in ontario respectively have approximately 30 seats at the university of toronto and approximately 24 seats at mcmaster university. in canada, the education of a physician assistant generally consists of three years of professional post-graduate university education. the education is delivered over a two calendar year time-frame by completing fall, winter and summer semesters for both years of the program in either a master level university physician assistant program or post-graduate professional university bachelor level physician assistant program. physician assistant graduates become eligible for the certification exam by being a graduate of a canadian physician assistant program that is recognized by the physician assistant certification council of canada (canadian armed forces physician assistant program, university of manitoba, mcmaster university and the consortium of physician assistant education all of which are accredited by the canadian medical association). scope of practice (canada) physician assistants resemble and provide many of the functions of physicians in canada and act as advanced-level medical provider. physician assistants may be compared to the role of nurse practitioner by the general public and may be confused as the same profession. nurse practitioners in canada practice under an advanced nursing model. physician assistants practice under a medical model, similarly modeled after medical school (physician) education. nurse practitioners practice within their defined specific scope of practice autonomously and sometimes collaboratively. the defined scopes of a nurse practitioner include the areas of (family care, adults and paediatrics). physician assistants are permitted to practice in all medical specialties by mirroring the practice of a physician with a full range of skills and scope by practicing both autonomously as a clinician and collaboratively with physicians when required. some examples of practice areas for physician assistants include (emergency medicine, critical care medicine, cardiology, psychiatry, community and family medicine, neurology, surgery, orthopaedics, internal medicine, oncology, gastroenterology, military medicine, respirology, dermatology, women's health and many more specialities). physician assistants may perform certain roles which have been traditionally only provided by physicians in clinical practice, making the pa's medical training over other providers unique in this regard. compensation (canada) physician assistant salaries in civilian practice in canada are relatively new and can range from approximately $80,000 cad for entry level positions to $142,000 cad a year for experienced providers which are not on call and up to $178,000 cad for experienced providers which are on call. the physician assistant profession is newer to civilian practice in canada. the compensation report published in 2019 by the canadian association of physician assistants outlines the typical salaries across canada being an entry median salary of approximately $80,000 cad and an experienced median salary of approximately $105,000 cad. regulation (canada) physician assistants are currently practicing across canada in the canadian armed forces as commissioned officers in domestic and international environments and have been in practice since the 1960s. physician assistants outside of the canadian armed forces practice usually in the public health care system in the provinces of manitoba, ontario, new brunswick, nova scotia, and alberta. physician assistants have been regulated in manitoba since 1999 and in new brunswick since 2009 and are registrants of their respective provincial college of physicians and surgeons. in ontario, alberta and nova scotia the profession is not regulated at this time. physician assistants in ontario were introduced in 2007 to the public health system as a joint venture between the ontario ministry of health and the ontario medical association. in alberta, a registry has been established for physician assistants under the college of physicians and surgeons of alberta with future regulation underway. in ontario, future regulation has been discussed by the ontario ministry of health in which physician assistants would be members of the physician assistants are represented by the canadian association of physician assistants, which originally was formed in october 1999 as the "canadian academy of physician assistants". germany in germany the physician assistant is called de:arztassistent. it was introduced in 2007. india the first pa program in india was established in 1992 with a focus on expanding cardiovascular surgery. since then, eight additional programs have developed (in total seven baccalaureate and two master's level programs). ireland physician associates were introduced by the health service executive in the mid-2010's. the royal college of surgeons has offered a pa postgraduate degree since 2016, with 28 graduating by january 2021. pas may not write prescriptions. israel physician assistants were introduced in israel in may 2016 to help augment a shrinking physician workforce. the initial training programs have been overseen by the ministry of health directly, but transition to academic training is planned. israeli pa education is modeled after united states' and netherlands' approaches, and has focused on former paramedics with bachelor's degrees. as of 2022, the 100 or so pas in israel work exclusively within emergency departments. while pa scope of practice includes many emergency procedures, israeli pas are not currently allowed to prescribe or administer medicine in non-emergency settings. new zealand in february 2015, health workforce new zealand completed a phase-2 trial of pas who worked for a period of two years (2013–2015) in four clinical settings. specifically, the sites included one rural emergency department and three primary care settings (two rural and one urban) located on the north and south islands of new zealand. at conclusion of the trial, several clinics continued to employ pas while the process of health regulation makes its way through the government bureaucracy. united kingdom the position of physician associate was established in the united kingdom in 2005. it evolved from that of physician assistant, developed in the us in the 1960s. in 2012, the profession voted to change the name to physician associate to distinguish it from another with the same name within the nhs. hillingdon hospitals nhs foundation trust was asked to manage the recruitment of 200 physician associates who are expected to come from the us for 40 nhs trusts in