TDNet Discover

Background: The global healthcare shortage has contributed to overwhelming healthcare disparities worldwide. The Physician Assistant (PA) role offers a sustainable solution to this problem, but PAs are not internationally utilized to their full potential. The globalization of PAs has not been adequately studied, so it is unclear what barriers face the continued development of this medical profession. Purpose: This research sought to provide insight into the ways PAs address healthcare needs as existing members of the international healthcare workforce to reveal capacities in which PAs can be utilized in countries seeking to alleviate their health needs across different health systems and economies. Methods: A comprehensive systematic literature review was conducted of both published and gray literature employing 3 databases and 3 search engines. A mixed-method study design was conducted involving 9 scripted interviews of international PAs and experts in global health. The researchers utilized a shared search log and a uniform data extraction template to compile and synthesize the data obtained across study designs. Primary outcomes sought by the researchers were geographic region, national economic status, healthcare need, and the healthcare system. The secondary outcomes included evidence of PAs being used in various clinical and rural settings, evidence of PAs working in countries other than where they were trained, and the successes/barriers faced by countries in implementing the PA concept. Results: Through reviewing 509 published and gray literature sources and 9 interviews, this study synthesized the utilization of the PA and PA equivalent profession around the world, encompassing 7 regions (North America, Europe, Africa, Asia, Oceania, Middle East, and Central/South America) and 59 countries. Of these countries, 13 have a “Developed Economy,” have an “Economy in Transition,” and 44 have a “Developing Economy.” In terms of healthcare systems, 6 utilize Beveridge, 5 utilize Bismarck, 7 utilize National Health Insurance, 19 utilize Out of Pocket, and 22 were not identified. PAs and PA equivalents hold 38 different titles, with the majority working alongside physicians in primary care settings, prescribing medications, and performing minor procedures. PAs have been utilized to address the most common global healthcare needs of healthcare shortages, economic disparities, and decreased access to healthcare, especially in rural areas. The most common barriers to the implementation of the profession are lack of legislation and regulation, understanding, and support. Due to a lack of universal recognition of the profession and a lack of regulations regarding standards of training and practice, PAs generally cannot work interchangeably around the world, with the exception of US-trained PAs working in other countries. Conclusion: Recommendations for countries facing barriers in implementing PAs include retrospectively seeking regulation and legislation regarding certification, education, and licensure. Recommendations for countries implementing PAs include training their existing workforce, employing pilot programs, and implementing PAs to address a specific need. The researchers recommend increasing international collaboration among all countries to enhance the global development of the profession through creating an international organization, establishing guidelines for licenses being honored across borders, and creating an international education framework.