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A two-way street

Zachary Hartsell, MHA, PA-C, DFAAPA

As a PA who has worked internationally, I was drawn to the special article by Kerlen and Ballweg in the August 2017 issue of
JAAPA. Ando Kerlen is a Dutch-trained PA who has also worked in South Africa and Australia Ruth Ballweg is an education leader who has promoted the PA profession internationally for decades. This combination of contributors provides both an interesting perspective as well as experience in developing
the PA profession internationally and navigating different healthcare systems. Kerlen and Ballweg outline some of the similarities in the PA profession between these countries as well as the differences in their development based on culture and healthcare system needs. What was interesting is that two common themes emerged for PA development in other countries: provider maldistribution and patient accessissues that the United States also faces.

Another theme of the article that resonated with me was the give-and-take Kerlen described when practicing in another country. In both developing PA professions in South Africa and Australia, Kerlen relates that he not only contributed to the development of the profession but also learned significantly from the providers with whom he worked. This give-and-take is an element that I can relate to in my own international experience. I also feel that it is an important element in the success of advancing an international PA profession in the future. I believe that the future international success of the profession will rely on exchanges of ideas as opposed to applying a set model.

I worked in Scotland as part of a National Health Service research project studying the effect of PAs on different healthcare care environments throughout the country.1 I worked in an ED outside of Glasgow from the end of 2007 through 2008.2 From the start, my experience was much more than simply introducing the PA profession to the NHS. The experience was truly two-sided. In that year, I not only helped demonstrate the value of PAs but I was able to grow significantly as a provider while being introduced to new models of care delivery. Many of the things I learned in Scotland, I still use today.

Although the pilot project was found to be overall successful, I understand the PA profession in Scotland continues to develop slowly. Colleagues have told me that the profession is facing many of the political challenges described by Kerlen, and which PAs in other countries also face. Nevertheless, the PA profession in the United Kingdom continues to move forward and with continued support can be a source of unique insight into innovative care delivery models for PAs here in the United States (for example, innovations in population health and home-based care). Likewise, the Netherlands PA profession is well established and has produced interesting research on the use of PAs in inpatient units.3 Perhaps the development of the PA profession in South Africa and Australia can yield innovative models for using PAs in caring for rural or underserved populations. Both are problems that we struggle with today.

A robust international network is important to the PA profession. PAs in the United States, the country with the most established of the PA professions, should lead the way in developing this network. Examples of the type of support that could be beneficial would be greater recognition of international PA trends and successes, research into differences between PA deployment models, and advocacy support. In launching this type of support, we also should understand that this exchange should not be one-sided. The real benefit comes from our learning about the deployment of PAs and workforce models that have been proven to solve similar healthcare problems faced by other countries.

REFERENCES
1. Farmer J, Currie M, Hyman J, et al.

Evaluation of physician assistants in National Health Service Scotland.
Scottish Medical J. 2011;56:130-134.

2. Hartsell Z, Kehoe K.

A day in the life.
JAAPA. 2008;21(8):20,22.

3. Timmermans MJ, van Vught AJ, Maassen IT, et al.

Determinants of the sustained employment of physician assistants in hospitals: a qualitative study.
BMJ Open. 2016;6(11):e011949.

Zachary Hartsell is program director and vice chair of operations and workforce development and an associate professor in the PA program at Wake Forest University in Winston-Salem, N.C. The views expressed in this blog post are those of the author and may not reflect AAPA policies.

Published: 8/7/2017 9:08:00 AM

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