International Physician Assistant/ Physician Associate (PA) Practice

The Physician Assistant/ Physician Associate (PA) profession began in the 1960s in the United States, but modern growth is not just about state practice law and institutional recognition. PAs are international! PA practice varies internationally, but the profession is proving its value and role in health systems in several countries.

The PA profession is established in several countries, and many other countries are hoping to support PA expansion. We discussed PA practice with some new graduate PAs from Ireland, some of whom we featured in our PA Jobs CME March Newsletter (subscribe to read for free!).

Read on for more information about PA practice abroad and PA practice experience in Ireland!

What Is a Physician Associate?

Physician associates are healthcare professionals trained to provide diagnostic, therapeutic, and preventive healthcare services in collaboration with or under supervision of a licensed physician. Their education typically includes completion of a Master's level program with a medical curriculum, focusing on on medical sciences, clinical skills, and patient care.

PAs perform varied patient care tasks, including:

• Taking medical histories

• Conducting physical exams

• Ordering and interpreting tests

• Diagnosing illnesses

• Developing treatment plans

• Performing minor procedures

• Assisting in operations

• Providing patient education

  
  

The PA role has broadened significantly since its inception (just see our pages on the varied PA specialties of practice, non-clinical roles, participation in research, and more!).

The Global Emergence of Physician Associates

The PA profession originated in the United States to address physician shortages, especially in primary care, and to answer to the complexity of modern clinical medicine and clinical teams. Since then, the model has spread internationally, adapting to local healthcare needs and regulations.

Countries with established or emerging PA practice include:

• Canada

• Australia

• The Netherlands

• South Africa

• India

• New Zealand

• United Kingdom

• Ireland

  
  

Each country has tailored the PA role to fit its healthcare system, regulatory environment, and workforce demands. See the legal practice law, PA societies, and job boards for countries abroad on our site!

Canada

Canada has recently expanded PA programs to address rural and underserved areas. Provinces like Ontario and Alberta have begun licensing PAs, allowing them to work in hospitals and community clinics.

Australia and New Zealand

Both countries have pilot PA programs focusing on rural health and indigenous communities. These programs aim to improve access where physician numbers are limited. Licensed PAs are encouraged to practice in Australia and New Zealand. However, the PA profession is not yet regulated.

The Netherlands

Physician Assistants (PAs) were introduced into The Netherlands in the early 2000s. PAs in the Netherlands are trained to perform a variety of medical tasks, including taking patient histories, conducting physical examinations, diagnosing conditions, and developing treatment plans, often working under the supervision of a physician. Their integration into healthcare teams has been shown to enhance access to care, particularly in primary care settings and specialized fields. Netherlands PAs contribute to patient safety and the overall healthcare system.

United Kingdom

The UK introduced the PA role in the early 2000s. The National Health Service (NHS) has integrated PAs into various specialties, including emergency medicine, surgery, and general practice. The UK’s Faculty of Physician Associates oversees education standards and professional development. Like Ireland, the PA role in the UK is currently contested and impeded due to disagreements about scope of practice and legal authority. UK PAs could use our support!

Ireland

Physician associates (PAs) first trained at the Royal College of Surgeons Ireland (RCSI) to enter the Irish workforce in 2018, and the Irish Society of Physician Associates (ISPA) was formed soon after. Ireland has one PA Program at RCSI, led by program director Lisa Alexander, EdD, MPH, PA-C. PA scope of practice in Ireland is adaptable to the practice location, and PAs are supervised by physicians. PAs in Ireland cannot prescribe medications or order diagnostic imaging without supervision review.

The basic steps to PA practice in Ireland are:

1. Complete a MSc from the Royal College of Surgeons Ireland at St. Stephen's Green

2. Pass the IPANE - the Irish National Certifying Exam

3. Practice with 'delegated autonomy' from a supervising physician

Frances Moran, PA-IC provided an interview to PA Jobs, LLC about her experience at the RCSI PA program and as a new graduate PA in Ireland. The following is courtesy of Frances Moran, PA-IC:

The Irish PA Student Perspective: Frances Moran BSc, MSc, PA-IC

My name is Frances, and I am a recently qualified Physician Associate from the West of Ireland. In December 2025, I completed the two-year MSc in Physician Associate Studies at the Royal College of Surgeons (RCSI) in Dublin. The programme began with an intensive eight-month didactic phase of daily lectures, tutorials, and weekly exams, followed by 16 months of clinical placements—amounting to over 2,000 hours across 16 core medical and surgical specialities.

With OSCEs, long cases, MCQs, and research projects every semester, followed by a dissertation, it was very demanding—time was limited, and every hour of the day counted. Coming from a BSc in Bioscience, I had no prior healthcare experience. Stepping into a tertiary hospital for the first time as a PA student was both daunting and exhilarating. I’ll never forget my first day in Beaumont Hospital, getting a tour from two experienced surgical PAs a few weeks before starting placement. I knew that day that this was where I wanted to be, and my placements only deepened that feeling!

Clinical teaching on placement varies depending on service pressures, but this often creates opportunities to step up and learn through experience. In Beaumont Hospital, we also attended teaching alongside medical students, which helped integrate us into the clinical environment and raise awareness of the PA role among future doctors. During my placements, only seven of my rotations had a PA, and most of these were in surgical specialities.

For a PA student training in a relatively new profession, being placed in teams with established PAs transforms the role from an abstract idea into a real career. Observing their continuity within teams, their knowledge and skills, and their rapport with patients and consultants highlighted the unique value of the role. I really enjoyed getting stuck in—scrubbing into surgery, assisting in theatre, practising clinical skills, contributing to ward rounds, examining patients in clinic, and witnessing the full patient journey from admission to discharge. I also valued attending MDTs and team teaching sessions, learning about clinical trials, and understanding how patient care is shaped by input from multiple specialities.

The variation in awareness of the PA role was striking at times, depending on the hospital, service, or region you were based in. In some settings, PAs were fully integrated and highly valued; in others, doctors had little to no understanding of what a PA was or could do. At times, this came with a sense of pressure—you might be the first (and possibly last) PA a doctor works with, and the impression you make can shape their perception of the entire profession. It meant needing to be prepared, to recall your medical knowledge on the spot, and to advocate not just for yourself, but for the role as a whole. 

The PA profession in Ireland is still evolving. It began with a pilot programme in 2015, which recruited four North American PAs to work in Beaumont Hospital. The RCSI MSc PA programme began in 2016, and the first Irish-trained PAs graduated in 2018. Today, there are approximately 110 trained PAs in Ireland, most working in surgical specialities. The MSc programme at RCSI remains the only PA course in the Republic, with our cohort of 25 being the largest to date.

Unfortunately, my cohort is entering the workforce during a very challenging time. A hiring freeze was placed on PAs in the public health system over a year ago. Due to this, most of us are qualified and certified to practice in Ireland, but remain unemployed, nearly four months into the new year. Despite this, I remain committed to ongoing learning, engaging in CPD/CME, and advocating for the profession through my involvement with the Irish Society of Physician Associates (ISPA).

Looking ahead, I would like to see structured regulation, prescribing rights, and increased job opportunities nationwide. I also hope to work and volunteer abroad one day, maybe in the US or in South America, combining my interest in global and inclusion health with my love for the culture, language, and history of Latin America.

Studying to be a PA in Ireland has been challenging; it demands resilience—but offers the promise of a meaningful and dynamic career. It is a profession still finding its footing, but one with enormous potential to support overburdened healthcare systems and improve patient care.

I'm so thankful to have connected with PAs in the US. Seeing your career progression has been nothing short of inspiring, and the support you have shown us during this difficult time gives us so much hope. As we say in Irish, Ní neart go cur le Chéile, meaning there is no strength without unity!

And with that, I’m delighted to share that I and four other PAs from the 2026 graduating cohort will be attending the AAPA Annual Conference in New Orleans this year, thanks to the support of our wonderful director of the PA Programme, Professor Lisa Mustone Alexander, and generous US-based donors (many of whom are PAs)!

Challenges in International Physician Associate Practice

As shared by Frances Moran's experience as a new graduate PA in Ireland, several challenges affect the global adoption of the PA role:

Regulatory and Licensing Barriers

Many countries lack clear regulations for PA practice, creating uncertainty about scope of practice, supervision requirements, and credentialing. This slows integration into healthcare systems.

Public and Professional Awareness

Patients and some healthcare professionals may not fully understand the PA role, leading to confusion or reluctance to accept care from PAs.

Education and Training Standards

Variations in PA education programs can affect the consistency of skills and knowledge. Establishing standardized curricula and accreditation is essential for quality care.

Workforce Integration

Integrating PAs into existing healthcare teams requires adjustments in workflows, communication, and role definitions.

Case Study: South Africa’s Use of Physician Associates

South Africa faces a shortage of doctors, especially in rural areas. The country introduced physician associates, locally known as clinical associates, to address this gap. Clinical associates undergo a three-year degree program and work under physician supervision.

Studies show that clinical associates have improved access to surgical and emergency care in district hospitals (source). Their presence has reduced patient wait times and allowed doctors to focus on more complex cases. This model demonstrates how PAs can strengthen healthcare delivery in resource-limited settings.

Let's Advocate Together

The rise of international physician associate practice is transforming healthcare delivery worldwide. By expanding access, improving efficiency, and supporting physicians and multidisciplinary care teams, PAs play a vital role in meeting growing healthcare demands. Countries adopting this model face challenges but also gain opportunities to strengthen their health systems.

For healthcare leaders and policymakers, embracing the PA profession means investing in education, regulation, and team integration. For patients, it means better access to timely, quality care. The global impact of physician associates will continue to grow as more countries recognize their value in modern healthcare.

See international job boards, PA societies, and practice laws on our PA Jobs page!