Going Global: PAs, NPs Practicing Internationally

“The pace of life is much slower here,” Forde says. “I enjoy living in the tropics, with the warm weather, and living near the coast.”

The James Cook PA program is up and running, Forde explains, but graduates can have a hard time finding jobs. That’s because the PA role has not completely caught on yet in Australia.

With such vast rural territory, Australia would seem to be perfectly suited to the skills and expertise PAs could offer. Forde and his colleagues have learned, however, that they must be patient and slowly encourage change within the current health care system. “It’s a matter of persistence,” he adds.

Australia’s health care system, Forde says, has a medical philosophy similar to the British system’s. The government pays for most health care in Australia, so market forces are not shaping the need for PAs the way they did in the US during the 1980s.

Doctors, for example, do only primary care, emergency care, and obstetrics. Specialists are called physicians. “They have different education and different roles,” Forde says.

It’s still unclear where PAs might fit into that system. One thing that is clear is the shortage of providers, particularly in remote and indigenous areas. “The state health departments, especially in the rural areas, are desperate for backup and help and manpower,” Forde says.

Some clinics in Australia are privately run, Forde says, and the doctors who staff them are interested in seeing whether employing PAs can be cost-­effective.

Forde, who now has permanent resident status, is willing to wait and keep promoting the value of PAs. Other than occasional pangs for good Mexican food, he would not want to be living anywhere else.

England: X-rays and Expressions
Physician Assistant Kristen Gipson has worked in emergency medicine for most of her 21-year career. She did her original training at Emory University.

Gipson was glad to be chosen as part of the first pilot group of 12 PAs to travel to the United Kingdom in 2004. She currently works in an emergency room (called Accident and Emergency) in Birmingham, England.

During her first year in the UK, Gipson ran into some unexpected bureaucracy. For example, each time she went to order an x-ray for a patient, she hit roadblocks. In the UK, Gipson explains, a radiographer can refuse to do an x-ray if he or she doesn’t feel it’s justified.

“Initially, we weren’t allowed to order them, but then the PAs in the hospital managed to attend a radiation safety course, which allowed us to request an x-ray,” Gipson explains. Now, most hospital PAs have the right to order x-rays, but PAs providing primary care in other parts of England still cannot order these basic tests.

In Accident and Emergency, Gipson’s daily routine is pretty similar to that in an emergency department in the US. “I see medical trauma, mental health, children, obstetrics, and gynecology,” she says. “I evaluate, diagnose, request tests, and make referrals.” She can discharge and admit patients and arranges for community care. Gipson also is involved in teaching and training medical students.

While four universities currently offer training programs in England, “physician assistant” is not yet an official role in the UK, Gipson says. To be able to officially practice medicine and prescribe, she had to find a physician willing to “delegate” care or treatment to her, under a specific clause in the British Medical Council’s laws. The employer also usually covers the cost of malpractice coverage.

After six years in England, Gipson says she feels pretty well acclimated to British culture. Even though British and American citizens all speak English, subtle language differences can sneak up on you and perhaps put someone’s knickers in a twist. “Both the medical and everyday expressions can be drastically different,” she adds. “Certain words are very differently used and could cause some embarrassment until you learn not to use them in their American context—for example, fanny and pants.”

Scotland: Of Tea Breaks and Trust
Sometimes, while doing rounds as a PA at the Edinburgh Cancer Center in Scotland, Juanita Gardner must stop and wait for her patients to partake in a bit of tea and crumpets. “Tea breaks are a vital part of the workday,” Gardner says. “The oncology wards have a person who will often come around with a cart containing tea, biscuits, and coffee for every patient at no charge.”

Right away, Gardner noticed the pace was different for workers in the Scottish medical system. They have more holidays and time off to be with their families. Unlike many American health care workers, her Scottish counterparts “work to live,” instead of the other way around.