AAPA

Licensure & Liability
Transporting Medical Supplies
Ethical Guidelines

International Opportunities for PAs

There are avenues for PAs to practice internationally, although a PA who wishes to work abroad may have to do some sleuthing to find the right opportunity. PAs encounter challenges in arranging to work abroad that they do not face stateside. The first challenge is that the PA profession is not widely recognized outside of the United States. In general, there are no set standards of education, licensing, credentialing, or reciprocity for PAs to work in other countries. The majority of PAs working internationally work for US based corporations, non-governmental agencies (NGOs), and the military.

Several demonstration projects are ongoing to introduce the PA profession internationally:

United Kingdom

• American-trained PAs now work in England and have been able to practice under the general delegatory clause of the British Medical Act.
• The UK Association of Physician Assistants, Ltd (UKAPA) serves as the official organization of Physician Assistants and future physician assistants in the United Kingdom.
  
  • The Modernisation Agency of the NHS has worked extensively on the development of the PA model in the UK. In 2005, NHS released "The Competence and Curriculum Framework for the Medical Care Practioner." A follow-up document released in 2006, " The Competence and Curriculum Framework for the Physician Assistant," replaced the working title Medical Care Practioner following suggestions received through the public consultation process. The title will remain a working title until the physician assistant role is regulated by the appropriate body.
• In June 2006, 20 PAs were hired to work in Scotland as part of a two-year project utilizing American PAs.

Canada

• Canada employs physician assistants in the military and several provinces are introducing physician assistants in the civilian sector.
  
  • In 2002 the Province of Manitoba, Canada, passed enabling legislation to allow organizations to hire American PAs. Several U.S. trained PAs are employed in that province. U.S trained PAs work in Manitoba under the title of Clinical Assistant (certified).
  • In May 2006, the Ontario government launched HealthForce Ontario, the government’s human resources strategy to introduce the physician assistant role in that province through a series of pilot projects.These demonstration projects are at hospital settings throughout the province.
    
    • Phase 1 completed March 2008 was an initial one-year Emergency Department pilot project.
    • Phase 2 (in progress) is a larger two-year demonstration project taking place in several health care settings and within different employment models.
  • To date 13 U.S. trained PAs were recruited for this project.
  • There are no reciprocity laws enabling Canadian PAs to work in the U.S.
• For more information on PAs in Canada, visit the Canadian Association of Physician Assistants.

Australia

• As part of the “New roles in context of Workforce Reform South Australian Health Care Plan 2007-2016”, the government of South Australia launched a South Australia Health PA trial in which US PAs will be recruited to work for one year in three clinical settings: surgery; anesthesia and peri-operative medicine; and pediatrics.

U.S. trained PAs interested in job opportunities should keep their eyes open for ads in AAPA News, JAAPA and on-line at the PA Job Link

Licensure and Liability Coverage

PAs may also face questions about physician supervision and liability coverage. AAPA’s Guidelines for PAs Working Internationally, approved by the 2001 House of Delegates and reaffirmed in 2006, state that PAs must establish the appropriate physician-PA team. That can be done with an American physician or local physician in the country. In general, there are no licensing laws or practice acts for PAs working abroad, special arrangements will have to be made through the ministry of health of the host country. In the case of U.S. corporations with international sites, you may find the company falling back on the licensing laws of the state in which their headquarters are located. Licensing issues also raise questions about physician supervision of PAs. Problems may arise if the physician and the PA are licensed by different states. Liability insurers may have other requirements and obligations for insured that are outside the jurisdiction of U.S. courts.

PAs who will be employed by the Ontario pilot project will be hospital employees.  Employers have liability insurance policies to cover all employees.  If you are interested in additional coverage, many insurance companies will not cover PAs outside the U.S., so it is important to contact your carrier prior to leaving the country. It is important to explore and resolve these types of issues before leaving the U.S.

Transporting Medical Supplies

You may find yourself volunteering or working abroad as a missionary or with an organization, and wondering about taking medical supplies into another country. You MUST research customs regulations and weight requirements prior to transporting medical supplies into another country, especially if you are carrying prescription drugs. Generally, you will need a ministry of health contact at your destination to help you get through customs with medical supplies. Do not plan to travel to another country with medical supplies and "sneak" them through customs. You could end up losing all of your supplies, paying excessive duties, or being arrested. There are organizations that can help you transport medical supplies into different countries, or provide you with pre-packaged travel packs. Medical Assistance Programs (MAP) is one place for you to look. When it comes to transporting medical supplies we highly recommend working with an established organization rather than trying to transport them on your own.

The above information is excerpted from AAPA's publication, Contacts and Contracts. To purchase a copy, visit AAPA's on-line store.

Ethical Guidelines

1. PAs should establish and maintain the appropriate physician/PA team.
2. PAs should accurately represent their skills, training, professional credentials, identity or service both directly and indirectly.
3. PAs should provide only those services for which they are qualified via their education and/or experiences, and in accordance with all pertinent legal and regulatory processes.
4. PAs should respect the culture, values, beliefs, and expectations of the patients, local health care providers, and the local health care systems.
5. PAs should take responsibility for being familiar with, and adhering to the customs, laws, and regulations of the country where they will be providing services.
6. When applicable, PAs should identify and train local personnel who can assume the role of providing care and continuing the education process.

All PAs working internationally need to adhere to the above guidelines, as well as the Guidelines for Ethical Conduct for the Physician Assistant Profession.