More than 50 countries have some form of the physician assistant profession, though the title, training, and legal authority vary widely from one country to the next. The United States has by far the largest PA workforce, with roughly 120,000 clinically active PAs as of 2020. Beyond the U.S., a core group of countries has formally adopted the PA model: Canada, the United Kingdom, the Netherlands, Ghana, South Africa, India, Israel, and Saudi Arabia. Dozens more, particularly across sub-Saharan Africa and Asia, train and employ clinicians in PA-equivalent roles under different titles.
The United States and Canada
The United States is the birthplace of the modern PA profession and remains its center of gravity. American PA programs typically run 24 to 36 months and award a master’s degree. PAs practice in virtually every medical specialty, prescribe medications in all 50 states, and work with a high degree of clinical autonomy.
Canada has four PA training programs, each 24 months long. Two award a bachelor’s degree and two a master’s. The regulatory picture varies by province. Manitoba was the first to formally regulate PAs, creating a physician assistant register back in 1999. New Brunswick followed with PA licensing legislation in 2010, and Alberta began regulating PAs through its College of Physicians and Surgeons in April 2021. Ontario, despite employing a significant number of PAs, still relies on a delegation model where PAs work under a supervising physician without independent regulation. British Columbia has no legislation accommodating PAs at all, and Nova Scotia is still in the advocacy phase. So while the profession exists across Canada, where you practice determines what legal footing you stand on.
The United Kingdom
The UK has seen rapid growth in physician associates (the British title for the role), with more than 40 educational institutions now offering training programs. In 2024, Parliament passed the Anaesthesia Associates and Physician Associates Order, establishing a legal framework for the General Medical Council to regulate both professions. This legislation covers education standards, a formal register, and fitness-to-practise procedures. Physician associates in the UK do not currently have prescribing rights, and the legislation did not set a specific timeline for granting them. The profession remains a point of active debate within the National Health Service, particularly around scope of practice and how PAs fit alongside junior doctors.
The Netherlands
The Netherlands is one of the most progressive countries for PA practice. Dutch PAs train through five programs, each 30 months long, that blend work and education. Students must already hold at least a bachelor’s degree in nursing or an allied health field, plus two years of clinical experience, before they enter a PA program.
What sets the Netherlands apart is the level of legal independence PAs have earned. After a five-year pilot period, the Dutch parliament granted PAs full authority to independently diagnose patients, initiate treatment, perform procedures, and prescribe medication. The specific tasks they can carry out on their own include catheterizations, surgical procedures, injections, punctures, endoscopies, and defibrillation. PAs still negotiate their scope of practice with their employer and the physicians they work alongside, and all care must follow national clinical guidelines. But legally, the Dutch PA has a degree of autonomy that PAs in most other countries do not.
The Middle East: Israel and Saudi Arabia
Saudi Arabia launched the Middle East’s first PA program in 2010 at the Prince Sultan Military College of Health Professionals, developed in partnership with George Washington University. The program focused on emergency medicine. Its first graduates, in 2013, received the title “Assistant Physicians” rather than “Physician Assistants” due to a translation issue, a distinction that stuck.
Israel followed in 2016, when the Ministry of Health developed its first PA program at Sheba Medical Center, also with an emergency medicine focus. The profession grew quickly enough that the Israeli Physician Assistant Association formed in 2019, and PAs were deployed during the COVID-19 pandemic in 2020.
India
India’s PA profession has an unusual origin story. It started in 1992 under the direction of Dr. K. M. Cherian, a prominent cardiac surgeon, and for years the workforce was concentrated almost entirely in cardiac surgery. By 2012, roughly 1,000 clinicians had been trained as PAs in India, with nearly all of those in clinical practice working in that single specialty.
The profession’s legal standing changed significantly in 2021, when Parliament passed the National Commission for Allied and Healthcare Professions Bill. This legislation officially recognized PAs and established a framework for regulating and standardizing education across allied health fields. Since then, the Indian Association of Physician Assistants has worked to expand the profession beyond its surgical roots.
Africa: PAs and Clinical Officers
Africa has the broadest adoption of PA-equivalent roles of any continent, with more than 20 countries employing clinicians who fill the same gap between doctors and nurses. In most of these countries, the title is “clinical officer” rather than physician assistant, but the function is similar: diagnosing and treating patients, often in rural or underserved areas where physicians are scarce.
Ghana and South Africa use models closely aligned with the American PA concept. Across East Africa, clinical officers are a well-established part of the healthcare system with defined training pathways. Kenya offers the most extensive education ladder, ranging from a diploma in clinical medicine up through a doctoral-level qualification. Rwanda, Uganda, Tanzania, Malawi, Zambia, and Zimbabwe all train clinical officers at the diploma or bachelor’s level. South Sudan has a diploma program focused on clinical medicine and public health.
Another group of African countries, including Cameroon, the Democratic Republic of the Congo, Eritrea, Madagascar, and several others in West and Central Africa, are associated with the clinical officer title but lack confirmed or well-documented training programs. The profession exists in some form, but the details of education and scope remain unclear.
Asia and the Pacific
Beyond India, more than 15 countries across Asia have some version of a PA or PA-equivalent practitioner. The specific titles, training, and scope vary widely, and many of these roles evolved independently from the American model to address local workforce shortages.
In the Pacific, Papua New Guinea has one of the longest-running PA-equivalent programs anywhere. It began training “medical assistants” in 1910, a role now called health extension officer. Australia launched its first PA program at the University of Queensland in 2009 as a master’s-level degree, though the profession has not yet achieved full regulatory recognition.
New Zealand is actively building its PA framework. The Medical Council of New Zealand has been designated as the regulatory body for physician associates and recently completed public consultation on registration requirements, practice standards, and a fee schedule. The profession is still in its early phase there, but the regulatory infrastructure is being put in place.
Europe Beyond the UK and Netherlands
Twelve countries across Europe have PA or PA-equivalent education and training programs. Poland has one of the oldest traditions, dating back to the late 1780s with an alternative medical training track for practitioners called feldschers. The specifics of current programs in other European nations are less well documented in English-language sources, but the profession is spreading across the continent as countries look for ways to address physician shortages and expand access to care.
Other Countries in the Americas
Outside the U.S. and Canada, Guyana is the other country in the Americas with a recognized PA or PA-equivalent workforce. The profession has not gained significant traction in Latin America, where different models of task-sharing and community health workers fill some of the same roles.