For most of their 40+ years, physician assistants and nurse practitioners have been a uniquely American phenomenon. But now, clinicians are starting to transport their ideas and expertise to all parts of the globe.
Training programs have already been established in parts of Europe and Australia. Now, as countries in the Middle East, Asia, Africa, and Latin America struggle with physician shortages in rural areas, they, too, are eager to bring these highly trained professionals within their borders.
Through international conferences, groups like the International Council of Nursing (ICN) in Geneva (which has NP or APN programs in 78 countries) and the International Academy of Physician Associate Educators (IAPAE) are connecting willing professionals to countries in need.
For clinicians with a sense of adventure, practicing overseas is a wonderful opportunity to delve into a new culture and share ideas and skills. Herein, we profile several PAs and NPs who are already living the international life. Read on, and be inspired!
Saudi Arabia: Welcoming PAs to the Middle East
As an established PA who had worked in emergency medicine for years and who serves on the faculty of the PA program at George Washington University (GWU), Amy Keim, MS, PA-C, is used to having a lot of freedom in her practice. Keim, who is the director of GWU’s International Physician Assistant Development program for the Department of Emergency Medicine, is also no stranger to working overseas.
So when Saudi Arabian government officials approached her department about designing a curriculum for the first PA program in the Middle East, she was thrilled and a little nervous. She wondered how she would be received, both as a PA and as a woman.
“I have worked in Beirut and Abu Dhabi, but Saudi Arabia had this more intimidating feel to it,” Keim says. “We think of it as this romanticized, really exotic locale. People don’t go on vacation to Saudi Arabia, let’s put it that way.”
Keim says she was pleasantly surprised during her first visit, when her Saudi hosts invited her for a wonderful fireside picnic out in the desert. “There was delicious food and music, and the people were very warm and welcoming,” she says. “They were so hospitable, it changed my impression overnight.”
Keim and GWU Program Coordinator Megan Williams both wanted to be sensitive to cultural expectations for women in Saudi Arabia. They learned, sometimes through trial and error, when it was acceptable to wear Western clothes and when they needed to cover their heads or don an abaya (a full-length black robe). Keim and Williams discovered, for example, that when they were shopping in a more westernized mall, they could wear their usual outfits. But if they were invited to an official military ceremony, they would wear an abaya out of respect for the culture.
“I haven’t run into any real difficulties because I’m a woman,” Keim adds. “They have been extremely open to the [program] model and to the leadership.”
The first 25 students started in the Saudi PA program in September. It will last 28 months and will be based on a military model, similar to that of the first PA programs in the United States and Canada. Only male military officers will have the chance to become PAs.
The program will be administered through the Prince Sultan Military College of Health Sciences in the Eastern Province capital of Dhahran. When the students graduate, they will be called “Assistant Physicians,” mainly because the title translates better.
“These highly trained students will not only be the first physician assistants in the Middle East, but will be a critical component to improving access to quality health care in military and civilian communities throughout the country,” Keim says.
Keim feels the Saudi Arabian PA program will serve as a model for other countries with similar health care needs. “I think this trend reflects a general need for this type of provider, with this type of training, to really close some of the gaps,” she says. She has enjoyed having the opportunity to help bring better care to Saudi Arabia, and to learn more about its culture.
Surprisingly, it was on US soil that an accidental cultural misunderstanding occurred, when one of the Saudi Arabian officials visited Washington, DC. Keim was driving him to an event, but needed to stop by the vet first to pick up her beloved Jack Russell terrier. When her colleague started to look uncomfortable in the passenger seat, she asked why. He told her almost no one in Saudi Arabia has a dog, because the Islamic religion considers the animal unclean. Her colleague “toughed it out” for the duration of the trip, but Keim wishes she had recognized the potential problem sooner.