Transformative Education
for Health Professionals

Israeli Physician Assistants

Oren Berkowitz PhD, PA-C, Eyal Jacobson MD, PhD, MHA, Marie Meckel PA-C, MPH

In more than 48 nations, the category of health worker - accelerated medically trained clinicians (AMTC) - have evolved to help meet the regional skills mix needs1.

In resource poor countries, AMTCs most often serve as the primary care providers in the rural communities, with several countries investing in the expansion of the AMTC skills mix to increase access to care in areas such as surgery, emergency obstetric care, ophthalmology, and orthopedics.

Resource rich countries have utilized the AMTC to address the general shortages of primary health care providers, as well as specialty care. 

Full project description: 

Israel has slowly been suffering from a decline in the rate of medical doctors per population in the last decade.  Physicians from the Soviet Union who immigrated in the 1990’s are set to retire in the near future, coupled with a loss of physicians to other industries and emigration. An increase demand for care due to high birth rates, an aging population, and an increase in chronic diseases has all lead to concerns about a shortage of health care providers.  

     Photo credit: Michal-Anita Schwartz, B.A, LL.B, M.P.H,

Israel was once well known for having one of the highest physician to population ratios, however, today things are changing. According to the Central Bureau of Statistics survey, the rate of active physicians in Israel in 2013-5 was 3.5 per 1000 population. According to Ministry of Health (MOH) data, the ratio of licensed physicians 65 years and younger to the total population is decreasing since the late 1990's: 3.43 – 2000; 3.25 - 2010, 2014 – 3.09; 2015 - 3.08 (all to 1,000 population). 

The development of the Physician Assistant in Israel was borne out of the need for increased access in emergency medicine. Expanding the skills mix and oversight of the bachelor’s trained paramedic was in alignment with the AMTC and cost effective.  This case serves as an example of how Israeli Physician Assistant profession has been established with a focus on the needed skills mix for Isreal.

Although there were many roadblocks to this development, in 2013 a committee formed by the director general of the Israel MOH recommended the development of PAs in Israel in the fields of internal medicine, surgery, emergency medicine, anesthesiology and pathology. For regulatory reasons, the model chosen was to create the Israeli version of PAs by expanding the capabilities and legal authorities of existing healthcare professionals in distinct medical fields.  The plan was to start with emergency medicine and then expand to anesthesiology and pathology.

In May 2016, the first PA course was opened and included paramedics, in possession of a bachelor’s degree, that were given the opportunity to acquire additional education and training to serve as PA’s in emergency medicine. This new program is managed by the MOH’s training department. Educational courses occur at Tel HaShomer’s Sheba Medical Center, and clinical training occurs in emergency rooms throughout the country. Emergency room physicians will serve as lecturers and the course is about nine months.

Advanced medically trained clinicians (AMTC) such as the Israeli PA are part of the solution to the worldwide health care provider shortage. Countries find their way to the development of the AMTC for different reasons such as: a loss of physicians, increase burdens on health care systems, or inadequate distribution of health care providers. Israel is yet another example of how the AMTC serves as a solution to the increased need for health care and decreased supply of physicians.

References: 

1. Cobb N, Meckel M, Nyoni J, Mulitalo K, Guadrado H, Sumitani J, et al. (2015) “Findings from a survey of an uncategorized cadre of clinicians in 46 countries: Increasing access to medical care with a focus on regional needs since the 17th Century.” World Health and Population: Special Edition The Global Health Workforce: Striving for Equity, Tackling Challenges on the Ground. 16(1).

Aaron, E. M., & Andrews, C. S. (2016). Integration of advanced practice providers into the Israeli healthcare system. Israel journal of health policy research, 5(1), 1.

Berkowitz, O., Jacobson, E., Fire, G., & Afek, A. (2014). Physician assistants in Israel. Journal of the American Academy of Physician Assistants, 27(12), 7-8. Israeli National News.com Arutz Sheva 7.     

 

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Quality: 
Yes
Quantity: 
Yes
Relevance: 
Yes
Sustainability: 
Yes