The 20th anniversary celebration of the Indian Association of Physician Assistants took place in Kochi, India, in October. The occasion was the annual conference of Indian PAs and it was marked by an international delegation of Americans and Australians to the conference. The first day of the conference was a series of presentations by international guests about the growth of PAs, their regulation, governance, and education in a dozen countries. Smaller group talks with educators, governmental policy makers and developers of the PA profession in India centered on certification, accreditation, registration/licensing and data development. The inaugural edition of a new journal was also presented: Physician Assistants Generating Excellence (PAGE).
At present, Indian PA education is at the bachelor’s degree level at three universities and postgraduate diploma level at two universities. All five programs are in large private medical institutions or academic health centers associated with large hospitals. Physicians trained in the U.S. have developed or influenced many of the programs. Of the 1,000 or so PAs who have graduated, 400 or so PAs remain in clinical care, with the majority in surgery. The education pipeline has difficulty keeping up with a supply of clinical PAs as many depart for industry jobs due to lack of scope of practice or regulation. Recently the Ministry of Health put forth a bill in Parliament to bring in a Council for Allied and Healthcare Professionals that will include physician assistants/associates. The IAPA intends to change their name to “physician associate” as “physician assistant” is not a protected name and is commonly used to refer to a wide range of personnel, including medical assistants and others.
India as a whole is attempting a major overhaul of its health system. The country spends 4 percent of its GDP on healthcare, up from 3 percent 10 years ago (the U.S., by comparison, spends more than 18 percent). At the moment, most patients pay “out of pocket” for their health care services. As a result, the “private sector” is the focus for most of India’s health service delivery and education.
However, last year, the MOH, in coordination with the prime minister’s office, drafted a policy on universal health care. The National Health Assurance Mission aims to provide free drugs, diagnostic services and insurance for serious ailments for India’s 1.2 billion people. If approved, universal healthcare will likely drive up demand and efforts are under way to fund PA education in the public sector as well. A bill is working its way through Parliament to develop regulation for a range of “allied health groups,” a definition that includes physician assistants/associates.
The PA movement in India is a recapitulation of PA development globally: Early recognition is slow due to small numbers, private enterprise tends to be the driver of need, and legislation lags innovation. The demand for healthcare professionals skilled in advanced care, the growing role of technology, population growth, aging societies and scarcity of medical services are predictors of PA development in India as elsewhere.