Jaclyn Rohan, PA-C
The Republic of Ireland is among the latest countries hoping to incorporate physician associates into its healthcare system. Through the Royal College of Surgeons in Ireland and Beaumont Hospital in Dublin, a 27-month pilot program started in July 2015. The program employed experienced American, Canadian, and Scottish-trained PAs in surgical specialties including vascular, general, colorectal, and
orthopedic surgery. Over the duration of the pilot program, data and feedback were collected to demonstrate the effect PAs had on various aspects of healthcare delivery. With anticipation of a favorable response to PA introduction, a 24-month master’s of physician associate studies program enrolled its first cohort of students in January 2016, second cohort in January 2017, and a third cohort of 12 students in January 2018. The conclusion of the pilot program in October 2017 leaves proponents of the profession optimistic but cautious, as they await approval and regulation of the PA role by the Irish Department of Health.
As with any new venture, challenges are expected, and the introduction of the PA pilot in Ireland was no exception. Initial PA recruits experienced setbacks, primarily related to their use and the expectation surrounding the role. By the time I joined the pilot in November 2016, these hurdles had been continuously tended to and although not completely resolved, were in a state of improvement. As part of the pilot, not only did I work with my PA colleagues to develop and deliver the PA program curriculum, I also had the pleasure of working alongside many physicians, nurses, and allied health professionals in the Irish healthcare system. Although pockets of resistance were present, a significant number of my colleagues were either were familiar with the PA role and could see its place in the Irish healthcare system, or had themselves witnessed the effect of PAs during the course of the pilot and supported the role’s continued growth in Ireland. This support was encouraging as it demonstrated that the role had, and if handled properly, would continue to speak for itself.
As is the case with most healthcare systems aiming to include PAs in their medical model, the ultimate goal is to educate and assimilate PAs of their own. However, until such a time, internationally sourced, seasoned PAs are critical to establishing and maintaining the workforce. In the case of Ireland, experienced PAs would be crucial to bridge the gap between the conclusion of the pilot program and assimilation of newly graduated Irish PAs into their professional responsibilities. The guidance of experienced PAs along with full governmental support, like that seen in Northern Ireland, England, and other European Union countries, is essential for successful implementation of the profession. Experienced PAs can help to define the role into one that is specifically tailored to meet the needs facing the Irish healthcare system, while not compromising the integrity of the profession.
To continue being the “boots on the ground” as a PA in Ireland, and fostering the development and growth of future PAs in Ireland would have been a welcome honor. However, most unfortunately, at the conclusion of the pilot program in October 2017, my employment permit was not extended beyond the life of the pilot. Having worked diligently to immerse myself socially and medically in the Irish community, I was faced with having to return to the United States after just 1 year. My departure came at a critical time when the PA model was showing a positive effect on the services piloted, and colleagues as well as supervisors were eager to continue developing the role. Although this result was always possible, it was unexpected. For PAs traveling overseas to countries piloting the PA role, these are outcomes that may not be highlighted and warrant further discussion.
Pilots such as the Irish one are both a top-down and bottom-up initiative but policy and systemic barriers remain. So after 2.5 years of PA practice in Ireland, we pass the torch to those first students now set to graduate from the program. My hope is that these newly qualified Irish-trained PAs, the medical community, and the governmental bodies that have embraced this concept will fight strongly to secure the role’s future. Perhaps then in a few short years from now, just as in the United States, we will see PAs listed among the top healthcare roles for those wishing to practice medicine in Ireland.
Jaclyn Rohan is a 2011 graduate of the University of Florida PA program. Since then, she has worked as a surgical PA based in Florida, specializing in general and breast surgery. The views expressed in this blog post are those of the author and may not reflect AAPA policies.