PAs in India expanding from specialty areas to primary care

Ebin Abraham, PA, explains how the Indian PA profession began in cardiology and is now starting to expand into primary care to help meet rural health needs.

PAs in India started out in the cardiology specialty. Photo courtesy of Ebin Abraham, PA.
PAs in India started out in the cardiology specialty. Photo courtesy of Ebin Abraham, PA.

The physician assistant (PA) profession started in India 20 years ago and has been going strong ever since. However, unlike the development of the PA profession in other countries, India's physician assistant program was first developed in a specialty field and is only now trying to expand into primary care. Many countries develop midlevel healthcare provider programs out of a need to increase access to primary care; the development of the PA profession in India is unique in that it started in a specialty field (cardiology and cardiac surgery). The PAs in India have many challenges, but they have achieved some amazing accomplishments. Indian PAs can be found in many areas of medicine. I had the privilege of speaking to Ebin Abraham, PA, who specializes in cardiac surgery. Below is a synopsis of our conversation.

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The history

The beginnings of the PA profession started in India in 1994. Its development was inspired by K. M. Cherian, MD, who had trained in cardiac surgery at the University of Alabama. In the 1970s, Dr. Cherian worked under John W. Kirklin, MD, who was a pioneer in the development of one of the earliest American Cardiac Surgical PA programs, and it was there that Dr. Cherian learned about the PA profession.

When Dr. Cherian returned to India, he wanted to develop this same cadre of healthcare professionals. India needed highly specialized healthcare professionals in fields such as cardiac surgery. Junior doctors were previously expected to fill this role; however, they were not a good fit. According to Mr. Abraham, junior doctors, who have bachelor's degrees in medicine or surgery, receive only minimal training in specialty fields. They also cannot be relied on as a regular source of workforce because they often go on sabbaticals to prepare for competitive higher education entrance exams. So, at any given time, there was a dearth of experienced hands in many areas of health care.

Mr. Abraham said that the large surgical patient panels also contributed to the need for another tier of healthcare professionals in surgery.

To Dr. Cherian, developing a PA program seemed like a natural solution to the specialty healthcare provider shortage. In Alabama, he witnessed firsthand how effectively PAs filled in the gaps that existed in health care. The other obvious advantage to introducing the PA position is that they only require 3 years of training versus the 6 years it takes to train medical doctors. There is also less chance of losing these professionals to “brain drain,” in which doctors and nurses leave their home country to work abroad.

The beginning

Dr. Cherian began the first PA program in 1992 with only 14 students. These students were trained in the hospital, and after 2 years of training, they received a postgraduate diploma. One year after the program began, it was upgraded to a postgraduate degree affiliated with the Birla Institute of Technology and Science in India. After a few years, it was changed to a 4-year bachelor of science degree.

According to Mr. Abraham, the profession spread because PAs proved to be such great assets to the work of cardiologists and cardiac surgeons. When cardiac surgeon trainees completed their training, they brought some PAs to their new hospital sites. Mr. Abraham noted that PAs are found mostly in Southern India where the profession began.

The PA profession has experienced significant growth and educational upgrading since its inception in 1992. In 2004, Amrita University in Kochi, Kerala, began a master's degree PA program. In 2012, 10 universities offered PA programs at 47 institutions in India. As of 2014, more than 1,000 PAs have graduated from these programs. The success of the transformation from a hospital-based program to a degree that is embraced by many Indian universities should not be understated; PAs in other countries have had a very rough road from conception to acceptance.

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