When I asked Mr. Abraham about the challenges that Indian PAs face, he told me that though the profession is not new, it still lacks some essential elements that cement it in the healthcare system. There is no government licensure or government council that recognizes PAs. The title of PA is not protected, which means that any type of professional assistant in a hospital can technically have the title of PA. This has the potential to spoil the reputation of formally trained PAs.

The curriculums across the different universities are not standardized, and there is no national licensing exam for PAs who graduate. This can lead to substandard programs and a certain degree of uncertainty for these professionals. Mr. Abraham said that this uncertainty has led many PAs to migrate to other fields or to pursue higher degrees in other countries. He also said that the profession is still somewhat unknown to patients and medical organizations.

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Despite the challenges that PAs face, there are plans to expand these professionals into primary care. The educational model for Indian PAs is similar to that of the American PAs, where students receive training in general medicine. This focus on general medicine will serve as good preparation for PAs to transition into primary care.

The need for primary care in India is immense, and the country has to deal with many healthcare challenges India. India is the second-most populous country in the world and has a double burden of communicable and non-communicable disease. Although health status has improved in India, many challenges remain. In 2012, life expectancy was 66 years, and infant mortality rate was 43.8 per 1,000.

India is showing signs of increased rates of non-communicable diseases. According to the WHO report, the rate of elevated blood glucose was 11.1%, and the rate of hypertension was 22.6% for women and 23.1 % for men.

There are public health center facilities available, but they are overcrowded and cannot service everyone. The general population lacks awareness of health issues, and many people are unaware of which disease conditions warrant medical care. Many Indians do not recognize the importance of treating and controlling chronic diseases, such as diabetes and hypertension. They present to clinics only at the end stages of these diseases, which makes it more challenging to deal with these conditions as a whole.

Compared with other countries, fewer people in India have medical insurance; 75% of the Indian population pays for healthcare service out-of-pocket. Because the out-of-pocket cost of care is so high, many families tend to ignore the health care needs of their elderly and female family members.


PA programs are usually a 3-year, bachelor’s degree level program with an additional 1-year internship in a chosen field. The university-based program accepts students who have graduated from the high secondary level. The programs’ curriculums concentrate on general medicine. However, because the program was developed at an institution that specializes in cardiovascular surgery, many PA graduates end up working in a specialized medical field.

Work environment

According to Mr. Abraham, Indian PAs do not only work in outpatient and inpatient settings, but they are also found in many non-clinical fields such as hospital information systems, hospital administration, and clinical research. Most PAs, however, work in highly specialized fields of medicine. There are 14 specialty areas, which include cardiac surgery, orthopedics, gastroenterology, plastic surgery, and neurology. Most PAs work in private institutions because their profession is still not recognized by the government.

I left it to Mr. Abraham to describe what he does on a day-to-day basis as a PA. He works at the Metro International Cardiac Center, which is the first and largest exclusive cardiac specialty hospital in Kerala. He works not only in a clinical arena, but also in administration where he plans admissions, schedules surgeries, and does clinical research.

Mr. Abraham’s clinical work consists of hospital rounds in the medical wards and in the ICU, educating patients and families, and acting as a go-between for the surgeon and other physicians. In surgical work, he serves as first assistant in all adult and pediatric surgeries, and he harvests radial arteries and saphenous veins for bypass surgery.

Mr. Abraham also is actively involved in the Indian Association of Physician Assistants, where he is the joint secretary and general secretary for the Kerala state branch.

Despite the challenges that lie ahead, Mr. Abraham is optimistic about the future of the PA profession. He is particularly excited that India’s government has begun to look into integrating PAs into primary care settings.