Meet The PA Pioneers of Israel The Israeli Physician Assistant

This is part four of a nine-part miniseries by documentary filmmaker Adam Halbur on the PA model around the world. View all posts in this seriesAs Good As You Can: The PA Model Around the World Part OneAmerican Cheese: The Origin of the U.S. Physician AssistantPAs in the Netherlands: The Dutch Physician AssistantWhy We Really Need PAs in The UK: The British Physician AssociateMeet The PA Pioneers of Israel: The Israeli Physician AssistantTrials and Tribulations of the Liberian Physician AssistantSouth Africa’s Clinical Associate (Clin-A): The PA Model Around The World The Test: PAs for Israel Israel, the only Middle East country other than Saudi Arabia to attempt a physician assistant program, graduated its first trial cadre in 2017, retrained emergency medical technicians to fill shortages in hospital emergency rooms around the country. The Saudi program, begun in 2010 with faculty from George Washington, takes 28 months including military training. The Israeli program, run by the Ministry of Healths Training and Development Department, does not have the military component; though service is mandatory for all citizens unless deferred, and the country is at odds with many of its neighbors, not to mention Palestinians who have been dispossessed of land and rights. I was aware of this tension seeing soldiers with machine guns at train stations and guards manning metal detectors at the entrance to hospitals and bus stations. I wasnt able to bring my tripod into one hospital for an interview. Unbeknownst to me, I was even being watched while I filmed B-roll of passing ambulances. This man came up to me to ask what I was doing, and when I told him I was making a documentary on Israeli medicine, he thanked me and offered me a box of cookies. One could grow paranoid and question motives. Israeli PA Master's Degree However, Udi Gelbshtein, coordinator of the pilot at Sheba Medical Center, said that if all goes well, Israel hopes to train PAs in other specialties and perhaps start a masters program. We are ready to do the next training. If we are going to have the 100 positions that we wanted to have in the emergency medicine department, we are not going to open the third one, he explained. I think that their success in the field will probably lead the university to start, you know, offer the program for a masters degree. I arrived at Sheba just as Gelbshtein was supervising the inaugural written exam. I asked one student who had finished, Idan, what had brought him to this point: I used to volunteer in MADA [Magen David Adom in Israel], which is an emergency ambulance. And a friend mine told me, Lets go and volunteer.So I said, OK, why not? So we started, we did this one-year course where you become an ambulance driver. And we started our training and we both went on this call and she saw a little blood and she lost consciousness, she fainted. And she stopped her volunteer [sic] and I stayed. And then I started working in that company and became a paramedic, instructor. PAs are a "Natural Progression" For Idan, who slowly worked his way up, the PA profession is a natural progression. For paramedics here in Israel, Gelbshtein said, for many years there was like a glass ceiling above their head. And someone who did the paramedic training and spent three years in a university and, you know, practiced paramedicine for a few years, if they wanted to change careers, it was very difficult for them. Some went to nursing, some went to other professions, you know, not even medicine, but this physician assistant program is now giving them another opportunity[iv] to continue in the same professionin the same way they did for so many years and spent so much timegives them the opportunity now to grow further and pursue something more challenging. Even With Years of Medical Experience, It's No Easy Task Many of the PA candidates, most of them men, had been EMTs for about 15 years, but while they were very experienced in the field, some students expressed academic frustration. He passed and he passed of course, one student said when I asked a group how they did on the test. Another replied in jest, 'I passed away' Gelbshtein said the program is tough and the students could do with more time to absorb the material. The students I cant say suffered, but they trained very hard. Personally, I think that its not easy to do such extensive training within one year. It normally takes two and a half years, he said defending his inaugural cadre. And most of them have families, wife, kids, you know, even parents they need to take care of. So its not easy. Its something that is very very demanding. So they deserve a big thank you, you know, for continuing and always studying and asking questions and everything. Improving Patient Outcomes A few days later I caught up with Idan at the Wolfson Medical Centers newly renovated ER where he told me his success story of adapting to his new PA role: It was a 60, I think it was a 60-year-old patient who came here with stroke signs, came with an ambulance. And I started managing. I asked the secretary to hold the CT. I talked to the neurologist. I didnt wait for someone to take him. I took him myself after doing the examination. And we went straight to CT, and I met the neurologist at the CT. And after doing the CT, we decided to take him straight to the stroke unit and give him treatment. In the evening, I got a nice call from the hospital which said theres no neurological deficit. Despite finding newfound fulfillment on seeing his patients recover in hospital, he was continuing to volunteer in the field as an EMT, for which he has a bug. And he indicated if a masters program were instituted, he might go for it. As Good as You Can, As Professionally as You Can Idan, as most PA-like professionals I have met, are for the most part very realistic about the professionit might be gainful employment for all, but for the successful, the drive to keep improving, to keep learning, is essential: Its like a routine, you come to work, you do what you need to do and you get a thank you from this and you get a thank you from that. This one or that one, it doesnt matter. And you continue your day. At the end of the day, its work. Youre trying to do it as good as you can, as professionally as you can. And you study, you keep studying all the time. After you finish the work here, you go home and you read and you learn. I dont think it ever ends. At the time of the interview, Idan had passed the written test but was still waiting to do the practical, or OSCE (objective structured clinical examination), which he eventually passed, as well. Will There be PAs in Palestine? With all the camera and audio equipment I had to tote around, and the wearisomeness of passing through security checkpoints, I never went to the Palestinian territories. But I wondered during my time if Palestinians, who are in great need of medical services, especially in Gaza, would benefit directly from the Israel PA program. All indications were that it was for Israelis and does not pertain to the Occupied Territories. When asked if Palestinians would have PAs, Gelbshtein replied: I dont see why not, meaning, as I understood, they could train their own. Any benefit to Palestinians would be to those living and/or working within Israeli society needing emergency care. Perhaps this will change, that any PA programs would educate Israeli and Palestinian alike and that they would live together, perhaps as two states and hopefully as one nation, everyone with equal socio-economic rights. Adam Halbur is a writer and teacher living in Tokyo, Japan. A short version of his filmAs Good As You Can, As Professionally As You Canpremiered at the 11th annual conference of the International Academy of Physician Associate Educators. Watch the American Cheese segment of the longer versionhere. Watch a short of the 50th AAPA Conference with interviews from Ruth Ballweg and David Kuhnshere. Halbur is entirely self-funded, so if you appreciate his work, please considermaking a small contributionto his feature documentary on the Kenyan clinical officer. Be Notified of The Next Post Resources and References Physician assistants in Saudi Arabia We are ready to do the next training Let's go volunteer Another opportunity I passed away It's not easy There's no neurological deficit It's a bug It's like a routine I don't see why not As good as you can The Test - PAs in Israel Support this work View all posts in this seriesAs Good As You Can: The PA Model Around the World Part OneAmerican Cheese: The Origin of the U.S. Physician AssistantPAs in the Netherlands: The Dutch Physician AssistantWhy We Really Need PAs in The UK: The British Physician AssociateMeet The PA Pioneers of Israel: The Israeli Physician AssistantTrials and Tribulations of the Liberian Physician AssistantSouth Africas Clinical Associate (Clin-A): The PA Model Around The World You may also like -Where PAs and Physician Associates Can Work Internationally The contemporary physician assistant/associate (PA) movementbegan in North America and Africa in the mid-1960s. As of 2018, the adoption of PAs has spread globally across a variety of health systems and at least fifteen countries []As Good As You Can: The PA Model Around the World Part One Welcome to part one of this powerful nine-part miniseries detailing filmmaker Adam Halbur's spectacular new documentary film about the PA model around the world. Make sure to sign up below to receive all the posts in this []Trials and Tribulations of the Liberian Physician Assistant This is part five of a nine-part series by documentary filmmaker Adam Halbur on the PA model around the world. As God Would Have It When I visited in 2017, Liberia was celebrating 150 years since its founding by Christian []