|Linda Zandbergen rounding on a dialysis patient in the Netherlands. |
Have you ever wondered what it would be like to be paid a salary to be a PA student? How about spending one day a week in the classroom and the rest of the week seeing patients? What about being trained in a specialty at the same time as your general medical education?
That's what you'd be doing if you were one of the approximately 150 students currently studying to be a physician assistant in the Netherlands. The PA profession, increasingly global, is now a part of the medical community that European country.
About five years ago, a cardiothoracic surgeon from the Netherlands came to the United States, attended a conference sponsored by the AAPA and was struck by the many benefits PAs can bring to patients and the medical community. He returned home and started training a brand-new crop of health care professionals, and the PA profession was born in the Netherlands.
The first PAs in the Netherlands were in cardiothoracic surgery, but now they are being trained in virtually all medical specialties. There are currently about 30 fully certified and practicing PAs, with that number growing yearly. There are also now two formal PA education institutions.
At the annual PA conference in San Francisco in May and June, the American Academy of Nephrology Physician Assistants (AANPA) hosted two nephrology PA students from the Netherlands: Linda Zandbergen, a second-year student, and Marije Evers, who is in her first year of training. Both women have nursing backgrounds. In San Francisco, they attended CME presentations, participated in practical workshops and gave a presentation about PAs in the Netherlands at the AANPA annual meeting, which also took place at the conference. (Since it was their first trip to the United States, they also did some sight-seeing in San Francisco.)
There are significant parallels to Netherlands-trained PAs and those in the United States, but there are also some fundamental differences. Health care in the Netherlands is fully covered by the government and is available universally. PA students are paid a salary while studying, which is covered partly by the state and partly by the physician doing the training. A bachelor's degree is required, along with at least two years of health care experience, before becoming a PA student.
The course of study is separated into ten 10-week blocks of time (see Figure). The students spend six weeks of each block of time working in their own specialty and then four weeks in another facet of medicine. Even though only one day a week is spent in a formal classroom, students do most of their didactic work at home and are then tested in the classroom.
When they finish the third year, they are certified and graduate with a master's degree. There is not an ending certification exam, but rather periodic tests that must be passed before moving on to the next section.
Ms. Zandbergen reports that PAs generally are very well received by patients and nursing staff alike. Most physicians are also quite positive about the benefits of PAs. Nevertheless, because it is still such a new entity in the Netherlands, some corners of the medical community there look upon PAs with puzzlement or resistance.
The physicians who are most uncomfortable are family/general practitioners. This is understandable and parallels the early experience of PAs in the United States. With time and education of the medical community along with the students, this resistance likely will evaporate. Ms. Zandbergen and Ms. Evers are planning on returning to the United States next spring to attend more presentations and learn more about how PAs function here, particularly with respect to patients with kidney disease.
Marilyn E. Olsen is a PA at Nephrology and Hypertension Associates in Middlebury, Conn., and is secretary of the American Academy of Nephrology Physician Assistants.