After many years of opposing the use of physicians’ assistants (PAs) common in the US and elsewhere, the Health Ministry has just issued a directive with details on their training, supervision work in hospitals and in the community. However, it will not automatically license experienced PAs who want to or have come on aliya, as primary legislation must first be passed that would recognize existing PAs. Eyal Ya’acobson of the ministry’s medical administration told The Jerusalem Post on Wednesday that “circumstances and needs change,” and that due to the shortage of physicians and the impending retirement of many doctors who came decades ago from the former Soviet Union, more people with expertise in medicine are needed.The directive was very slow in coming, as nearly two years ago, the ministry announced that it decided to recognize it as a medical occupation after a committee of nine experts recommended this. According to the committee, the PAs would start by working in hospitals, especially in fields in which there is a severe shortage of physicians -- anesthesiology, urgent care medicine, surgery, internal medicine, geriatrics and pathology. PAs, recognized in the US since 1960, are less expensive than doctors but possess practical experience treating patients under an MD’s supervision. When US doctors and medical educators realized that their country was suffering from a lack of primary-care physicians and an uneven distribution of those that they had, Dr. Eugene Stead of Duke University Medical Center in North Carolina established the first class of PAs, basing the curriculum partly on his knowledge of the fast-track training of doctors during World War II. The class consisted of Navy veterans who had considerable medical training during the war in Vietnam but couldn’t put that knowledge and experience to use in a civilian job. Today, the PA profession based on Stead’s model has grown and thrived, and nearly 100,000 PAs are currently working abroad for impressive salaries in hospitals and clinics under the supervision of MDs. PA training is usually two to three years of full-time post-secondary education. Five years ago, when the Post conducted interviews with immigrants from the US who were licensed there in the two professions, both the ministry and the Israel Medical Association were opposed to recognizing them; they argued that recognition would "cheapen” the MD degree. Immigrants coming with such accreditation have had no choice but to work in other professions, hoping the ministry would come around to recognizing the professions. The IMA no longer opposes the change. But the ministry has put the focus on paramedics working for Magen David Adom or United Hatzalah who are already working in emergency care or graduates of Ben-Gurion University’s program for paramedics who are not physicians, instead of working with Nefesh B’Nefesh and the Absorption Ministry to bring and assist existing PAs who want to come on aliya. Experienced immigrant PAs would need a short time to study the Israeli health system and medical practices used here, but would come readymade with their intensive medical experience. Ya’acobson said that to recognize foreign-trained PAs would require primary legislation that could take years unless they entered the system with more limited responsibilities than they had abroad. The ministry had also been opposed to recognizing nurse practioners, who are nurses who undergo additional medical training and treat both physical and mental conditions through comprehensive history-taking, physical exams and ordering tests for interpretation. But as the shortage of doctors, especially in geriatrics, became severe, it agreed to this as well.