Season 2: Episode 30 - The German Model

Season 2: Episode 30: The German Model

SUMMARY KEYWORDS

profession, pa, germany, programs, physician, pdas, german, physician assistant, medical association, united states, establish, practice, scope, people, years, netherlands, europe, discuss, initially, family physician

00:01

We respectfully acknowledged the University of Arizona is on the land and territories of indigenous peoples. Today, Arizona is home to 22 federally recognized tribes, with Tucson being home to the Ogden and yaqi. committed to diversity and inclusion the university strives to build sustainable relationships with sovereign Native nations and indigenous communities through education offerings, partnerships and community service.

00:36

Welcome to this episode of the PA path podcast, I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession

00:52

that right now we live in very exciting times and we have the opportunity to expand the scope of practice of a lot of medical professionals for example, Corona is a catalyst for that, because we now we realize there's a necessity for more hands and brains in health care.

01:15

Well, hello, and thank you again for joining us today. Today we're going to explore the PA profession in Germany. We are delighted to have our honored guest Dr. Marcus Hoffman join us. Dr. hoppin played a major role in the establishment of the further education decree physician assistant of the state of Baden Wurttemberg, Germany, which grants an academic degree to successful graduates of this program and entitles them to use the additional professional designation state approved physician assistant. He was also a key member of the joint working group academic health care professions of the German Medical Association, and the National Association of statutory health insurance physicians just developed the concept paper physician assistant, a new profession in the German health care system. As always, you can learn more about our guests and our website pa path podcast.com We hope you enjoy this episode. Hello, good noggin. Who didn't happen? Guten Morgen.

02:15

How are you, Marcus? I'm good. I'm good. Well, Marcus, thank you so much for joining us on the podcast today. We're just so excited to learn about the model of this profession in Germany. You know, we you and I go back quite a few years when you first visited USC and it's really great to have you on the show. Thank you. Thank you. Thanks for having me. Of course, let's start with learning about your path. Because you are a you're a family physician, as I recall you so you have a unique experience did expose you to the PA profession and ultimately became one of the international leaders of the profession. So why don't you tell us about your particular path to getting involved with Bas? Yeah, it's quite interesting, because when I went to medical school, during that whole time, I never came in touch with physician assistants, or, for example, other health care professionals like nurse practitioners, because at that time, we did not have any of them in Germany. But that doesn't mean we never had any in Europe, or maybe a different name. Maybe for some of you the name fell chair sounds familiar. So we've always had the concept of non physician professionals being part of the medical team one or the other civilian and military over the course of centuries. So for example, the the before mentioned Felcher, was part of several armies during the 30 year war in Germany, which which took place in the 17th century. So I came in touch with the with the name physician assistant, which is very difficult to pronounce for Germans, by the way,

03:52

but I give you the German equivalent are the German translation, which is probably difficult for you to pronounce. It's called Art assistant, meaning

04:02

arts is a German word for doctor or physician and assistant is like assistant. Sure, I do not think this translation is appropriate to what the scope of practice. As far as the scope of practice is, it's regarded. But that's the official German translation we have so far. Obviously, it's also an ongoing discussion worldwide about how to describe this profession and the scope of practice that entails with the correct name. So physician assistant is I studied medicine in Germany, you you start studying medicine out of high school, it takes six years to complete your studies. And then I was one of the few people who were still drafted into the military service, and I was fortunate enough to be sent abroad. That's what they told me you're going to be sent abroad and

05:00

At the time, it was exciting because at that time, the German military did not really have engagement abroad. So I was excited to go abroad and abroad meant you are going to Belgium, which is a small country.

05:17

And not quite what you're imagining, I guess. Yeah.

05:21

And so it's it's it's obviously the seat of the European Parliament and also the seat of NATO, and also the military NATO headquarters, they are called shape. Supreme Headquarters, Allied forces Europe, is located in Belgium, and that's why they sent me and and this community is very interesting. And there's about at that time, there were about 10,000 people living their families, people from more than 30 Nations, NATO and affiliated nations also representatives from from Warsaw Pact at that time. Very, all very, very interesting. And most interesting for me and closes the circle to your question. I was able to work with physician assistants there because there is a it's a hospital,

06:14

which which has an American Medical Director, and under the roof of that hospital, all other nations have their small clinics. So I worked in the German clinic, my neighbor across the hallway was it was an Italian family physician. Next door was a French physician. We had meetings in the mornings in initially, I had I spoke a little bit of English, of course, high school English, but the the abbreviations in medical English, there were a real challenge to me. Also, how to learn how do we work in a team, we as Germans, how do other nations work in a team and it really shaped my my idea of medicine because it was completely new to me. And also, the deputy commander of this hospital, was a male nurse, and officer. And, you know, for me, naive, not used to that. I, it was a it was amazing for me to see that you could have a career as a non physician and in the military as an officer, high ranking officer, I think it was a lieutenant colonel. And to be deputy commander of such an installation, it was an eye opener.

07:31

A very positive experience for me. And that's that's how I first worked with with PJ's.

07:38

After that, after my my time as a draft T in the German army, I, I went on to my residency, I spent some time working as a research assistant in public health. And I never forgot, but I was absorbed in a German medical system after that for a while, actually. And the next time I came in touch with with a named physician assistant, was when I was working at Heidelberg Medical University. And there was an initiative from the state of Baden Wurttemberg, which is in the south west of Germany, a very innovative state, home to Porsche, Mercedes Benz and Saturn, also very technology driven, and of course, home to several very reputable medical schools.

08:26

They were there was a minister of education and science, who was trained at Berkeley among other places. And he was familiar with non physician professions during his time there. And he wanted to establish the PA profession because he foresaw the shortage of medical workforce. And he wanted to build a perspective for for healthcare professions besides the traditional. So they came up with this plan, and they were looking for somebody who could.

09:02

Yeah, who was who knew how to pronounce the word physician assistant. So number one,

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that's the step one, you have to build. One,

09:13

the door opener. And then they were really surprised to hear that I worked with with PAC. And I was quite familiar with the concept. What I what I didn't mention earlier was that I also spent some time as a volunteer and during a deployment in Afghanistan. So this is where I really learned to rely on P as, as valuable parts of the medical team. That's, that's when you really know what people are able to do. And really, you know, opened my heart again, the second time after my first time as a draftee in more or less peaceful setting, NATO headquarters. It really opened my eyes

10:00

Heart to the profession. And,

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you know, when this opportunity arose, I took it by the horns, I grasped the opportunity. And so I started with a lot of enthusiasm establishing this, this profession

10:18

with 11 students, I always say I started with a soccer team

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because that's the number of players in a soccer team, you know. And even though I'm not not so familiar with this game, which is interesting for a German, I guess, but you know, it's a nice metaphor. Yeah, of course. Yeah, even more so. Because I, I'm so proud of the fact that we started with with the number 11 in 2010. And usually in Germany, we met and we enroll the new students in any kind of cost study course, on the first of October, that's when our winter semester starts, you know. And so for the first time, since we enrolled those first 11 students, in last October, the the number exceeded 1000. Wow, enrollees. And this, of course, is not the program I have established, or named 2020 10. But it's in a total of more than 25 programs all over Germany now. So

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100 fold expansion, or multiplication in 10 years, I'm so proud of

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you, surely, I'm so happy to see this profession thrive. So you started with this, this concept of first I have to be able to pronounce this this title. And then I'm going to start a pilot of 11 students. What were some of the early challenges as you tried to introduce this to your physician colleagues, and and the Minister of Health and others in Germany? Right. And so we had a, we had the backing from the Ministry of Science,

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initially, and then there was a was a change in in parties and policies. And then it was not on the on the priority list anymore to establish the PA profession. There were other priorities. And I must say, from my very good experiences,

12:30

internationally with the PA profession, on a practical level, on an educational level, on a level of interacting, relying on PDAs. I was Yeah, I was I was struck. I was I was almost shocked by the fact that no, not everybody wanted TAS desperately. Sure. So is to phrase it carefully. So there was initially a lot of opposition, a lot of opposition from the Medical Association, from the German Medical Association. There was a lot of opposition from from other health care professional associations. But I now see that it's it's understandable, there's something new, there's a new concept, there's an unknown factor. And that's how they looked at the, at this new profession, unpronounceable profession. And so I engaged in a lot of discussions with the German medical association with funding authorities, that's always important, because the question was, and and is part of still in some areas? How do we finance this new profession? I engage with, with a lot of discussions with with eila health care professionals and their professional associations. And, you know,

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it became a constructive discussion.

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So we had initial funding from the from the ministry, to establish this program.

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But we also had to evaluate the whereabouts of our graduates. And whether they find a position an appropriate present position as physician assistant in a healthcare setting or not, and how they're a piece perceived by other healthcare professions, also by patients, and how

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do they feel in their new profession? So what we did is we did this mandatory study of the first two graduation classes. And it was a huge success. And that was the first breakthrough and breakthrough for this profession. But as you can imagine, so this was in 2015. So it took five years for the first two classes to graduate because our program in Germany

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Our PA programs, our bachelor's programs have six semesters, so three off training, and

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then two classes. And then we ask the graduates, and we ask the day environment, and there was a, there was a big breakthrough. And so that meant the funding, the government funding for those classes would be continued. There was a big boost for the profession. So in Germany do you have to know we have basically two parts of our healthcare system, they are bit separated. So we have hospitals,

15:39

where people are treated as inpatients and these are financed from a different pot, you know, then the ambulatory care with private practices and so on. It's two different sources of funding for those two. And it is easier or was easier to implement the PA profession in the hospital setting. Also, because there was a bigger demand. And and a better understanding, I must say, especially in certain specialties, for example, trauma surgery, very pragmatic, and a lot of trauma surgeons and German trauma surgeons have either spent time in the United States or other countries where PhDs are definitely part of the team. Or, in some cases, for example, in cardiac surgery, we have American trained physicians that work in Germany, and that help establishing the profession because they know how valuable PA is Rs as part of the of the team. So most of our graduates end up working in, in a clinical setting in hospital care for inpatients. That's really smart. So essentially, by by getting them placed with folks that had experience with PDAs, in the United States, you were able to kind of get to a tipping point of acceptance in the culture of medicine there. Yes, yes, you what you need is like with any new idea, you need proponents, we had a few and we built on them, we had a few doctors who knew PDAs. And we're all convinced that they that they are true

17:20

gain for the team and available, you know, professional Germany. And also we had we had,

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you know, economists that said, and statisticians who said, you know, we cannot train as many physicians as we need in the future in Germany. So I guess it's a similar setting and a similar outlook in many of the Western countries. The second, you know, setting that we are focusing on now, our rural areas, guess this is where the US pa profession started out from a shortage of primary providers, primary health providers in rural areas, Germany's not as big but we also have rural areas where there is a will be a drastic shortage of Family Physicians. And so slowly, there's an understanding that PHS might fill the gap. While I don't really like that phrase, but you know, what, I'm what I'm referring to. And also, we have migration from the rural areas, also of young people of professionals into into the city areas, but even there in bigger cities, there are, let's say, medical deserts,

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where there is no

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family physician readily available. So we are working on concepts, how to implement PHS, and maybe also other new health care professionals into those practices are in into that, you know, population based health care settings. So So Marcus, you were describing that you're now at about 25 programs in Germany? Yeah. At what point in the evolution of the profession in Germany, did you go from the the one program to whatever the number was next and then to 25? How did that all roll out? Yeah, it was initially, we were quite alone.

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And then the first 234 years, there were one or two more programs popping up. And like I said, I guess a motivation also for other universities or institutions of higher education, to also start a PA program was the evaluation that I refer to before the very positive outlook of everybody involved with PHS. We publish that and it was very well received in the German public. So there was one

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breakthrough that

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that's when it started to the number of programs all over Germany started to rise. And another breakthrough was

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a regulation and a recommendation that was published by the German Medical Association. And by the, let's say, financing bodies, I'm making this up this translation, because some of the German terms and institutions are not that easily to pronounce or to translate. Sure. Anyway. So the breakthrough really came with the publication of evaluation results. And the publication of a framework for the physician assistant profession, by the German Medical Association makes a lot of sense, right? You finally have data, you have regulation, you have an endorsement. And you have the funders that are willing to fund that expansion of this. Exactly. So we worked on all all those fronts, but it took five, six years, until it really kicked in. And I'm not a very patient person. But I learned patience through this

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through this

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process, and I looking back, and looking back at the history of PDAs in the United States and the evolution. And we you and I discussed this many times. And I've read about the history of PDAs in the United States. So we are on a fast track, because we have a blueprint. Sure. So for example, we are like I mentioned before, we are still graduating our periods on a bachelor's level. So that's okay for now. But there will be master's programs like in the United States. But I guess 20 years ago, most PA programs in the United States were also bachelor's programs. So maybe we are at that point at the moment. But and we can we can talk about it the scope of practice of PhDs in Germany, although the concept is the same as part of the team of the of the physician's team. The scope of practice is not where I wanted to be yet. Sure, sure. Yeah, it takes time. I agree. And just to come do a comparison, the US medical school path is slightly different than the German medical school path you described. You go right down that path right in from high school into college. It's six years and then I presume, if you choose to do a residency, you can do that. Is it I believe in the UK that results in a master's degree initially is at the same in Germany, not for physicians, we still have this old fashioned track. We have that for other professions too. But most study programs, most academic programs have been switched to bachelor's, and or consecutive master's programs, from almost professions. When in or the medical profession we still have the so called stats exam and the public exam government exam. Okay, okay. So let's talk a little bit about your program that you started and maybe the evolution of the curriculum in Germany, how did how did you first develop that program? What is the typical? You said three years was the timeframe but how much the didactic? What are the things you're teaching in the blueprint? Where do you do your rotations? What does that look like for a typical applicant as they're exploring your program? Yes. So in Germany, every university or every institution of higher learning, has has freedom. There's there's a freedom of teaching. And since there is no government mandated curriculum,

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we were able to start with with a blueprint taken from from the US model. So I did not create all of the first of all the initial PA program there were there were people in the background that had done a lot of preparation work. And they had taken the blueprint from from the US PA programs.

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But one of the biggest difference is the following. So our program, a three year program was structured as follows. So our students

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went to four lectures, classroom training, they had their classroom training for three months. Then they went on clinical rotation for another three months. So one semester of six months consists of three months classroom training, and then practical applications. So and then that we do this, we did this six times, the six semesters, and then they, they graduate, and they write a bachelor's thesis and so on. And at the end, of course, we also had a practical exam that we did together.

25:00

with some of the most reputable University Hospitals, in a patient centered setting,

25:06

this is not mandatory. And then, after we had started with the program, and I mentioned some more programs came to existence, and they were slightly different. For example, they had different standards for enrollment. They, they had different rotation schematics. But basically, it's the same as in the United States, you you study, initially basic sciences, and then more and more you you gain an understanding of the clinical setting, you get more and more engaged with patients, during your clinical rotations, and so on. And we also had, from the beginning, some electives that you could choose from, for example, if you're very interested in trauma, surgery, and orthopedics, you could take some extra classes, electives in that, or in other fields. And there was also to train people according to demand, because we had, of course, done some market research. And we were looking at where's the demand. And of course, the trauma surgeons there, there was a high demand pragmatic profession, and others too. And so we offered this as elective. So the challenge was initially, one of the challenges, obviously, there were many challenges. But the next challenge was, so when there were more programs, starting in Germany, they were different, obviously, from from ours, which is not bad, which, which might be a good thing. And the and the idea was the same. But in order to establish a profession, a solid profession, you have to stand together, and you have to have at least you know, a basic framework amendatory framework, which was not easy to do, because there was no legal framework. So what we what we had to do was, we had to find a place where we could discuss this, and we had to find an authority that could at least give us, you know, guidance on this, or an authority that everybody respected outside of politics. And that was the German Medical Association and the funding authorities. And so we came together

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as representatives from several universities. And we compare our curricula.

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And obviously,

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you know, everyone was, was convinced this was the best maybe, or not, so we had this typical discussion, but after the very short time of two years, joking, because, to me, that was an eternity.

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Well, we've been working on it for 50 years. So you're doing okay.

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We reached an agreement. And so we have, we have some core subjects that that every program should have. And these are the recommendations that were published by the German Medical Association. And that, and after that every new program, took these recommendations, and and the curriculum, and built on that, so so there was, you know, goal achieved on that part, there are differences still in clinical rotation. There are differences in you know, emphasis, for example, more on family care, or more on this or that in some other programs, I think very similar to the progress of the United States. But we have a standard, a set standard.

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I guess, we'll be able to work on it on this standard. And I'm looking forward to do that, to doing that, because I mentioned the scope of practice of PA in Germany. And and that is not enough for me yet. Yeah, yeah. So so when you think about the ideal scope of practice, are you falling closer to what you experienced in Afghanistan with the military? PDAs?

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Yeah, I mean, that would never be optimal. Obviously, you cannot transfer

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military standards to a civilian setting all the time, or equally. But so let me let me talk about the scope of practice in Germany. So for Pa, Pa is in Germany are part of the medical team. And they work responsibly, but under the doctor's authorization, for authorization, so we also call it delegation. The tasks are delegated to PHS. And this This can be done on a one on one basis, but it can also be done after the physician and that's that's a legal requirement for any kind of delegation of tasks to non physicians.

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If the physician knows the person and they know they can perform, and that's that's true for all other professions also in the medical field, then they can

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perform their tasks by themselves. It sounds very complicated. But you know, that's the framework we have right now. Sure.

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Physician Assistants in Germany cannot prescribe,

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which is difficult sometimes. And maybe there will be new or new laws enabling this, but right now, only physicians can prescribe medication in Germany.

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There are some model programs, some some evaluation going on for non physicians to prescribe medication. And I hope that will, you know, foster and expand the scope of practice for PA as well, we will see, and I presume you have you have pharmacology and pharmacotherapeutics in your curriculum. Oh, yeah, definitely. The trainer, the drugs are just not able to prescribe. Exactly, exactly. And anyway, another anecdote of many of one of the many discussions I've had with with healthcare professionals and this one with pharmacists, and because I've had pharmacists, very reputable pharmacists teaching at my program, and they said, Okay, we teach him all we know, and I discussed with him, I said, Hey, what do you think about pa prescribing, and not just the physician colleagues that prescribe and you fill the prescription? And the pharmacists were a bit reluctant? And I said, Hey, we know more about pharmaceuticals, then sometimes also physician colleagues, and I would agree, you know, no physician knows everything. Nobody knows everything in every field. And so why should we not get prescription rights? First? There was their question, because in Germany, they don't have prescription rights. It's just an anecdote. But yeah,

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that is something that and this is very, very current development. COVID. So maybe, you know, that, that we're trying to vaccinate a lot more people until the end of the year. That's what our new government proposed and wants to do. And so there they are discussing about

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pharmacists, vaccinating, I know in the United States is it's normal and standard procedure. But in Germany, it's not. So maybe this discussion of tasks sharing, forced by this unfortunate pandemic, can can help open the mind of people. Yeah, when I first graduated from PA school, United States, I practice in the state of Illinois, and we were not allowed to prescribe in Illinois initially. And what was intriguing for me was that, you know, we took the same pharmacology courses, the Do students at the university I attended from the exact same professors, and had the same tests and and the same number of hours of pharmacology and pharmacotherapeutics. There were definitely differences in our total training around clinical hours and other things. But ultimately, we were able to get that law changed about two years after I started practicing. But those first two years were tough, it made it very difficult on the patients. And the end the team as well, but the patients, it makes it confusing. It lacks validity to the professions, intellect when they're not allowed to do that, to try to provide a smoother transition for the patient to get in and out of the practice. So I do hope that they come around soon for you.

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Yes, and Reality Reality looks different. Lee, when I was in residency, and I had my first emergency on intensive care, elderly gentleman with with a myocardial infraction, I relied on the staff, the non physician staff in an intensive care to explain to me what what the schematics were, I had to bear the responsibility, yes, but they had the experience. So but in like, like, I like to say in Germany, you need a driver's license for everything.

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That's great. Even even for fishing, even for other things, and of course, for for serious tasks like, like prescribing. So if you're, if you're a physician, for example, I like to give that example I am I have the license to do transplant, but I would never do it. There are other people who are a lot more qualified than me to do it. And so we have to rethink this concept that if you have this or that driver's license, in other words, your your medical degree or your physician's license, that you're in

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able to perform everything that can be done in medicine, maybe there are other professions that are better suited to do that. Well, and that's a classic argument for scope of practice, right scope of practice gives you the range to do the things that you have the experience to do, and allows you the portability to take that with you into your next role. So in the PA world, if I've done dermatology for 10 years, and then I go work in primary care, the fact that I, in some states, I'm not allowed to practice the skills that I have been doing under the leadership of a dermatologist for 10 years, it's really just hurting the patients. It's it's hurting the health system. I agree. I fully agree. And, like in the United States, we also have a federal structure of our country, we have a federal system. And every state in Germany, we have 16 states has their own requirements. They're very similar for the established medical professions, but they can make their own rules. And the first rules for PHS were done based on our curriculum. But they were basically an addition to nursing law. They were not a law in my state, but it was a beginning. You know, so yeah, we have, we have to go state by state to expand that. And I must say, this is really

36:24

a matter that counts a lot for me, comes from a heart that, that right now we live in very exciting times. And we have the opportunity to expand the scope of practice of a lot of medical professionals, for example. Corona is a catalyst for that, because we now we realize there's a necessity for more hands and brains in healthcare. And so we do it. And we can tear down those barriers, between professions. And in our minds, especially, we've discussed it, why not? If you've worked for 10 years, in dermatology, you probably know more about dermatology than then I do most likely

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100% Because I never worked in dermatology. So that should be a certain standard that we have to we have to look at the time of training as well. But of course, also qualification. So

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another aspect is that our new government in Germany, we just established a new government in Germany. They have in their contract that is a coalition of three parties. And they made a contract and they outlined, you know, different kinds of policies and ideas for the new government for the next four years. And for medical professions, they want to open up the scope of practice, and also

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discuss or establish prescription rights, not for physician assistants explicitly, because it's still a small group in Germany, Shrum but for other professionals, and for direct access, for example, to other professions, like physiotherapists, because right now in Germany is still very complicated. If you need

38:24

a referral to a physio therapist, for example, because you broke her ankle and in need rehab, then you have to go to your family physician first or your to your orthopedic first, and he writes up, he or she writes a prescription. And now there's discussion about, you know, direct access, why not? Physiotherapists are very well trained. It just clogs up access to the primary care providers who need to see people with real illness. Exactly, exactly. Yeah, we, you know, we're, we're in our remaining time, I'd love to ask you to two more questions. You know, first, I'm just so honored to interview the father of the profession for Germany, this is really cool. You must be very proud. When you when you look ahead, maybe 10 years from now, what what do you envision that the best case scenario will be for your profession in that country? Yes. First of all, thank you for for giving me the honor to, you know, call me the father of the profession. At first it was a team effort, and without many people who dare to do something new, we wouldn't be where we are now. But thank you. So, in 10 years, I would like to be where the United States are at with a PA profession, meaning an expansion of programs, meaning it's the number one profession according to the ranking for four years in a row. But I also envision other professions with with more scope of practice

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developing because they all will help tackle the challenges we are all facing, but especially for the

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pa profession, the, my, my hero, and my my, my blueprint is Disney United States, definitely master's program,

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master's programs as standards for PDAs, prescription rights, etc. And understand that for Germany for for all federal states of Germany. Fantastic. And the last question I wanted to ask you is I know that you have, because of your role in Germany, you have taken on a leadership role in Europe as well. So could you briefly talk a little bit about where things are going in, in Europe as a whole for the profession? Yes, there are several countries who champion the profession in Germany, I think, the most advanced the Netherlands,

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within Europe, and I think that their role is the most independent worldwide, actually, the PA role, which has been the source of many discussions as well because PJ's in the Netherlands can work independently from physicians. And it can be a good thing. It can be discussed, but the Netherlands are actually very far advanced. When it comes to the PA profession. The other country was really established the PA profession, also in bylaws and laws is the United Kingdom, and then the Republic of Ireland and also Germany. So my idea was because initially, we've had a group of people from the above mentioned or before mentioned, countries, and we were discussing the profession, also USPS, they were helping to us to understand what what does it mean, a PA profession? What does it mean to be a PA, what does a PA actually do? In a setting in a healthcare setting? So we've always had this discussion as international discussion, because I think, if we copy a name, we also have to copy or take, take a name and establish a profession, it has to be has to have the same content eventually meaning same kind of education. I mean, every country has their own healthcare system, but at least similar to like a physician is basically the same worldwide. And nurse is basically the same worldwide. So So my goal from the beginning was that also the physician assistant standard is the same in Germany. That's why we had this working group with a German Medical Association. And we're working on federal laws regarding this, and also from the beginning, I tried to understand so what's the scope of practice of Pac in the Netherlands, where what's the prerequisite to be admitted to PA school, and so on. So in order to have a platform to discuss this, and the pros and cons of every country's initiative, we established the Euro pack, which is the European pa collaboration. Nice. It's spelled with a PA dash c, like the certified PA. And one of the goals of this association is, of course, discussing promoting the profession in Europe, but also, with a big C, this certification is to find maybe a common European standard for a certification exam. Like it is established in the United States. So we've had our first international meeting, and I think that was the first international pa meeting with that kind of attendance in Europe, in 2019. was a huge success. So we had representatives from APA, us from the from, from the American side, from from arc PA, both presidents of the associations we've had the leaders from, from all the countries, you know, Pa associations, and we we've had very fruitful discussions in Berlin, and we initiated

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a discussion about a common certification exam. So then can COVID then came back? Yeah, or Brexit first, then COVID. Or, you know, so at the moment, we are, I think, all focused all those countries, most European countries focused on the task at hand. So to of course, you know, be able to find a way out of this pandemic, and, but we're still talking. So we've had to skip the 2020 Euro pack, which was already planned for Berlin. And in 20, winter, we only had a small event in in Heidelberg, but I'm hopeful that we can revive this and my my goal is to have it in other

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Other countries to have us excited to be in the Netherlands, they are much more organized. I must say, I think in the Netherlands, they're already 10 years further, and we are, which are affected. But also, you know, if you look at the, I'm sure you will talk to some of the leaders in the UK, they've also had tough times they initially they had several programs, and then they had to close down some. But eventually, they found the allies in the English Medical Association. And now they're, they're part of it. So I think the lesson learned is to talk to talk

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within the profession, to discuss experiences to learn from history, especially from also from the US history. That's That's what I like to look at, and to have a positive outlook, because if you're convinced that the PA profession is something so positive, it will eventually be part of the medical system in any in any country. Yeah, that Christine grit and determination we look for in our students is what we need to show as leaders as we build this up, Marcus, thank you so much. This is so interesting. I hope we can circle back in a year or two to kind of get an update on how things are going. But congrats on on a great start. And we're very excited to watch you over there and do really appreciate your time and insights. Thank you very much for having me. Thank you.

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Well, I'd like to thank our guest, Dr. Marcus Hoffman for sharing his perspectives about the PA profession in Germany. They have exciting things going on with the significant increase in PA programs, and we look forward to hearing more about our German colleagues in the future. Tune in next week as we speak to Mr. Quinton Vanden Driessen, from the Netherlands who will share with us the origin of the PA profession in the Netherlands and where they stand today. They are one of the earliest adopters in Europe of our profession, and it'll be a very exciting informational conversation.

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Until next time, we wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or policy of the University of Arizona.