The profession of Physician Assistant (PA) was introduced in the Netherlands more than 20 years ago, inspired by its success in the United States. Since then, PA training in the Netherlands has evolved and been tailored to meet the specific needs of Dutch healthcare. But how similar is the training in the Netherlands compared to the USA? Are the curricula and professional roles aligned, or have significant differences emerged? We explored these questions with Emily during her internship.

Emily holds an undergraduate degree in Public Health from the University of Georgia. In 2022, she decided to transition to a career as a Physician Assistant, preferring the direct, one-on-one interaction with patients over developing programs to promote community healthcare education.

The PA program in the USA spans 2.5 years, divided into a didactic year focused on classroom learning (during which work is not permitted), and a clinical year, where students complete rotations every four weeks in key specialties and two elective specialties.

For one of her elective rotations, Emily chose the Netherlands. Through LinkedIn and with assistance from Dr. Luppo Kuilman of Hanze University of Applied Sciences in Zwolle, she secured a position with Babylon, a provider of general practitioner care at the Asylum Seekers Center in Assen. Over the course of four weeks, she worked at the Asylum Seekers Center in Assen.

When asked about her experience in the Netherlands, Emily described her rotation as a unique opportunity to immerse herself in Dutch culture. She lived in Groningen but commuted to Assen for work, finding Groningen more appealing than Amsterdam, due to its authentic charm and lack of heavy tourist traffic.

During her stay, Emily attended a physical examination class at Hanze University, where she participated in group assignments – despite the language barrier. She noted how her peers’ kindness and the visual aids in the presentations helped her follow along. One memorable moment involved creating a patient case: her group imagined a scenario of a cyclist who had bruised his abdomen after flipping over his handlebars. This case, influenced by the prominence of cycling in Dutch culture, amused Emily, as such an injury is far less common in the United States.

To cap off the day, a PA student invited her for dinner with their family and lent her a bike. Learning to cycle “the Dutch way,” without a helmet, was an experience that made her mother uneasy but added to the authenticity of her stay.

Emily observed numerous similarities in how PAs operate in both countries: ‘For example, abdominal examinations are conducted the same way I have been taught in the USA. PAs in both nations have significant autonomy in creating care plans and prescribing medication. While we as PAs work closely with supervising physicians, they don’t need to be physically present in every interaction.’

However, Emily also identified notable differences. ‘Diagnostic practices in the Netherlands are often more conservative. Rather than rushing to scans or X-rays, Dutch healthcare providers tend to adopt a “wait-and-see” approach, influenced by differences in insurance structures and the absence of malpractice lawsuits.

Similarly, I observed a more cautious approach to prescribing medication in the Netherlands, contrasting with the broader availability of over-the-counter drugs like Hydrocortisone 1% in the USA. These differences prompted me to reflect on the necessity and rationale behind medical interventions.’

Emily described her time working with asylum seekers as eye-opening. While she had encountered refugees in the USA, working with individuals from African countries presented unique challenges and learning opportunities.

‘Hearing their stories provided a human perspective on their struggles, and from a medical standpoint, I encountered health issues such as tropical diseases and psychosocial complaints, which I had previously only studied in textbooks.’

Emily graduated on May 12, 2024, and passed her national certification exam on May 22, 2024, officially becoming a certified PA. After 2.5 years of rigorous training, she briefly enjoyed reconnecting with friends and family before accepting a position at Atlanta Colon & Rectal Surgery. In this new role, she focuses on diagnosing and treating colorectal health issues, including cancer prevention.

Reflecting on her internship in the Netherlands, Emily expressed heartfelt gratitude to everyone she met. “The experience was truly one in a million and something I will cherish forever,” she said.

Interview by Petra van Houten, physician assistant in The Netherlands. Photo’s by Emily Krause
This article was published in NAPA Magazine (nr. 25), the bi-anual magazine of the Dutch Association for Physician Assistants. For more information please visit www.NAPA.nl

This interview is also available in Dutch.