Work abroad as a physician associate: UK, Ireland, EU, US

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   1. Check that your country has a route

   Only the UK and the Netherlands register foreign-trained PAs. Ireland and Germany do not regulate the role, and the USA requires an ARC-PA accredited programme. Decide where you can realistically work before you spend money on tests or assessments.
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   2. Check your qualification against the criteria

   For the UK, read the GMC's nine acceptable overseas qualification criteria: course length, about 3,150 hours, at least 1,400 hours or 40% in-person clinical experience, and rotations in seven named areas. The most common problem is criterion 2: you must have been registered as a PA where the profession is regulated by law. The GMC fee is not refunded if you do not meet a criterion.
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   3. Ask your university for the evidence early

   The GMC needs a letter from your university confirming course length in years and clock hours, any online study, in-person clinical hours, who oversaw them and which specialties they covered, plus transcripts. The BIG register also needs certified documents and course overviews. Universities can be slow to respond.
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   4. Prove your English or Dutch

   The GMC asks for Academic IELTS 7.0 in each area and 7.5 overall, or OET Medicine at grade B in each area. The Netherlands needs Dutch through the NT2 State Examination and English reading skills. Results usually expire after two years, so time your test with the rest of the route.
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   5. Pass the assessment

   In the UK, once the GMC accepts your qualification it tells the Royal College of Physicians that you can sit the PARA: an online knowledge test and an OSCE in Liverpool. In the Netherlands the committee may interview you or require extra training. Prepare for the specific format and dates.
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   6. Verify your qualification and good standing

   The GMC requires primary source verification of your PA qualification by ECFMG, and a certificate of current professional status from any regulator you have been registered with in the last five years. The BIG register asks for proof that you have no foreign restrictions or convictions. Request these early.
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   7. Apply for registration

   Apply to the GMC within two years of passing the PARA, or to the BIG register after you receive your certificate. The GMC keeps an application open for three months, so have your references and documents ready before you start.
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   8. Find a job and sort out your visa

   Check with employers before you begin, as the GMC itself advises. In the UK, the Health and Care Worker visa needs an eligible occupation code, a licensed health or care sponsor and the right salary. Check the official immigration rules for the country before you resign.

Only the UK has a national public pay scale used for PAs. NHS Health Careers says PAs typically start on Agenda for Change Band 7, with internships at Band 6. Ireland's HSE consolidated scales list no PA grade, and we could not confirm figures for Germany or the Netherlands from an official source, so we describe how pay is set.

• UK£49,387 to £56,515 (Band 7), 2026/27NHS Agenda for Change in England from 1 April 2026. Internships at Band 6: £39,959 to £48,117.
• IrelandSet by employerThere is no physician associate grade on the HSE consolidated pay scales from 1 June 2026.
• GermanySet by employer or collective agreementWe could not confirm current figures from an official source.
• NetherlandsSet by the sector collective agreement (CAO) or employerWe could not confirm current figures from an official source. Ask the employer which CAO applies.
• USA$135,880 median annual wage (May 2025)US Bureau of Labor Statistics. Open only to graduates of ARC-PA accredited programmes.

See your NHS band and annual pay

PA careers in the UK are being reshaped by the Leng review, which the government accepted in full. Official sources confirm the direction: a renamed role, permanent faculties to set standards, and clear team structures led by a senior clinician. Specific career grades beyond that are still being worked out, so treat any promise of rapid progression with care.

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   Specialty experience

   PAs work in general practice, acute medicine, surgery and other specialties as part of a medical team. Experience in one area can lead to more responsibility within that team, always under the supervision arrangements your employer sets.
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   Education and supervision

   Experienced PAs help teach PA students on placement and in universities. Academic posts usually need a master's degree or higher.
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   Professional leadership

   The government said permanent faculties will be set up to give professional leadership and set standards for physician assistants. These will create roles in standards, education and representation.
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   Management and service roles

   Some PAs move into service improvement, clinical governance or management posts, where pay and grading depend on the employer and the job.
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   Retraining as a doctor or another profession

   Some PAs go on to study medicine or another regulated profession. This is a new qualification, not a conversion, and follows that profession's own route.

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   Paying for a GMC qualification assessment without meeting every criterion. The GMC says it is unlikely to accept your qualification if you cannot show all nine, the fee is non-refundable and you cannot appeal.

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   Missing criterion 2. Your qualification must be from a country where PAs are regulated by law and accepted for registration there, or you must have held PA registration in another country where the profession is regulated by law.

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   Not having enough in-person clinical hours, or missing one of the seven required areas, such as mental health or gynaecology.

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   Assuming a medical degree counts. The GMC assesses PA qualifications only; doctors use the medical route, including PLAB.

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   Taking the wrong English test. The GMC accepts only Academic IELTS at 7.0 in each area and 7.5 overall, or OET Medicine, not OET Nursing.

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   Letting the 18-month or two-year windows run out. Pass the second PARA part within 18 months of the first, and apply to the GMC within two years of passing the PARA.

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   Moving to Ireland or Germany expecting a licence. Neither country regulates PAs, so there is no registration to apply for and jobs depend entirely on employers.

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   Ignoring the job market. The GMC strongly recommends checking your chances of PA employment in the UK before you start, given the cost and time involved.

• Review of your qualifications, transcripts, experience and current registration

• Check against the published requirements of the regulators you choose

• Check of how recent your practice is and whether any gap in practice affects your route

• English or other language requirement for each route, with any exemption you may qualify for

• Comparison of routes and countries, with the trade-offs explained

• List of the exams, aptitude tests or adaptation periods each route is likely to involve

• Written roadmap: exams, English test, documents, fees and timeline

• Budget built from the official regulator, exam and verification fees, kept separate from our own fee

• Flags for slow steps to start first, such as primary source verification and language learning

• A call to walk you through the plan and answer your questions

What our eligibility assessment includesPackages and fees