The development of physician assistants (PAs) in the Republic of Bulgaria began in 2014 with the inauguration of the first class at Trakia University, Stara Zagora, and at Faculty of Public Health, Sofia. Modeled after North American and European education systems, the preparation of PAs complies with state requirements for higher medical education from the Bulgarian Ministry of Health. As of 2020, the PA training program is in the state's register of regulated professions. Three programs, in Ruse, Burgas, and Plovdiv, will start in the early 2020s, building on the success of the initial programs in Sofia and Stara Zagora. In the Bulgarian PA education system, a bachelor's degree includes 8 semesters and nearly 5000 combined classroom and clinical hours (254 credits). Accreditation is through the state system, and graduation is achieved by passing 3 national examinations, after which the PA is awarded a diploma. The quality of PA education is guaranteed by the Ordinance of Unified State Requirements for the acquisition of higher education with a bachelor's degree in the PA specialty. As of 2020, 2 PA cohorts have graduated and serve in ambulatory medical roles throughout the state. Newer roles in curative (hospital) centers are being explored. This new medical workforce is designed to contribute to the national health system as a cost-effective medical resource that replaces an older feldsher system.
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