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Legislation of competencies and opportunities for specialization of feldshers and physician assistants in primary health care

Penka Vracheva


INTRODUCTION: The changing health needs of the population in terms of deficit and uneven distribution of medical staff, the increase in the cost of medical services and limited financial resources define the legislation for professional realization of feldshers and physician assistants as topical issue.

AIM: The aim of this paper is to explore:

• the legal regulation of the professional activities and competencies of feldshers and the possibilities for specialization with a focus on primary health care (PHC);

• the training of physician assistants for a career in PHC.

MATERIALS AND METHODS: Analysis of legal documents with regard to the professional realization and specialization of practicing feldschers and training of physician assistants was performed.

RESULTS AND DISCUSSION: The health care field professions Feldsher and Physician Assistant have different names but are characterized by similarity. The professionals are trained following a medical model, which differs from that for doctors by its accelerated pace and shorter time to acquire professional competencies and develop practical skills during the training. The competence of the professionals involves carrying out activities for overall care of patients by diagnosis, treatment and prevention. The certain degree of autonomy in their professional activities determines that feldshers and physician assistants are capable of supporting medical practices in PHC, mainly in small and remote locations. The analysis of the active regulatory documents determines the legislative regulation of: competencies and the opportunity for specialization in PHC for the practicing feldshers; training of physician assistants for a career in PHC. The conclusions of the study outline prospects for employment of feldschers and physician assistants in PHC.


feldshers, physician assistants, PHC, competencies, professional activities

Full Text


Health Act (SG Issue 70 / 10.08.2004, last amend. and suppl. SG Issue 27 / 05.04.2016) (in Bulgarian)

Higher Education Act (SG Issue 112 / 27.12.1995, last amend. Issue 43 / 299.04.2008, the last suppl., Issue 42 / 05.06.2009) (in Bulgarian)

Professional Standards for the specialty “Feldscher”

Regulation 1 / 08.02.2011 on professional activities that nurses, midwives, associated medical specialists and healthcare assistants are able to perform under supervision or by themselves (SG /18.02.2011 Issue 15, and suppl. in SN №50/2011) (in Bulgarian)

Regulation 1 / 22.02.2015 on acquiring specialty in the healthcare system. SG. 2015; 7. (in Bulgarian)

Regulation of the Unified State Requirements for acquiring higher education in the specialties in vocational direction „Health Care“ (SG Issue 95 / 29.11.2005, title amend. and suppl. – SG Issue 32 of 2016) (in Bulgarian)

Regulation № 21 / 30.09.2004 for implementation of the system of accumulation and transfer of credits in higher education institutions. SG. 2004; 89.

Curriculum of the Physician Assistant program, Bachelor’s degree



About The Author

Penka Vracheva
Trakia University

Department of Health Care, Medical Faculty

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