Background: Many countries are seeking ways to improve the delivery of health care services, especially in undeserved areas.Some countries have developed Family Medicine programs that stress the primary care, while others continue to train specialist physicians who prefer to practice in the urban areas.Because of the lack of physicians available to practice outside larger cities, medical care in smaller towns and villages is often inadequate.Internationally, there is an evolving interest in the development of physician assistant type programs by many other countries with identified medical workforce shortages.