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Unique Experience for PAs Combines Leadership, Patient Care

If you’re a Board Certified PA who thrives in unpredictable environments, joining the U.S. Department of State Bureau of Medical Services (MED) – the health care branch of the foreign service – offers the opportunity for you to showcase your exceptional skills.

“This is a job that you will never find boring,” said Shane Pierce, MS, PA-C, MED’s Medical Specialists Staff Office Director.

From performing routine check-ups for U.S. government officials and their families posted at embassies and consulates worldwide to managing life-threatening emergencies in resource-constrained settings, Pierce finds purpose tackling tough tasks.

“I still love my job because it changes constantly,” Pierce said. “Whether it’s evacuating a post or preparing for hurricanes that are coming in, we do a little bit of everything.”

Pierce said PAs with MED are also liaisons who work with local hospitals and clinics to handle big emergencies.

“You really need to know who your local contacts are,” Pierce said. “You actually become a diplomat.”

Approaching his 20th year with MED, Pierce grew up on the West Coast and was working in an emergency practice setting in rural Nebraska when he stumbled upon a State Department ad seeking PAs and FNPs. His decision to apply led to a relocation to Conakry, Guinea, marking the beginning of a diverse career to include serving in overseas postings ranging from Cambodia, Zimbabwe, England and Ethiopia.

MED boasts a team of over 200 clinicians in over 170 countries, supported by medical and administrative personnel in D.C. and abroad.

For MED’s Medical Provider Program Manager Lindy Nester, MS, PA-C, not only is patient care a priority, but the position includes leadership responsibilities.

PAs in MED manage locally employed staff, serve as medical leaders at post, advise Ambassadors and senior leaders, and address health issues pertinent to the host country. Nester emphasizes that each tour offers a unique experience, with duties varying from one location to another.

“The pandemic was a great example of this,” Nester said. “It was really our foreign service medical specialists who kept our overseas missions up and running. Testing, taking care of patients with COVID-19, setting guidelines and expectations for maintaining safe and healthy work practices. These were all things that we did.”

During Nester’s first tour with MED in Kinshasa, the capital of the Democratic Republic of the Congo, she encountered a patient with malaria – for the first time – as well as learned to manage an Ebola outbreak in the region.

“We do a lot of emergency preparedness at our overseas post,” Nester said, “and then a lot of professional development. Education and training is a big part of working for the Department and in the foreign service.”

Highlighting her growth, Nester added a special privilege: meeting Nobel Peace Prize winner Dr. Denis Mukwege, a Congolese gynecologist and human rights activist dedicated to treating wartime sexual violence.


PAs who are interested in this unique career path are encouraged to seek experiences across all age groups – from pediatric to geriatric patients, as well as providing OB-GYN care to pregnant patients. Having a background in practicing with autonomy and a broad range of primary and emergency skills is essential.

Working for the State Department offers numerous benefits such as health and medical coverage, federal retirement benefits, and paid leave. Overseas benefits include tax-free housing, tax-free education allowance for dependent children between K-12 overseas, and an unrivaled opportunity to see the world and experience different cultures. The Department also facilitates international moves, ensuring a smooth transition for PAs and their families.

MED has multiple vacancy announcements each year and aspiring PAs can expect to face a rigorous selection process involving the Foreign Service Specialist Assessment interview to ensure they demonstrate the “dimensions” that are essential to Foreign Service work.

Interested PAs must be US citizens, at least 20 years of age, appointed prior to age 60 (preference eligible veterans excepted), and able to obtain a top secret security clearance, which can take several months.

More information is available at, or by emailing [email protected].



Listen to Pierce and Nester discuss their experiences on the next episode of PA Insights with NCCPASubscribe to our podcast and you’ll be notified when it’s released!