A comparison was made of the role of midlevel health practitioners and how they came into being and flourished in three countries: the "feldsher" of the Soviet Union, the barefoot doctor of China, and the physician assistant of the United States. Information was gathered from books, journals, periodicals, governments, and newspapers as well as from interviews with a doctor of traditional Chinese medicine, a physician assistant, a Russian medical journalist, and several researchers. The study found that midlevel health practitioners are essential to a country's health care system when there is a shortage and/or a maldistribution of fully trained physicians, when a country is so vast that a large percentage of its population lies beyond modern medical care, and when the centralized government initiates crash programs in an effort to upgrade the public health system. In addition, the research shows that midlevel health practitioners increase in number and importance when popular unrest or upheaval challenge established systems or traditions of health care. Study of the role of midlevel health practitioners can lead to development of a model for using them to provide health care in underdeveloped countries and, in developed countries, in inner city and rural areas that lack physicians. (167 references) (Author/KC)