By Chris Farnady, AEMCA, ACP
Paramedicine as a profession has evolved by leaps and bounds in the last twenty years – from increases in the scope of practice practitioners can draw from to innovative programs such as the Vital Heart Program (Alberta), STEMI bypass, acute stoke bypass, Tactical EMS and Community Paramedicine, just to highlight a few. However, in some provinces the regulatory framework concerning Paramedics has evolved at a snail’s pace. Some have chosen the route of self-regulation while others continue their attempt at streamlining bureaucratic infrastructure without actually delving into the world of self-regulation.
As a practitioner who has been presented with the opportunity of practicing in three provinces (Ontario, Alberta and now Manitoba) with varying degrees of Paramedic legislative framework I still believe self-regulation is not only worth while but important for the patients we serve, for us as practitioners and the continued evolution of the Paramedic profession.
Why is Self-Regulation Important?
The self-regulation of professionals has been in existence for more than two hundred years, it has been used as a means of controlling the practice of some professions (Randall, 2000). The Government’s authority delegated to self-regulated professions has provided autonomy as well as the authority in determining “how many, and who, would be allowed to enter each profession” (Randall, 2000, p. 3). The ability for autonomy and control ultimately translates into “independence of individual members of a profession to carry out activities with less or no supervision” (Randall, 2000, p. 3). Perhaps one of the most convincing arguments in favour of self-regulation noted by Randall (2000) is the understanding that, as an occupational group evolves over time and comes to develop a specialized body of knowledge; members of the group become experts. Due to this knowledge being so specialized, the Government is presented with the difficult and expensive task of determining and monitoring standards of practice for the profession in question. The thought is therefore that, “members of a profession are in the best position to set standards and to evaluate whether they have been met” (Randall, 2000, p 4.).
Another important aspect is risk of harm, the basic philosophy of self-regulation. In Ontario, the Ontario Paramedic Association [OPA] provided a comprehensive explanation of the risk of harm Paramedics pose to the public while carrying out their professional activities (Ontario Paramedic Association, 2013). However, the explanation failed to specify areas of practice outside the traditional realm of working for a ‘licensed’ ambulance service. This means Paramedics working in non-traditional roles still pose a risk of harm to the public due to a lack of oversight, which could only be corrected through self-regulation. Examples of these roles include Paramedics working in the industrial setting (mines, occupational health roles, power plants), clinical research setting (Contracted Research Organizations), policing roles outside of Tactical EMS roles directly attached to licensed ambulance services, private patient transfer services and special event medical coverage companies.
While Base Hospitals in Ontario provide certification for and the authority to Paramedics in performing ‘controlled medical acts’, Base Hospitals also act as the point of contact for Online Medical Control [OLMC] (Ontario, 2015). The Base Hospital framework only concerns itself with licensed Paramedics working for a licensed ambulance service.
Additionally, the Ministry of Health and Long Term Care – Emergency Health Services Branch [MOHLTC-EHSB] only concerns itself with Paramedic practice in terms of licenced ambulance services. The framework failure of these entities has led to a lack of supervision with respect to Paramedics employed in non-traditional roles, highlighting the continued issue regarding Paramedic risk of harm under the current system. However, the advantage with the self-regulation model is found in the ability for Paramedics to explore opportunities in non-traditional roles currently reserved for self-regulated healthcare professions. While these roles currently fall outside of today’s legislative framework, unlike the provinces of Alberta and Saskatchewan. Self-regulation would offer longevity in the profession. No longer would Paramedics be constrained to finishing out their careers in supervisory or educator roles, rather they would have the ability to continue working as clinicians, providing acute care experience and leadership in these non-traditional roles, all while having the public’s interest in mind and safeguarding it through the self-regulation framework.
The Good, the Bad and the Ugly
As with any system there is good and bad, and the self-regulation model is no different. As many may recall in recent history, the Alberta College of Paramedics came under fire due to its handling of a registration renewal for one of its members who had reported a PTSD diagnosis (Warnica, 2015), despite having been cleared to return to work the College decidedly withheld the practitioner’s licence and demanded to examine his medical file (Mertz, 2015). The general sentiment of the profession in Alberta, including that of a human rights lawyer was that, the College had gone far beyond its reach to limit registration to those reporting a mental health issue by requiring members to disclose their full medical records even after having sought treatment and being given the all clear to return to work (Warnica, 2015). The outcome of this debacle ultimately led to the firing of the eight-member registration committee (Querengesse, 2016).
Additionally, there has been concern over the registration fees a College charges its membership. Currently, in Alberta, the College of Paramedics’ membership is fighting for increased transparency with regards to the proposed increase in registration fees (Roebuck, 2016). These issues can be mitigated through active practitioner participation in the College process. This is perhaps the single most important advantage in the self-regulation model versus other legislative framework models, Paramedics have the opportunity to participate in the guidance and advancement of their profession as opposed to sitting back and allowing bureaucrats to impose their will on the future of Paramedicine. Schultze (2007) exemplified this by noting “individual members […] have the responsibility to participate in the maintenance and development of the profession to keep it strong and healthy for the future. In this way, they ensure the continued viability of the profession and themselves as professional practitioners” (Schultze, 2007, p. 52).
Further mitigation with respect to registration fees can be done through collective bargaining, as is the case with Beaver EMS in Alberta. Full time Advanced Care Paramedics (EMT-P) receive $1,700, Primary Care Paramedics (EMT) receive $1,500 while part-time employees receive a prorated amount which can be used towards:
“ […] Tuition costs; course registration; manuals: ACLS, ITLS, PALS, NRP, CPR recertification
ACP [Alberta College of Paramedics] registration
Driver’s license medical
Reimbursement for additional health, dental, or optical not covered by benefit plans
Wellness expenses such as fitness centre membership or equipment
Kit allowance: boots, stethoscope, duty belt, gloves, hat, ballistic vest […]” (CUPE Alberta, 2015, p. 12-13).
The Big Picture
Despite the examples of so-called ‘bad’ and ‘ugly’, it is important to understand the four groups that benefit from self-regulation model: the public, the profession, the practitioners and Government.
First and foremost, the public benefits under the self-regulation model because public interest comes first. This is achieved through accountability for competence and professionalism through the regulator by public representation appointed to the governing board or council by way of legislation and government oversight (Paramedic Association of Manitoba).
The benefit to the profession comes in the form of recognition of professional status, which lends credibility, respect and legitimacy within public, political and health sectors. As discussed earlier in this article the profession is also graced with greater autonomy, control and is granted the privilege in determining entry requirements, setting practice standards. This allows for increased flexibility in establishing regulations alleviating government processes, which are often time-consuming; this ultimately leads to increased access to Government (Paramedic Association of Manitoba), (Randall, 2000).
Practitioners benefit in that, their peers set standards. This creates the opportunity for peer evaluation within the profession. The self-regulation model allows for increased professional opportunities for practitioners (Paramedic Association of Manitoba). Practitioners also reap the benefit of prestige from professional status, which in many cases over time, can lead to potential financial reward (Paramedic Association of Manitoba), (Randall 2000) and (Schultze, 2007).
Government benefits from the self-regulation model because it ultimately reduces their role. The Government is seen as acting in the interest of public protection. The model also increases flexibility in the establishment of regulations, since we know government processes are often time-consuming. The self-regulation model inherently insulates government somewhat from the actions of the profession and transfers the regulatory cost to profession, relieving taxpayers of the burden (Paramedic Association of Manitoba).
The attainment of self-regulated status does two important things for a profession, it “sends a message to society about the expertise and professionalism of an occupational group” and “provides members of the profession a priceless opportunity to gain control over their future and that of the entire profession” (Randall, 2000, p. 6). In the absence of self-regulation, we as Paramedics can anticipate to be consigned to “the status of second class citizens in a world which has come to highly value professionals” (Randall, 2000, p.6). Decidedly, making the move towards self-regulation is a step with which the profession has to make after thoughtful deliberation, keeping in mind that “ultimately, self-regulation has tremendous benefits – but with those benefits come costs and responsibilities (Randall, 2000, p. 6).
About The Author
Chris Farnady is a practicing Advanced Care Paramedic in Manitoba, employed with FAST Air Medevac Services. Prior to completing his ACP education, Chris was a practicing Primary Care Paramedic graduate of Loyalist College’s (Bancroft, Ontario) PCP program His clinical practice experience includes the County of Simcoe Paramedic Service, Flightexec Air Ambulance (Ornge SA carrier), the Region of Peel Paramedic Service, The City of Edmonton (transitioned to Alberta Health Services in 2009) and Air Bravo Corp. (Ornge SA carrier). Chris is a member in good standing with the Alberta College of Paramedics and holds an ACP license in Ontario and Manitoba. Chris is nearing the completion a Bachelor of Health Sciences from Thompson Rivers University, and a Bachelor of Technology in Technology Management from the Northern Alberta Institute of Technology. When not at work, Chris enjoys spending time at home with his wife and daughter on the shores of Lake Huron. He can be reached for comment at email@example.com
CUPE Alberta. (2015). Collective Agreement between The Canadian Union of Public Employees Local 5133 -and- Beaver EMS . In By Local. Retrieved from http://alberta.cupe.ca/files/2014/06/L5133beaverambulance2017.pdf
Mertz, E. (2015, May 14). Alberta College of Paramedics defends return-to-work process. In Global News. Retrieved from http://globalnews.ca/news/1998750/alberta-college-of-paramedics-defends-return-to-work-process
Ontario Government. (2015, July 1). Ambulance Act, R.S.O. 1990, c. A.19. In Ontario. Retrieved from https://www.ontario.ca/laws/statute/90a19#BK16
Ontario Paramedic Association. (2003, March). Regulation of Paramedics under the regulated health professions act, 1991. In Application for Self-Regulation. Retrieved September 5, 2016, from http://hprac.org/en/projects/resources/OPAapplicationforparamedic-self-regulation13March2013.pdf
Paramedic Association of Manitoba. (n.d.). Understanding Professional Self-Regulation. Retrieved from http://www.esmmb.ca/pam/storage/Self-Regulation/Tab_17.PDF
Querengesse, T. (2016, January 14). Embattled Alberta paramedic college fires registration committee. In Edmonton Metro. Retrieved from http://www.metronews.ca/news/edmonton/2016/01/15/embattled-paramedic-college-fires-registration-committee.html
Randall, G. E. (2000). Understanding Professional Self-Regulation. Retrieved September 5, 2016, from http://pam.in1touch.org/uploaded/web/pdf/Understanding%20Professional%20Self-Regulation.pdf
Roebuck, C. (2016, September 14). Alberta paramedics demand answers after fee hike. In CTV News Calgary. Retrieved from http:// calgary.ctvnews.ca/alberta-paramedics-demand-answers-after-fee-hike-1.3066425
Schultze, R. (2007, July). What Does It Mean To Be a Self-governing Regulated Profession? Journal of Property Tax Assessment & Administration, 4(3), 41-53. Retrieved from http://www.collegeofparamedics.sk.ca/docs/about-us/IPTI-article-on-regulated-professions.pdf
Warnica, M. (2015, April 14). Regulator’s PTSD suspension is ‘unlawful,’ says human rights lawyer. In CBC News Edmonton. Retrieved from http://www.cbc.ca/news/canada/edmonton/regulator-s-ptsd-suspension- is-unlawful-says-human-rights-lawyer-1.3044054