Frequently Asked Questions
The following FAQs are intended to answer many questions about professionalization, self-regulation and the future of our vocation.
Are all paramedic programs in Ontario required to become accredited by the Canadian Medical Association?
No. Only the Advanced Care Paramedic programs require accreditation. This lack of consistency is a significant shortcoming in Ontario's system.
Once a paramedic graduates from college are they required to renew their A-EMCA at any time?
No. Once someone graduates from a Primary Care Paramedic program and gets their Advanced Emergency Medical Assistant certificate from the Ministry of Health and Long Term Care (MOHLTC), there is no requirement to renew - ever. If they gain employment with an event medical or transfer company, they may be able to perform controlled acts under a freelance physician but there is no requirement for continuing medical education or testing at any time in their career. This poses a significant risk to the public and is a great disservice to those graduates who want very much to be held to the same standard as paramedics working for paramedic services.
Can Ontario paramedics work in other provinces?
Yes and no. Paramedic graduates are eligible to work in any other province upon graduation. However, paramedic graduates who do not work for an ambulance service, even though they may be providing patient care through another agency, lose their eligibility to work for an out-of-province ambulance service beyond a year post graduation in many cases. This occurs because, despite the Agreement on Internal Trade, if a paramedic is not “certified" under a Base Hospital within a year, they are no longer considered current. Under a College of Paramedics, all graduates, regardless of whom they work for, would be able to maintain their registration.
What does a regulatory college do?
Despite the name, regulatory Colleges are not teaching institutions. Instead, under statutory authority, they provide oversight of the profession(s) belonging to the College, which includes determining the scope of practice, initial education and continuing competency requirements for membership, conducting quality assurance, investigation of complaints and discipline of it's members when necessary.
There are currently over twenty regulatory colleges in Ontario.
How are paramedics in Ontario currently regulated?
Currently, most paramedics work for one or more of the 51 municipal paramedic services regulated under the
Ambulance Act (1990) and Regulations. Ontario has two regulatory bodies: The Emergency Health Services Branch (EHSB) of the Ministry of Health and Long Term Care (MOHLTC) and eight Base Hospital Programs (which are funded by and accountable to the MOHLTC). Despite the fact that Ontario has two regulatory bodies, not all paramedics are regulated.
Would the establishment of a college make paramedicine a profession?
Yes. Paramedicine already has many of the characteristics of a profession. However, in Ontario it currently lacks two key components, namely, a self-governing regulatory body and the protection of the title of “paramedic". A College of Paramedics will protect the title by preventing unregulated, unqualified or unlicensed individuals from adopting the title. It will also enhance paramedics' interprofessional collaboration with allied health professions.
Will a College of Paramedics add another layer of bureaucracy to a system that is already too complicated?
No. Other self-regulated health professions have one regulatory body. A College of Paramedics would be responsible for all regulatory functions that are currently carried out by the base hospitals, medical advisory committees and Ontario Ministry of Health Emergency Health Services Branch. The college would reduce the current bureaucracy, be inclusive of all paramedics and facilitate interprofessional collaboration, thereby leading to better health outcomes for Ontarians.
Could a regulatory college stop me from working as a paramedic?
Only in very narrow circumstances. First, if membership and registration has lapsed, a re-registration process is generally required. Second, in cases of the most serious professional misconduct, a regulatory College may issue a suspension or even a revocation of the individual's registration to practice. Typically, however, such drastic measures are only applied in a very small percentage of cases, and are only taken after an investigation and disciplinary hearings that allow the practitioner to give evidence on his or her behalf and to demonstrate accountability.
Currently, paramedics are subject to certification by a Base Hospital Medical Director. Under this model, a Medical Director extends his/her medical licence to allow paramedics to perform controlled acts, and can also suspend or revoke a paramedic's certification, thus preventing the paramedic from continuing to work. No single individual should have that level of authority, nor should they want that level of responsibility and accountability. Under a College of paramedics, paramedics are evaluated by their peers, people who understand the uniqueness of out-of-hospital care.
Will self-regulation involve costs for paramedics?
Yes. There are two types of costs involved in self-regulation. First, an annual membership fee is required to sustain the regulatory College. Second, self-regulation under the RHPA requires that individual practitioners have professional liability protection (malpractice insurance). Current annual fees for the regulatory Colleges vary greatly. Here are some sample fees: Alberta College of Paramedic: $525/year; Saskatchewan College of Paramedics: $450/year; Paramedics Association of New Brunswick: $400/year.
Would self-regulation increase paramedic pay?
No. Self-regulation would not have a direct impact on paramedic pay. However, self-regulation will give paramedics the opportunity to explore other avenues of employment outside of licensed ambulance services while maintaining their professional credentials. It will also enhance inter-provincial mobility by allowing all paramedics to become registered and maintain clinical competencies through the college and its quality assurance programs.
Isn't paramedic self-regulation just a way for existing paramedics to protect their interests by making it difficult to enter the profession?
Very little would change for paramedics under a college. Paramedic self-regulation would set and maintain standards, not unlike what exists currently, but would also make it easier for people to maintain their registration, whether working, for example, on an ambulance, in a hospital or as a paramedic educator, by establishing uniform requirements for entry to practice and maintenance of registration. Under the RHPA (Regulated Health Professions Act), each regulatory college is statutorily accountable for acting in the public interest, which includes ensuring that professional requirements are regulated to support that objective.
Are paramedics in other provinces self-regulated?
Currently, paramedics in Alberta, Saskatchewan, Manitoba, Nova Scotia and New Brunswick are self-regulated. Alberta was first regulated under a “ physician delegation" model but transitioned to self-regulation. A number of other provinces are also currently pursuing self-regulation.
What other changes would happen as a result of paramedic self-regulation?
One significant change would be “title protection". The title “paramedic" would be reserved for professionals regulated by the College of Paramedics and who are able to work in all contexts of health care - not just in municipal paramedic services. Currently, the title is not protected outside of the Ambulance Act Section 20.0.1 “Holding Out”. As such, paramedics cannot legally use the title “paramedic” when working in other contexts of health care and must only use it when working under the Ambulance Act. There is no other health care profession in Ontario that restricts medical titles to specific workplaces.
How will self-regulation affect my union membership?
Establishment of a regulatory College of Paramedics will have no impact on the role of unions that represent paramedics in Ontario. Unions represent the rights and interests of employees and negotiate that relationship with employers. The relationship between the paramedic and the College of Paramedics would be virtually no different, from a regulatory standpoint, than the current relationship between the paramedic and the two existing regulatory bodies (EHSB and Base Hospital).
What is the difference between a regulatory college and a professional association?
A regulatory college for a health profession in Ontario is statutorily charged with protecting the public interest by setting educational requirements, competency profiles and standards of practice, developing and enforcing a Code of Ethics, ensuring professional competency through quality assurance, promoting inter-professional collaboration, maintaining a public register of members, conducting public outreach, and responding to public complaints. Each regulatory College has a Council that includes members of the public as well as members of the profession, to ensure that its direction of regulation follows the governing legislation in a transparent and accountable way to protect the public interest. Membership would be required for all professional practitioners.
In contrast, a professional association, such as the Ontario Paramedic Association, is an organization that exists to advocate on behalf of members and to promote the profession, through research and policy engagement. For health professionals, this includes the aim of improving the health-care system and educating the public, the media and politicians about who we are and what we do. Membership to a professional association is currently voluntary in Ontario.
Under the present structure, who is responsible for certifying, registering or licensing paramedics in Ontario?
Although these terms are sometimes used interchangeably, “certification", “registration" and “licensing" have different meanings in regard to regulation. “Registration" refers to the
identification of those who are qualified to practice in a specific profession, pay their college fees and remain in good standing. “Certification" is a judgement of an individual's competency. “Licensing" is not a term used in Ontario with regard to professional practice.
Will physicians continue to be involved in the profession if paramedics become self-regulated?
Yes. In other provinces where paramedic self-regulation exists, the College of Paramedics works collaboratively with physicians and other healthcare providers to develop clinical practice guidelines (similar to our existing medical directives) and to strengthen the link in the chain of survival. Self-regulated paramedics in other provinces have the ability to contact a physician from the field for a consultation, and in some cases, to request an order for select interventions.
If paramedic self-regulation is approved, when would a College of Paramedics come into existence?
For any group of health providers, the transition to self-regulation and professional status is a lengthy and detailed process. If paramedic self-regulation is approved, the next step would be the establish a Transitional Council to oversee the process required to create a College of Paramedics, which would include the creation of a Paramedic Act and all of the College activities described in a previous FAQ.