This post is a follow up to my post What it means to be a professional paramedic (May 15, 2021):
… but this time the perspective is more from the paramedic employers in the relatively new world of Paramedic registration in Australia.
Given the defined responsibilities expected by AHPRA for the registered paramedic and the continuing growth of the private sector, what do you see as the responsibilities of the employer towards the registered paramedic and the community in terms of training, education, recertification, CPG’s and clinical governance?
I note in your response on 15 May you stated that;
“An authority to practice issued by an employer is not required by the Health Practitioner Regulation National Law. It is an employer’s risk management process and part of defining what the paramedic is employed to do. It is not a legal requirement for practice; it is a legal requirement for practice with that employer. A paramedic’s right to practice comes with their registration.”
Would you be able to expand on this further possibly and detail what you think could be the potential repercussions were an ambulance jurisdiction or private company to view their registered paramedic employees as totally independent practitioners now and responsible for their own upkeep i.e. training, procedures, education and governance while also trying to keep abreast of advancements in process and treatment modalities within paramedicine as often detailed by ILCOR, ARC, ITIM, CEC etc?
Basically I guess what I am trying to articulate is, can a paramedic employer responsibly say to their employed paramedic; “All that is all up to you now because you’re registered”…………?
I do ask people to distinguish between AHPRA and the Paramedicine and other professional boards. AHPRA is the secretariat, they assist the Boards. It is the Boards that publish codes, guidelines etc. It is the Boards that register health professionals. What is expected by registered paramedics is set by the law, the Paramedicine Board and relevant Tribunals and Panels, but not by AHPRA. With that aside, let me get to the gist of the question.
Can a paramedic employer responsibly say to their employed paramedic; “All that is all up to you now because you’re registered”…………?
Some employers could, some could not. We have to think of paramedics working beyond the jurisdictional ambulance services. Jurisdictional ambulance services could not responsibly say to their employed paramedic; “All that is all up to you now because you’re registered’ because they employ a lot of paramedics to provide services to the public. They are responsible for the conduct of the paramedics, and they have a duty to ensure that the patient’s receive good quality care. This duty is non-delegable so the ambulance service will have breached its duty to its patients if a paramedic is negligent. As Kirby J said in Ellis v Wallsend District Hospital (1989) 17 NSWLR 553
In my opinion authorities who run a hospital [or an ambulance service], be they local authorities, government boards, or any other corporation, are in law under the selfsame duty as the humblest doctor [or paramedic]; whenever they accept a patient for treatment, they must use reasonable care and skill to cure him of his ailment. The hospital authorities cannot, of course, do it by themselves: they have no ears to listen through the stethoscope, and no hands to hold the surgeon’s knife. They must do it by the staff which they employ
The ambulance service owes a duty of care to its patients, and it meets that duty by employing paramedics and others. It also then has a duty to ensure that those paramedics are providing appropriate care and that carries a duty to set standards, give training as to what they expect etc. and attempt to ensure that the care delivered is comparable regardless of which employee arrives on scene.
But for paramedics making sure their CPD is relevant to their practice is a matter for them. An employer may want to make sure that they assist paramedics to meet that commitment because they need the paramedics to complete CPD and it will help them retain the workforce. I note for example that the ACT Public Sector Medical Practitioners Enterprise Agreement 2017-2021 provides (at [104.1]) that medical specialists get an allowance of $18550 pa for medical education expenses as well as leave in order to complete ongoing medical education. The employer is not saying – getting CPD is a whole lot of your business, but neither are they taking responsibility for providing that CPD. What CPD the doctor does is a matter for the doctor. No reason a paramedic employer could not take the same approach. In fact if an employer said to paramedics – you will do this CPD – that may not be sufficient for registration purposes if the paramedic cannot say how and why the CPD was relevant – ‘I did a course or diving injuries because my employer told me to, and they told me to because it was the cheapest CPD they could find even though it has no relation to the work we do’ would probably not ‘cut it’ when seeking renewal of one’s registration.
And some employers (in particular private providers) are trying to engage paramedics as private contractors. If that is legitimate rather than sham contracting then indeed paramedics will be responsible for all of their own training, CPD and meeting whatever requirements are imposed by their local Department of Health for any drugs authority. That is where paramedics who are independent contractors need to make sure those costs are included in their charge out rate.
But not all employers are or will be ambulance services. Imagine a company that operates a large heavy industry site. They know that they need to provide first and emergency services (Work Health and Safety Act 2011 and Regulations) so they employ a paramedic to take charge of their emergency medical response arrangements. That employer won’t know anything about paramedic practice so could quite responsibly say to the paramedic employee ‘it’s up to you to manage all the things you need to do to maintain your currency and ensure that our employees get best quality care – that is what I’m paying you to do’. The employer would have to meet the costs so, perhaps like the ACT public service (above) would provide an allowance or a budget for that to happen, but it would be reasonably be a matter that the employer leaves to the paramedic.
The world of paramedic registration means that paramedics are independent practitioners. It opens a world of possibilities as paramedics make choices of where and how they want to practice. It follows that indeed some paramedic employers, or contractors, could ‘responsibly say to their employed [or contracted] paramedic; “All that is all up to you now because you’re registered”. Whether that’s reasonable or responsible will depend on the nature of the employer and the bargaining ability of paramedics (individually or collectively) to obtain working conditions that they want – that either allow them to take that responsibility or, if they prefer, to ensure the employer takes that responsibility.