Today’s correspondent refers me to an ad for employment as a ‘Paramedical Aide’. My correspondent says:

I thought you might find this advertisement useful in a blog if you are looking to discuss yet another controversial title discussion. The latest I have seen is “Paramedical Aide”, obviously very dangerously close to leading you to believe a person employed under that title has some type of paramedical qualification. However, AHPRA disagrees with me.

Apparently I can call myself “Doctor-Aide” or “Medical Practitioner-Aide” “Pharmacist-Aide” or “Paramedical Aide” and these are not misleading or regulated titles and the Board’s are powerless to act. 

My correspondent did make a complaint to the Australian Health Practitioner Regulation Agency (AHPRA). They said:

Thank you for raising concerns with us regarding the use of protected titles in advertising.

The Council of Australian Governments (COAG) decided in 2008 to establish a single National Registration and Accreditation Scheme (National Scheme) for registered health practitioners.

In December 2018, paramedicine became the newest profession to join the National Scheme, making the title ‘paramedic’ protected nationally.

The use of the term “Paramedical Aide” is not considered to be using a protected title and as such no further regulatory action will be taken.

The ad came from South Australia, so I’ll quote the Health Practitioner Regulation National Law (SA).

Health Practitioner Regulation National Law (SA) s 113

Section 113 says:

A person must not knowingly or recklessly—

(a) take or use a title in the Table to this section, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the health profession listed beside the title in the Table, unless the person is registered in the profession; or

(b) take or use a prescribed title for a health profession, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the profession, unless the person is registered in the profession.

The table lists the relevant protected titles; for example ’medical practitioner’, ‘midwife’, ‘midwife practitioner’; ‘nurse’, ‘registered nurse’, ‘nurse practitioner’, ‘enrolled nurse’, ‘paramedic’, ‘pharmacist’ and ‘pharmaceutical chemist’.  Clearly ‘Doctor-Aide’, ‘Medical Practitioner-Aide’, ‘Pharmacist-Aide’ or ‘Paramedical Aide’ as well as ‘Assistant in Nursing’ and ‘Physician assistant’ are not protected titles.  If they are not protected titles, there is no breach of s 113 .

To make that clear with an example. If I was to add to the list of ‘My Qualifications ‘Bachelor of Paramedicine’ I would be lying, but I would not be in breach of s 113. Depending on my intention I may be guilty of some other offences, but it would not be a breach of s 113. If, on the other hand, I described myself as ‘Michael Eburn, Australian Lawyer and Paramedic’ that would be a breach of s 113. Section 113 prohibits the use of protected titles, not conduct that causes a person to believe that another person ‘has some type of paramedical qualification’. And AHPRA cannot extend the list of protected titles. The titles that are protected are listed in the Act. Titles that are not listed in the Act, for example ‘Doctor’ (see Can a person other than a doctor use the title ‘Medical Officer’? (November 25, 2017) and Is ‘Doctor’ a protected title? (February 14, 2018)) and ‘Paramedical Aide’ are not protected titles.

Health Practitioner Regulation National Law (SA) s 116

Section 116 says

A person who is not a registered health practitioner must not knowingly or recklessly—

(a) …

(b) take or use a title, name, initial, symbol, word or description that, having regard to the circumstances in which it is taken or used, indicates or could be reasonably understood to indicate—

(i) the person is a health practitioner; or

(ii) the person is authorised or qualified to practise in a health profession; or

(c) claim to be registered under this Law or hold himself or herself out as being registered under this Law; or

(d) claim to be qualified to practise as a health practitioner.

This would be relevant if the title eg ‘paramedic aide’, although not a listed protected title, implied that the person was a registered health professional (r 116(b)(i)). But calling oneself a ‘paramedic aide’ is surely not suggesting that the person is a registered paramedic?  Even if the title suggests someone has a ‘type of paramedical qualification’ that is not the same as suggesting they are registered. Again I can give an example. If I were to claim that I had a Bachelor of Paramedicine degree (which I do not) that would not be a claim that I am a health practitioner anymore than the claim that I have a Bachelor of Laws (which I do) means I claim to be a legal practitioner (see ‘Today, I am a lawyer, but not a barrister or solicitor’).

Further, if the title ‘Paramedical aide’ implies someone ‘has some type of paramedical qualification’ that does not imply that they are ‘qualified to practise in a health profession’. A person may have, or claim to have, a Diploma in Paralegal Studies – a type of legal qualification – but that is not the same as claiming they are qualified to practice as a lawyer. Equally a person who holds, or claims to hold, a Bachelor of Health Science (Physician Assistant) – a type of medical qualification – is not claiming to be qualified to practice as a physician (medical practitioner). Even if the term ‘paramedical aide’ does imply ‘some type of paramedical qualification’ it is not the same as implying a qualification to practice as a paramedic.

If the person is providing health care, as a paramedical aide presumably is, then there may be a suggestion that, in context and taking into account the way they work and they way they are ‘held out’ to potential patients that the use of the term ‘paramedical aide’ ‘could be reasonably understood to indicate’ that they are ‘health practitioner’ (paramedic) or ‘qualified to practise in a health profession’ (paramedicine), but personally, I cannot see it. It seems to me that the title ‘paramedic aide’ in no way suggests that the person is a registered paramedic. Describing oneself as an ‘aide’ to a professional surely implies you are there to assist or aid the registered health professional, not that you are, or are qualified to be, a registered health professional. The ultimate conclusion to what might be ‘reasonably understood’, however, depends on all the facts and the conduct of the people involved, but prima facie, I cannot see any offence in creating a position called ‘paramedical aide’ any more than in creating a job entitled ‘assistant in nursing’.

Conclusion

Use of the title ‘paramedical aide’ is clearly not a breach of the Health Practitioner Regulation National Law (SA) r 113.  It could be a breach of r 116 if in all the circumstances the use of the title implied that the person was a registered paramedic or qualified to be registered as paramedic.  Whilst that would depend on context – when and how the title is used – I cannot see how creating a job with the title ‘paramedical aid’ (or for that matter Doctor-Aide, Medical Practitioner-Aide, Physician assistant, Pharmacist-Aide or Assistant-in-Nursing) would imply that the person was registered, or qualified to be registered, as a medical practitioner, pharmacist or nurse, respectively. The various titles imply that the person is there to aid a health practitioner, not that they are a health practitioner.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.