CANADIAN PARAMEDIC REGULATORS WORKING GROUP
January 9, 2009
Meeting of Paramedic Regulators from Across Canada
December 2 and 3, 2008 in Toronto
Paramedic Regulators from every province except Quebec met in Toronto December 2 and 3, 2008, to consider how to meet the requirements of the amended provincial-territorial agreement on Labour Mobility under the Agreement on Internal Trade (AIT). Regulators have identified what it will take to bring jurisdictions into compliance with full labour mobility. The regulators developed an ambitious action plan to achieve basic compliance on an interim basis by mid 2009 and to build the necessary cross-jurisdictional mechanisms to sustain full labour mobility over the longer term.
The regulators believe that full labour mobility can best be achieved by recognizing four distinct occupational groups within Paramedicine. This approach will incorporate work that began in 1998 to define national occupational competency profiles. Significant adjustments will be required within some provinces to transition to a regulatory approach that corresponds to these groups.
Although the AIT does not mandate common provincial standards, regulators are committed to working collaboratively over time to develop more common ground and to promote the notion of "Paramedics without borders".
What is changing in Labour Mobility?
Premiers have agreed to amend the Agreement on Internal Trade, Labour Mobility Chapter, effective January 1, 2009, to establish full labour mobility for all regulated professions by April 1, 2009. Full labour mobility means that every worker certified for an occupation by a regulatory authority shall, upon application, be certified by the receiving province with no further assessment, training or experience requirements. The only exceptions will be those established by the provincial government as "legitimate objectives" based on material differences in occupational standards and/or scope of practice. A difference in certification requirements is not, by itself, sufficient to justify additional requirements.
Currently some Paramedic Regulators use licensing examinations or practical skills assessment to determine a practitioner’s competence to be licensed when s/he transfers from another jurisdiction. Other regulators assess whether a practitioner received Canadian Medical Association accredited training as a means to determine competence. Under full labour mobility these practices cannot continue except for unique provincial requirements protected by a legitimate objective approved by the province. If the practitioner is licensed in one province, s/he will be licensed by the receiving province regardless of any differences in standards.
What is the current labour mobility situation for Paramedics?
The Paramedic Regulators from across Canada came together in December, 2008 to determine how best to meet the April, 2009 deadline for full labour mobility. This is a challenging task given the complexity of regulation of Paramedics across the country. There are over 20 different titles in use in the profession with many differences in scope of practice and required occupational competencies.
In recent years the Paramedics Association of Canada (PAC) has brought together stakeholders to develop a set of National Occupational Competency Profiles (NOCP) for four levels of paramedic practice: Emergency Medical Responder (EMR), Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP) and Critical Care Paramedic (CCP). The NOCPs are currently being updated and PAC has agreed to a significant role for regulators in finalizing the competencies and the formats for their presentation and use.
Some Paramedic Regulators have begun to reference the NOCP titles in establishing registration and licensing levels but have not always adopted all the NOCP competency standards, nor does scope of practice consistently reflect those standards. As a consequence, the same title may not mean the same level of competence or scope of practice as one moves from province to province. However, with full labour mobility, practitioners with these titles would have to be licensed by any jurisdiction with the same or similar titles unless a province approved a legitimate objective differentiating a material difference in competence or scope of practice.
It was clear, however, at the December meeting that, while regulators may have local differences in the "working titles" of Paramedics, many of these classifications have already been mapped to the four NOCP levels, or a transition plan has been mapped out and is being implemented. Furthermore, regulation is undertaken either by government ministries or professional self-regulation, depending on the jurisdiction, and there are many differences in regulatory requirements and processes for licensing or registering practitioners. There has not been a functional network of all these regulators.
What will Paramedic Regulators do to achieve full labour mobility?
The Paramedic Regulators agreed to a short term approach to provide comparability across jurisdictions to enable licensing of transferring practitioners at the most appropriate level, and to a longer term approach to ensure full labour mobility on a sustainable basis.
The Paramedic Regulators agreed to establish an interim arrangement for compliance with the AIT full labour mobility provisions. Regulators agreed to identify and define the range of paramedic practice across the country into four occupational groupings based initially on the NOCPs, as a starting point. The regulators agreed that an updated occupational competency profile would be developed for each of these four occupational groups which provides an outline of the scope of practice for each level. Each regulator would then identify the occupational group for which each of its licensure levels were fully compliant. This would create a matrix or "cross walk" that could be used across the country on an interim basis to establish the license level warranted for in-coming workers.
However, given differences in scope of practice, occupational standards, assessment and licensure requirements across jurisdictions, the Paramedic Regulators recognized that the matrix was not sustainable and would be insufficient over the medium and long term to ensure full labour mobility for the occupation. A more robust transition plan will be required.
The regulators recognized that each province would need to consider how to:
- phase out levels of practice that did not conform to the four occupational groups so that all jurisdictions are working with the same four levels of professional practice; and
- bring training programs into alignment with the revised NOCPs for the four occupational groups.
The regulators also agreed to collaborate to:
- work toward a common assessment for internationally trained Paramedics;
- collaborate to develop an assessment toolkit which could be used across jurisdictions to assess competence in each of the four occupational groups;
- incorporate best practices in regulatory processes; and
- track the evolution of professional practice and identify regulatory implications.
How will this be accomplished?
In order to accomplish these objectives and support their continued viability, regulators determined that a formal mechanism needs to be established for collaboration of Paramedic Regulators which would oversee the agreed work, share best practices, develop a national process for continuous improvement of regulatory practices, and develop a process for managing the evolution of the profession to facilitate continued labour mobility over time.
This Paramedic Regulators collaborative would seek financial assistance to support the initiatives identified. An Interim Steering Committee, with three subcommittees, was established to further develop action plans and coordinate the work:
- a Funding subcommittee will develop the project proposal and seek funding;
- a Communications subcommittee will develop products and strategies to assist regulators to explain our objectives and activities to key stakeholders; and
- an AIT Compliance subcommittee will develop the matrix and determine the work needed for transition.
The Interim Steering Committee and subcommittees have scheduled meetings for the next two months. A follow up meeting of all Paramedic Regulators is tentatively planned for February 2009, to finalize interim arrangements and begin work on the longer term.
In addition, the Paramedic Regulators will seek approval for this plan through their separate governance processes.