1. Paramedic Self-Regulation The New Brunswick Experience May 15, 2013 OBHG Annual Conference

2. “Self-regulation will always be a challenge, but if somebody's going to be in charge, it might as well be me.” Daniel Akst, We Have Met the Enemy: Self-Control in an Age of Excess, 2011

3. Scientific Survey How many people support health professionals like paramedics achieving Self-Regulation? Why? How many people do not support health professionals like paramedics achieving Self-Regulation? Why?

4. Impetus for Change Prior to Paramedic Act regulation through DOH Act prevented Minister from acting against incompetence/ethical issues Processes Audit/CE/Entry to Practice were flawed DOH was not interested in Regulating 1998-2000 saw complete demographic switch in practitioners ie. Volunteer to Career Move from post to pre employment education Before 2007 fragmented EMS system then consolidation into Ambulance New Brunswick

5. “You will find that the State is the kind of organization which, though it does big things badly, does small things badly, too.” John Kenneth Galbraith US (Canadian-born) administrator & economist (1908 - 2006)

6. NB Model Self Regulating Body for Paramedic Profession Mandate under Paramedic Act (Private Members Bill) Royal Assent June 26, 2006 Proclamation in 2008 No Regulations – covered by Bylaws and Rules Up to 15 Directors (13 Current) – 2 Public Appointees (Minster of Health)

7. Role of PANB Protect Public Interest –Entry to Practice Requirements –Code of Ethics –Standards of Care –Ensuring Ongoing Competence –Discipline and FTP Advocate for Profession –PCP, ACP, CCP –Current Practice Trends –Non-Traditional Roles for Profession –Membership Services – Liability Insurance

8. Regulator or Association or Both? Regulatory Body Competency Profile Standards of Practice Code of Ethics Practice Guidelines Association Liability Insurance Continuing Education Advocacy Member Services

9. Demographics 1072 Practitioners 67% Male 33% Female 3% Advanced Care 97% Primary Care Mean Age 37.2 Years

10. What! No Health Disciplines Legislation A major impetus for most Provinces - increased sexual misconduct by Health Professionals Decrease in public confidence in Regulatory Bodies Advocacy and Regulation seen as competing interests Most Gov’t used Health Disciplines Legislation NB Gov't introduced strict guidelines for private legislation and mandatory reporting of sexual abuse of patients

11. Role of Physicians and Paramedic Regulation Paramedics are Independent Practitioners Scope of Practice in Bylaws Hold Scope of Practice 24/7/365 Mandated to carry Professional Liability Insurance Physicians have consultative role similar to other Health Disciplines Still role for Medical oversight through operations but may not be physicians

12. Entry to Practice Responsible to set Scope of Practice (2011 NOCP) Approval of Educational Programs Responsible to set pre-requisites (CPR, ACLS, Good Character, No Crimes of Moral Turpitude) Responsible to design/administer/deliver Entry to Practice Examinations Legally Defensible Psychometrically valid Written examination only Working on practical component

13. Continuing Competence Multi Pronged Approach – No Silver Bullet Clinical Activity - Minimum hours of practice and Pt. contacts Self Reflection /Educational Planning to support weaknesses Mandatory and non-mandatory CME’s Can’t have gotten caught in C&C Process

14. Complaints, Discipline, &FTP Can be considered one of the most important parts of self- regulation Helps ensure public trust is maintained Quasi-judicial processes Costly Follows rules of “Natural Justice” 3 separate committees, Complaints, Discipline, FTP Consists of practitioners and lay people on all three Probability of guilt different for Complaints vs Discipline/FTP

15. How much does all this cost? Initial development work to become self-regulating ~$400K Ongoing costs of operation for 2013 ~$500K Costs for C&C budgeted for 2013 ~$70K Professional Liability Insurance $50 PCP, $200 ACP Membership fees 2013 $395 PCP, $545ACP

16. Potential Pitfalls Hire the right person to lead Conduct and Competency Costs Employers using C&C for HR work Communications, Communications, Communications Get the Right People involved Educate the Governance Structure repeatedly Budget for almost worst case scenario

17. “He who rejects change is the architect of decay. The only human institution which rejects progress is the cemetery.” Harold Wilson, Speech to the Consultive Assembly of the Council of Europe, Strasbourg, France, January 23, 1967 (1916 - 1995)

18. Questions??

19. Thanks! chris.hood@panb.ca www.panb.ca