Paramedic registration in New Zealand has been on the sector 'to do' list for some time now. While it now lookes inevitable within the next few years and many in the industry are hailing it as an empowering thing, I cant help but reflect on the negatives that also come with it.
Government Registration essentially means we have to 'pay' to do what we currently do now and will now have total personal liability for doing it. For some this will be a huge shock and for a minority even possibly the end of their career.
Practising pre-hospital medicine, like other areas of medicine, has always inluded that very component - practice! That means that like doctors, sometimes we get it wrong, even with serious consequences (ie death). I personally believe the current scheme of working under an approved protocol and esentially practising under the license of a Medical Director(s) has provided a more positive learning environment without the pressures of being subject to an external industry body watchdog.
Health practitioners are currently subject to the Health & Disability Commissioner Code of Rights in New Zealand ensuring quality of healthcare in the sector. This includes paramedics and there have been some investigated by this body for mis-demeanors. Registration will now make us also subject to the Helath Practitioners Disciplinary Commissioner as well and therefore subject to censure and fines for our mistakes.
Approximately eighty percent of the paramedic workforce are voluntary and we are relient on some of these volunteers in very remote areas. With the introduction of additional personal responsibility and cost of registration this may disuade vounteers from providing their services, or at least have the effect of a barrier to gaining higher qualifications (the proposal is for registration only for paramedic level and above).
Paramedics may have to obtain indemnity insurance to cover themselves in the event of censure/fine. While ACC prevents personal lawsuits, a fine or censure by the HPDC could mean the end of a career / earning potential and credibility as a practitioner since names are usually published.
Proof of competence and practice will be part and parcel of the registration process, but what happens if this prevents a significant number from gaining registration or causes them to become de-registered? Competence and de-skilling has always been a challenge, particularly for remote and rural areas and while this is being addressed more now than ever before it is unlikely that it will be solved by the time registration appears.
We do have the advantage of learning lessons from the UK registration process and a good comparisons of some of the pro's and cons can be found here
Some in the industry believe it will provide more freedom for individuals to practice without relying on the current ambulance provider in New Zealand which currently has the monopoly. Unfortunately, proof of practice and CME may dictate that individuals show current practice which may dictate even more relience on the monoploy to stay registered. The provider also has their own Authority to Practice (ATP) system and they have made it clear that registration does not automatically entitle ATP so there will still be two hoops to jump through.
A recent published study into paramedic attitudes towards professionalism (including registration) showed many in favour of registration as many of the pro's are blatantly highlighted (see here) but I wonder how many think about the down sides, particularly increased accountability?
New Zealand has already made the move to require future registered paramedics to have a tertiary education (BHSc) and I think this has been a good move overall but education does not guarentee competence.
Still, with the current split qualification system and the aim of only registering paramedic and above we will end up with a two tiered system of ambulance officers - registered vs non registered - on par with RN vs EN's but both groups will be doing the same job at least from the publics perspective (ie ambulance arrives, AO jumps out and treats the patient who typically has no idea nor cares if they are registred or not).
While registration may improve the professional status of paramedics, particularly amongst healthcare colleagues, I welcome it with caution and a little trepidation and I am glad the process is taking its time.