Self-regulation of paramedics a step closer to reality, but firefighters' union douses move

Manitoba paramedicine professionals may be one step closer to forming a self-regulated college after a series of recommendations were released Wednesday, but the union representing firefighters is pouring cold water on the move.

"One of the things that is really unfortunate is that in this time of austerity measures that the province has brought forward, we have always said that it doesn't make sense to create another level of bureaucracy," said Alex Forrest, president of the United Fire Fighters of Winnipeg. 

Last fall, Health Minister Kelvin Goertzen requested former assistant deputy minister Reg Toews consult with 15 Manitoba fire and paramedic associations and provide three options for how to form a self-governing professional college for pre-hospital practitioners.

In the report, Toews writes that the first and most expansive of those options — and the one he suggests is most viable — will require the province to ensure the job of paramedics is defined broadly to reflect the realities of the profession, and that representatives from rural health authorities, along with firefighter-paramedics, be appointed to a college council.

Past recommendations unpopular

Toews cites concerns with previous recommendations from the Health Professions Advisory Council that turned out to be very unpopular with stakeholders.

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HPAC wanted to limit the scope of paramedic responsibilities to just pre-hospital emergency treatment and patient transport.

"Such a limited scope of practice would not cover what paramedics are already doing and would limit the future development of the profession," he writes in the review.

Toews also found pushback to another advisory council recommendation that would restrict paramedics from making certain decisions without oversight and approval from a physician.

"Again, the [HPAC] recommendation that paramedics not be granted authority to perform reserved acts but rather that they continue to work under the supervision of a physician who approves all transfer of functions was seen by a number of stakeholders as too limiting and not consistent with the intent and purpose of a regulatory college," Toews writes.

Toews described a general feeling among firefighters trained in paramedicine that they're not viewed as equals by conventional paramedics, as well as concerns among rural paramedics that their priorities could be eclipsed by those of workers in Winnipeg.

In both cases, Toews said a self-governing college could address the issues by reserving council positions for a cross-trained firefighter representative and members from all five regional health authorities.

"The one issue that may not be fully resolved and may still attract negative comments on self-regulation is the matter of startup costs, membership fees and possibly professional liability insurance," Toews concludes. "More fulsome support could be anticipated if some financial relief was available for these costs."

Praise from paramedics' association

The Paramedic Association of Manitoba (PAM) and the Manitoba Government General Employees' Union (MGEU) have been asking the province to make paramedic medicine a self-regulated profession for several years.

"This will ensure that the paramedics who arrive in a medical emergency have the skills and experience to save your life," MGEU president Michelle Gawronsky said.

Cameron Ritzer, chairperson of PAM, said he was pleased with how thorough Toews was and said he's encouraged by where things are heading.

"We're feeling optimistic that the path forward has now been defined and that we can start working on the actual concept of a college," said Ritzer.

We don't agree with the decision but we thank the government for allowing us to put our concerns forward.- Alex Forrest, United Fire Fighters of Winnipeg president

Ritzer lauded the recommendation that the scope of paramedicine work be broad to reflect the realities of the job 

"Paramedics' roles are evolving every day throughout Manitoba and Canada, and to have that flexibility and broadness within our scope and function statement really allows us to flourish as a profession and genuinely provide better care," he said.

The association, which represents 2,500 Manitoba paramedics, projects membership fees under the proposed new college would cost between $300 and $400 annually.

'Unbelievable amounts of money'

Toews writes in the report that membership fees could cause a stir. Ritzer said the government has the power to cover those costs but that's something that will have to be hammered out in the transition process.

Gawronsky said there's precedent for employers to cover professional membership fees, although MGEU — which represents just under 1,100 paramedics in Manitoba — also has yet to secure those kinds of terms.

"We believe all paramedics should be treated fairly in the province," she said in a statement. "This is an issue that can be addressed when we go back to the bargaining table." 

Meanwhile, Forrest says membership fee costs alone should make the move toward self-regulation seem unappealing.

"It's going to cost the system unbelievable amounts of money," Forrest said.

Forrest said the firefighters' union's latest collective bargaining negotiations established that the city of Winnipeg will foot the bill for all fire paramedics' membership fees, which could cost taxpayers $1 million annually.

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"We are the only paramedics in the province that will have their fees paid for at this time," he said.

The union represents just under 1,000 Winnipeg-based firefighters and has long been against the idea of a college. Forrest said the union hasn't changed its stance in light of the report, but he said he is glad to see a spot would be reserved on the proposed college council for cross-trained firefighter-paramedics.

"We don't agree with the decision but we thank the government for allowing us to put our concerns forward and we're going to do everything we can to ensure that this will not negatively affect the citizens of Winnipeg."