In this thread I will argue that paramedics who do not practice in the out of hospital enviroment and instead work as ACPs / in traditional medical roles are no longer paramedics and should therefore be regulated separately
(With particular reference to the UK and commonwealth.)

What makes a profession?
The heavyweight sociologist Eliot Freidson literally wrote the rule book on this.

Essentially there are 3 criteria to define a profession in the true sense

1. A unique domain of knowledge and expertise that cannot be reasonably performed by others
2. That members of the profession can be trusted to work independently and without supervision
3. That the members of said profession can regulate themselves https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265366/

What do we understand from this?

Paramedics working outside of hospital in the commonwealth have a unique domain of knoweldge - paramedic practice.
They are independent practitioners. And they are a self regulating profession.
Ok cool.
So what?

WELL....

Here’s the thing.
What makes a paramedic a paramedic, and not say, a doctor on an ambulance ?

Whilst Freidson’s criteria are essential, the argument is best illustrated with a more practical tool.

The substitution test.

Could you substitute the average paramedic with the average member of another profession and would they still be able to do the job?

The answer for those with any OOH experience is; no.
Paramedics have a unique skill set and domain of expertise which other professionals must take time to learn in order to perform in that role were they to be substituted.

A doctor would not be able to walk into an ambulance and practice safely, neither would a nurse.

Similarly a doctor or paramedic could never be substituted for a nurse one morning and be able to practice safely.

This gives us a great deal of insight in the pragmatic sense as to whether one is a “professional”.

So, now what?
Surely paramedics are still paramedics whether they wear green or not?

This is the complicated bit.
Once a paramedic (or nurse) steps into a role which was traditionally occupied by a different profession (ie physicians in community or hospital medicine)
Then does that paramedic still have a unique inability to be substituted ?

That is to say practically speaking, once a paramedic is working in general practice as an advanced clinical practitioner or equivalent, what makes them non-substitutable by a GP, or nurse practitioner, or physician assistant / associate ?

I would argue they no longer are

If a paramedic now practices in a role and context so different from their original professional domain that their practice can be performed by others then are they still practicing as a paramedic?
Or have they become something new? Something else ?

This isn’t for a moment to suggest that their identity isn’t still that of a paramedic, but rather that their professional practice is no longer Paramedicine in THAT role, and therefore they should not be regulated by the paramedic profession.

Rather, they should be regulated by whatever collective group is responsible for this type of practice.

Except - and here’s the tricky bit.
Are they a new profession? Or are they now a discipline and a Para-profession?

In her seminal work on the subject my friend and the world expert on the subject of paramedic professionalism @RuthTownsendlaw discuss these and many more concepts in her Doctoral thesis
https://openresearch-repository.anu.edu.au/bitstream/1885/144663/1/TownsendPhDthesis%202018.pdf

What’s distinguishes a discipline and para-profession from a profession?
Dr Townsend describes the history of Paramedicine a transition from the former to the present.

I would argue that because the work of ACPs, PA’s, paramedics in non-uniquely-paramedic-roles etc were all traditionally done by physicians, and there is not a unique domain and body of knowledge,

that this practice is a discipline and Para-profession; but not a true and independent profession in the technical sense of the word. And therefore whilst practitioners should be regulated independent of their “home” profession of origin,

this regulation might require either regulatory oversight or co-ownership/ sponsorship by the profession whom traditionally “owns” this domain of practice
OR practically, the practitioners will require a degree of supervision/ consultation.

I would like to make a few qualifying statements.

1. It’s very likely that nurse practitioners and paramedic practitioners are still those professions if their practice remains unique.

2. Regulation as a profession, being a profession in the technical sense, and “acting professionally” should not be conflated; though they may easily be.

3. I think there is a very strong case to be made for the creation of a regulatory body for PA’s, ACPs, and other clinical practitioners in the UK who may appropriately regulate the activities of this group.

4. The term non-medical prescriber should NOT be used in this case, because a physio/paramedic/nurse with the ability to prescribe but whose practice is still natural to their original professional domain has not moved beyond that profession.