As millions of Canadians struggle to access family doctors, provincial governments are increasingly turning to another profession for help: pharmacists.
Provinces are giving pharmacists a more prominent place in the health system, helping patients get access to more care and changing the nature of pharmacies as a business. And analysts see pharmacists’ new powers as a revenue driver for major chains.
But this has also sparked confrontation with some doctors’ groups, who agree that pharmacists have an important role in health teams – but only as long as physicians are still in the lead.
Alberta has led the way since 2007, when it gave pharmacists the power to prescribe a wide range of drugs. Other provinces have followed suit in more recent years, particularly since the onset of the COVID-19 pandemic exacerbated lack of access to primary care. A national survey conducted in the fall of 2022 estimated that 6.5 million Canadians – more than one in five – don’t have regular access to a family doctor.
Ontario allowed pharmacists to prescribe for 19 minor illnesses in 2023, and closed consultations on Sunday about whether to allow them to prescribe for 14 more conditions and to order laboratory tests.
Last month, Nova Scotia announced it was adding 14 more locations to a program designed to turn pharmacies into primary-care clinics, bringing the total number to 45. The province said in May the program had contributed to a 9-per-cent decline in non-urgent visits to emergency rooms.
But exact responsibilities for pharmacists vary widely across the country. There is little rhyme or reason: For example, B.C. pharmacists can prescribe drugs to treat indigestion but not nausea, while Saskatchewan pharmacists can prescribe for nausea during pregnancy but not indigestion.
Danielle Paes, chief pharmacist officer of the Canadian Pharmacists Association, said the variation baffles her because pharmacists receive the same education wherever they train.
“There’s really no reason why a pharmacist in one province can do one thing and not the other,” she said.
She chalked the variation up to the whims of local policy makers and said her association is pushing for uniformity across provinces.
Kristen Watt, owner of Kristen’s Pharmacy in Southampton, Ont., and vice-chair of the Ontario Pharmacists Association, said the health care system is vast and increased care should be accessible throughout.
“We think that every single patient should have access to a family physician,” Ms. Watt said. “But we also think that there are so many qualified providers in the community – be it physiotherapists, optometrists or pharmacists – who should be able to provide the level of care that matches their training.”
But the Ontario Medical Association (OMA), which represents doctors in the province, has pushed back publicly. They argue that team-based care – where professionals from different disciplines work together – can help patients, but that only doctors have the necessary training to properly diagnose patients.
“There’s nothing minor about many of the things that are listed on the minor ailments list,” OMA president Dominik Nowak said, referring to the list of conditions pharmacists can treat in Ontario. “And when I see someone with a sore throat, there are times when it’s turned into something life-threatening. … It takes a doctor to know that.”
Dr. Nowak also questioned whether the provinces were making changes based on lobbying from large corporate pharmacies, which he said could be motivated more by profit than patient well-being. “Are they being led by interest that advances from shareholders, rather than patients?” he said.
The OMA has raised concerns about corporate ownership before. In August, a Globe and Mail story about Loblaw’s growing health care ambitions quoted Jeff Leger, president of Loblaw-owned Shoppers Drug Mart, as saying pharmacists can do “40 to 60 per cent” of what physicians can do. The OMA released a video on social media, in which Dr. Nowak argued that Mr. Leger’s comments were “categorically not true.”
Pharmacists expanding their range of services is key to Shoppers’ ambitions in health care, analysts say. A September report from Veritas Investment Research Corp. by researchers Kathleen Wong and Maggie Wang identified pharmacy-led clinics as a growth engine for Loblaw. They said Alberta clinics made 3.5 times more clinic-services revenue than locations in other provinces, and an aging population and physician shortages would keep demand up.
Loblaw spokesperson Catherine Thomas said the goal of the clinics is to improve the patient experience for those in need of care.
And independent community pharmacists have said the same. For Ms. Watt, measures that increase the supply of services while demand remains high are a good thing.
“The whole point of all of this is for patient care,” she said.