The Canadian healthcare landscape is undergoing significant changes as the number of family physicians declines for the first time since 1997. A recent report from the Canadian Institute for Health Information (CIHI) highlights that only 77% of respondents reported having a family physician or nurse practitioner (NP), reflecting a growing concern about accessible primary care. The number of family physicians per 100,000 people decreased from 124 in 2022 to 120 last year, with the total count falling from 48,292 to 48,264. This marks the first decline in over two decades, drawing attention to a critical shift in healthcare accessibility.
In recent years, the average number of patients seen by family physicians has declined by 18% from 2013 to 2022. This reduction is partly due to increased administrative burdens and logistical challenges within the healthcare system. Dr. Tara Kiran, a family physician, noted, “Most of us go into family medicine because we love seeing patients and interacting with people. But so much of the job now is sorting through paperwork and struggling to support our patients to navigate through the healthcare system because they can’t get the care that they need.”
Urgent care access remains a pressing issue. Only 35% of individuals seeking urgent care from a practice where they had an established relationship secured a same- or next-day appointment. Alarmingly, about 21% of those seeking urgent care had to wait two or more weeks or were unable to secure an appointment at all. This situation underscores the need for alternative solutions to relieve pressure on family physicians and improve patient access to care.
Provinces across Canada are responding by expanding the roles of pharmacists and nurses. British Columbia, Alberta, and Ontario now allow pharmacists to prescribe certain medications. In Ontario, residents can obtain contraception directly from pharmacists, a move supported by Joelle Walker of the Canadian Pharmaceutical Association, who stated, “There’s no reason why pharmacists in Ontario shouldn’t be able to prescribe for contraception.” Such measures aim to enhance primary care accessibility by utilizing pharmacists’ expertise.
Moreover, Quebec, Ontario, and Nova Scotia have removed the requirement for sick notes from clinicians for short-term work absences, with health expert Reimer noting, “Getting rid of sick notes for those short-term self-resolving illnesses could have a big impact on accessibility in the health system.” This initiative seeks to alleviate unnecessary burdens on both patients and healthcare providers.
Newfoundland and Labrador, Ontario, and British Columbia have granted registered nurses prescribing powers through training programs. These measures intend to enhance healthcare delivery by expanding the scope of practice for nursing professionals. Additionally, new NP-led clinics have been established in Quebec, Ontario, and Saskatchewan to address regions with limited access to family physicians. These efforts are crucial in bridging healthcare gaps and ensuring that patients receive timely care.
The CIHI report emphasizes the potential benefits of allowing pharmacists to prescribe more medications as a way to improve primary care access. Joelle Walker advocates for broader adoption of these practices across provinces, suggesting that “provinces should consider adopting expanded prescribing authorities that have worked in other parts of the country.”
Despite these progressive steps, there remains a need for public education about the roles of NPs in healthcare delivery. VanGorder highlighted this necessity, stating, “The other thing the government has to do is to educate the public on the benefits of using NPs because there’s still a feeling that somehow that’s not at the same caliber as going to a family physician.” Educating the public can help integrate NPs more fully into primary care roles and alleviate some of the current system’s pressures.
