Broader Medical Roles May Endanger Patient Care

The cancellation of a program intended to widen the expanded scope of practice for pharmacists in New Brunswick has reignited debate over similar moves in other provinces. The CBC article, published October 1, called the initiative a “convenient new option” rather than a quality‑first reform.

New Brunswick pilot collapses

Launched as a “convenient new option,” the pilot was promoted without clear evidence that it would improve care quality. Officials later admitted the hypothesis that pharmacy‑based visits would ease pressure on the public system remained unproven. Lobbyist Perry Martin, paid by Shoppers Drug Mart, pushed the regulatory change.

One major criticism focused on the requirement for pharmacists to order blood tests, a capability many argue exceeds their training. The initiative also saw a surge of patients referred by Maple, a private e‑visit provider, to Shoppers Drug Mart locations. Pharmacists in the pilot said they were inundated with point‑of‑care test orders from Maple’s e‑visit platform, stressing workflow.

Investigative reporting noted that Shoppers Drug Mart had poured $75 million into Maple, yet the financial link received little attention. Critics say the arrangement creates a conflict of interest when public funds flow to a for‑profit chain.

Provincial physicians warned that duplicative testing and fragmented care could result. A claim that pharmacist‑treated minor illnesses cut emergency visits by 9.2% in Nova Scotia was later attributed to multiple concurrent initiatives, not the pharmacy model. An Ontario pharmacist survey later noted pressure from corporate quotas and revenue targets.

The report’s director of primary care, Nicole Poirier, highlighted that the study offered “no conclusive findings” on system pressure or patient outcomes.

Mixed results from other regions

A three‑year study of nurse practitioner autonomy in U.S. Veterans Health Administration hospitals showed a 7% rise in immediate patient‑care costs and a 15% increase when downstream expenses were included. Researchers linked the jump to longer evaluations and more ordered tests.

The same analysis reported suboptimal triage, with both under‑admission of needed cases and over‑referral leading to higher downstream costs. Patients under nurse practitioner care also experienced more return visits to emergency departments.

An Australian review that generally favored broader roles for allied health professionals stressed the need for training, regulation and funding to ensure safety. It warned that many providers lack the skill to distinguish serious conditions from minor complaints.

Another study suggested nurse practitioner‑led primary care for patients with multiple chronic illnesses produced outcomes similar to physician care, but deeper examination revealed most models involved physician‑NP teams rather than fully independent practice.

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These findings illustrate a pattern: expanded roles can improve access, yet they often bring higher testing rates and potential care fragmentation.

Stakeholders remain divided.

Ontario faces similar choices

On September 17, the Ontario government announced a review of expanding the scope for numerous allied health professionals. The move mirrors the New Brunswick effort that recently failed.

Data from provinces permitting pharmacist‑prescribed antibiotics show higher per‑capita prescription rates, suggesting a correlation between expanded authority and increased drug use.

Liability concerns also surface; U.S. courts have recorded a rise in lawsuits against nurse practitioners, hinting at possible insurance cost hikes for other professionals if similar expansions proceed.

While some literature notes benefits such as better access and comparable outcomes for chronic disease management, the evidence often stems from settings with strong support structures—team collaboration, oversight and robust training.

In Ontario’s fragmented system, integrating additional testing and prescribing into existing workflows could be challenging, potentially leading to gaps in patient records and duplicated services.

Given the mixed evidence, policymakers risk assuming that successes in well‑resourced environments will translate to broader contexts lacking those safeguards.

One way to view the issue is that health systems thrive when a single clinician can see the whole picture. When care is split among many providers without seamless communication, the likelihood of missed diagnoses or unnecessary procedures rises.

The consultation period will close on January 15, 2025, allowing stakeholders to submit written comments. As the province moves forward, the balance between expanding access and maintaining quality will shape outcomes for patients across the province.