Expanded Scope of Practice Will Hurt Patients

Expanded scope of practice will ultimately hurt patients, according to family physician Dr. Sohail Gandhi, who argues that recent failures in New Brunswick and Nova Scotia serve as a warning for Ontario.

Critics say the New Brunswick experiment failed

On October 1, the CBC reported that a program in New Brunswick to expand the duties of pharmacists was cancelled after a short time in operation. The project aimed to let pharmacists order bloodwork and treat minor illnesses, but officials found the initiative lacked solid evidence.

Gandhi points to specific failures in the New Brunswick rollout. The program promoted a “convenient new option” rather than focusing on quality care first. The core hypothesis—that every patient getting care at a pharmacy would take pressure off the public system—remained unproven. This approach also ignored the role of paid lobbyists, like Perry Martin for Shoppers Drug Mart, who pushed for the changes.

The rollout was also messy. The pilot pharmacists were deluged with patients prescribed point-of-care tests by Maple, a private virtual care company. The connection between Maple and Shoppers Drug Mart, which invested $75 million in the company, was notably absent from the official discussion. The government cited an Ontario report that surveyed pharmacists who complained of corporate pressure to hit quotas and revenue targets. Nicole Poirier, the director of primary care in New Brunswick, pointed out the report contained “no conclusive findings” that it reduced pressure on the public system or improved health outcomes.

The Nova Scotia experience reinforced these concerns. While a 9.2% drop in emergency room visits was initially celebrated, Health officials concluded the drop was due to a combination of several initiatives, not just pharmacist scope changes. The provinces’ physicians also feared that allowing pharmacists to treat minor illnesses would lead to test duplication and fragment care.

Studies show increased costs and fragmentation

Ontario’s recent plans to expand the scope of practice for allied health care professionals may repeat these mistakes. Gandhi notes that a three-year study of expanding Nurse Practitioner autonomy in US Veteran’s Health Administration hospitals found immediate costs rose 7%, with an overall 15% increase when downstream costs were included. Sub-optimal triage was also noted, leading to under-admission when needed or over-referral/overuse. Patients under NP care had worse decision-making about hospital admissions and increased return ED visits.

Other studies generally supportive of scope expansion often included physician-NP teams or limited scope changes, rather than fully independent practitioners. Training, team collaboration, and oversight remained intact in these models. In Australia, a generally favorable report still mentioned significant concerns about training, regulation, funding, and the risk of fragmented care, waste, and higher long-term costs.

Dr. Gandhi argues that in Ontario, the system is already too disjointed for widespread scope expansion. The lack of a consistent family doctor—often called a medical home—means that information is not consolidated. If allied health care providers begin ordering more tests and prescribing antibiotics without a central record, the result will be fragmentation. This disconnect leads to worse health outcomes and higher costs.

This fragmentation is already visible in antibiotic stewardship. Provinces that allow pharmacists to provide antibiotic prescriptions have higher per capita rates of antibiotic use. There is also a significant risk of over-ordering diagnostic testing when providers are unsure of a diagnosis. Without strong safeguards, the push for expanded scope risks over-treating patients and driving up the cost of liability insurance for allied health professionals.