Ontario looks to expand pharmacist prescription powers, take pressure off family doctors

Ontario residents could soon get prescriptions for 14 more health issues from a pharmacist, rather than a family doctor, under new regulations proposed by the province, but the Ontario Medical Association says the expansion could put patients at risk.

The province is consulting with health-care associations to implement the changes, which would also expand the authority of optometrists, psychologists and physiotherapists, according to a government news release Wednesday.

"We have gaps in our healthcare system," said Justin Bates, the CEO of the Ontario Pharmacists Association. "It's really about complementing primary care, utilizing the resources to build capacity in our healthcare system and creating access points."

Currently, Ontario pharmacists can write prescriptions for 19 ailments, including tick bites, cold sores and UTIs. The proposed changes would add shingles, swimmers' ears, sore throats and more to that list.

The proposed regulations would also expand allowances for other health professionals. Optometrists could perform minor surgeries, certain psychologists could prescribe medications for mental health conditions and health-care workers like dental hygienists and physiotherapists could order and perform X-rays, MRIs and CT scans.

"These changes would help alleviate pressures on primary care providers, walk-in clinics and hospital emergency departments, giving them more time to help people with more complex needs," according to the province's statement on Wednesday.

The proposed regulations would also expand allowances for other health professionals. Optometrists could perform minor surgeries, certain psychologists could prescribe medications for mental health conditions and health-care workers like dental hygienists and physiotherapists could order and perform X-rays, MRIs and CT scans.

The average wait time for an MRI in Ontario is 75 days, and 38 days for CTs, according to the latest reports from the province.

Dr. Zainab Abdurrahman, president of the Ontario Medical Association, said the new regulations are risky as many professionals lack the years of training that doctors have.

"Expanding prescribing for complex conditions without proper training, oversight and monitoring jeopardizes patient outcomes," she said.

In her work as an allergist and clinical immunologist, Dr. Abdurrahman said she saw patients who had adverse reactions to medications that weren't prescribed by doctors after the provinces' first expansion of allowances. Or, she said, it delayed patients discovering underlying causes for the symptoms they tried to treat.

"That's the thing about medicine, you have to be able to ask all the specific questions," she said. She said family doctors develop relationships with patients and know their medical history which helps them accurately assess the issue.

Dr. Abdurrahman said the province should instead increase the scope of public health care to include mental health, and create a digital system that would allow patients' medical histories and charts to be accessed by doctors across the board.

"Getting piece-meal, fragmented care is not the solution for not having access to a family doctor."

Bates said pharmacists are qualified to make decisions regarding prescriptions.

"Pharmacists are trained in medications more than any other health profession. They are competent. They can do this safely."

Dr. Mark Eltis, president of the College of Optometrists of Ontario said training is ongoing for optometrists that would perform the surgeries the province is looking to allow, like treatments for cataracts and glaucoma.

"Many optometrists that are graduating have it integrated into their schooling already, and optometrists who are in practice have taken continuing education courses."

Last year, about 2.5 million people in the province were without a family doctor. And the Ford government has said it will connect every Ontarian to a primary care physician by 2029.

Mammal Kelada, a Toronto-based pharmacist, said most people still go to doctors or nurse practitioners for their illnesses. She said some patients are uncertain about what pharmacists can prescribe and said the expansion could increase awareness of the program.

"It will help our patients to be able to get the medication they are looking for."

She said pharmacies are often open outside regular hours of clinics and doctors offices.

Dr. Diana Velikonja, a neuropsychologist and former president of the Ontario Psychological Association, said the new regulations would speed up processes of getting prescriptions for mental health issues.

She said most patients have to see a physician to be prescribed medication for mental health issues, but family doctors may or may not specialize in mental health, and many clinics have long wait times.

She said patients' needs would be met earlier if psychologists were able to write prescriptions.

"We're asking pediatricians or psychiatrists to see our patients and they already have really long wait lists and high patient loads," said Velikonja. "And now they have to see new patients to try to do med changes."

Bates said pharmacies became used to an increased demand during the COVID-19 pandemic, which lead to a smooth rollout when the government first allowed pharmacists to prescribe medications

"It was wildly successful in part because we had prepared several years in advance to not only manage the demand of patients, but handle it within our workflows and operations," he said.

He said the incremental introduction of ailments added to the list has provided pharmacies with time to prepare infrastructure and staffing. But that will need to be monitored.

"We need to keep a close eye on to make sure we have the right labour ratio to the demand and to the services."