With no family doctor, Yvette Jarvis said she was forced to go to the emergency department to have her prescriptions refilled — a process that took a staggering 15 hours.
She soon turned to a nurse practitioner (NP) instead, and said she paid nearly $2,500 over five years for the same service.
The St. John’s resident said the primary care she receives from a nurse practitioner is wonderful, but the service should be available to everyone without having to pay out of pocket.
“They gave me the exact same care that I would normally get from a family physician, so I feel like we shouldn’t have to pay the $75 and it should just be covered,” Jarvis, 55, said.
Relief is coming for Jarvis on Wednesday, when she, along with residents across most of Canada, will be able to see a publicly funded NP for services that a physician would otherwise provide.
In January 2025, the federal government said provincial and territorial health plans should start covering the services of NPs, pharmacists and midwives who provide primary care, setting a deadline of April 1, 2026, with enforcement kicking in later.
The directive ― outlined in an “interpretation letter” of the Canada Health Act ― effectively revised which providers fall under Canada’s medicare system to ensure people are not being billed for “access to medically necessary care.”
Patients in Ontario will likely have to wait a little longer, with the province’s health minister saying it won’t meet the April 1 deadline — but should do so by next year.
Given nearly six million Canadians don’t have a family doctor, nurse practitioners could help relieve the pressure on primary care physicians and the broader health-care system.
Nurse practitioners apply clinical skills associated with nursing and medicine to assess, diagnose and refer patients, mirroring many of the tasks of a primary care physician, such as a family doctor or pediatrician. They work in family health teams and community health teams, hospitals and long-term care homes.
Jarvis said despite her rotating work schedule, it was easy to access the nurse practitioner.
“I want to keep up on my treatments or whatever the case may be; my own yearly visits,” she said.
Jarvis said a relative who didn’t have a family physician also benefitted from the NP’s attentive care, which provided them peace of mind.
Trent McDonald, who provided care for both Jarvis and her family member, said the imminent change means he’ll be able to take on 800 patients and be their primary health-care provider not only when they’re sick, but for prevention and health promotion as well, such as keeping screenings up to date.
“Since 2019, I’ve had some patients who could not afford to pay me, and I knew that, so I never charged them,” McDonald said.
He said he can see the relief on his patients’ faces when he tells them the fees will soon be dropped.
Professionally, McDonald likens the change to the “shackles coming off” nurse practitioners, allowing them to open their own clinics or join established ones.
More Canadians have family doctors, but accessing care remains a challenge
While patients in most of the country will no longer pay out of pocket this spring, Ontario will be an exception.
Ontario Health Minister Sylvia Jones said the province won’t be able to follow suit immediately, but rather by April 1, 2027, when Ottawa could begin levying penalties on jurisdictions that are not in compliance.
The province does have more than two dozen publicly funded nurse practitioner-led clinics, but those NPs are unable to establish independent practices. Their provincial association is pushing for a model similar to what many provinces and the Northwest Territories have shifted toward, where NPs will be able to bill the government for their services.
“The Ministry of Health is actively reviewing and engaged in ongoing discussions with provincial and territorial partners and the federal government regarding implementation expectations of the federal government’s direction,” said Ema Popovic, spokesperson for Ontario’s health minister.
“Nurse Practitioner-Led Clinics (NPLCs) that receive annual base funding from the Ministry of Health are already prohibited from billing patients or other entities for services covered under the agreement.”
The federal government has discretionary power to withhold cash contributions to provinces and territories that fail to comply with principles of the Canada Health Act, such as “reasonable access” to medically necessary care.
It’s “confounding” that Ontario is lagging behind other jurisdictions on NPs providing primary care, said Valerie Grdisa, CEO of the Canadian Nurses Association.
Grdisa said the model could save taxpayers money. She gave a hypothetical example of a family doctor billing the province $100 to see a patient, compared with an NP charging $75 to treat the same issue.
“We as taxpayers want our dollars to be spent in the right places at the right value, and we are not spending it in the right places at the right value,” Grdisa said of Ontario.
The College of Family Physicians of Canada said in a statement while it supports a single-payer, publicly funded health-care system offering universal access to essential medical services, “family physicians are not replaceable.”
“They are uniquely trained and trusted for major health concerns and replacing one role with another can create confusion and break care into pieces,” the statement added.
The college said team-based care is about collaboration, which “works best when family doctors and other health-care providers are able to use their full skills and training, and when everyone is clear about their role.”
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But Grdisa, who previously worked as an NP in hospitals, said there’s more than enough work to go around to meet the health-care needs of Canadians.
“We have to actually stop the turfism and protectionism and the diminishing of each other based on our entry-to-practice qualifications and build the right models of care,” she said.
Whether it comes from a physician, an NP or a pharmacist, “medically necessary care” is a grey area and its definition needs to be updated, said Erin Strumpf, a health economics professor at McGill University who has studied the funding of primary health care in Canada.
“You want to balance protecting patients and making sure that they’re getting high quality care from qualified providers,” Strumpf said. “But you also need to balance people’s ability to access care from the provider of their choosing.”
Other researchers have proposed more federal funding for primary care tied to a stronger condition of reasonable access within the Canada Health Act.
