Finding your niche in primary care teams

Across Canada, provinces are increasingly investing in team-based primary care models designed to improve access to essential health care services. While Ontario’s Family Health Teams are one of the most established examples, other interprofessional approaches are emerging as provincial governments look for new ways to manage growing patient complexity and provider shortages.Within these settings, pharmacists are beginning to play more visible clinical roles, working alongside physicians, nurses and other providers to support safer prescribing, chronic disease management and medication optimization—often earlier in the care process than in traditional models.When Jay Reaume started pharmacy school in Toronto, pharmacists working in Family Health Teams weren’t yet part of Ontario’s healthcare landscape. Like many students at the time, he imagined his future behind the counter of a community pharmacy, with little sense of what else the profession could offer.That perspective shifted during a fourth-year placement at Mount Sinai’s academic Family Health Team (FHT) in 2009—one of the first such teams in the province. At the time, few students had exposure to pharmacists embedded in primary care. “People were super jealous that I got one,” Reaume recalls. The experience opened his eyes to a different kind of practice, focused on collaborative, patient-centred care. A mentor on the team helped him see how pharmacists could function as clinical partners alongside physicians and other providers.After graduation, Reaume went into community practice but quickly grew frustrated. “So much of the work was dictated by the processes of filling prescriptions,” he says. “I didn’t get to spend time actually assessing medications or educating patients.”When a pharmacist position opened at a FHT in Elliot Lake, Ontario—just as his community pharmacy contract was ending—the timing aligned. He made the move north and has now spent 14 years practising in primary care.Reaume works as part of a 20-member interdisciplinary team that includes physicians, nurse practitioners, nurses, a dietitian, social worker and respiratory therapist, serving about 9,000 patients. His days include booked appointments for comprehensive medication reviews, chronic disease management visits, and frequent informal consults from physicians seeking guidance on treatment decisions.“I love that I feel like I’m doing what I was trained to do,” he says. “Being in this position, I get to practise as a medication expert without a lot of other constraints or distractions.”Building a role from the ground upWhen Reaume started, the pharmacist role inside FHTs was still evolving. “I didn’t really have a strict job description,” he says. “One of the biggest challenges at the beginning was just figuring out what I was supposed to do every day.”That ambiguity became an opportunity. Over time, he helped shape the role around the needs of his patients and team. Early on, much of his work focused on medication reviews. Today, those reviews are targeted to the highest-risk patients—people on 15 to 20 medications with multiple chronic conditions.Working in primary care also creates space to develop a “niche within a niche,” he says. In response to the opioid crisis, Reaume became increasingly focused on chronic pain management and the safe use of opioids—an interest that led him to pursue extensive continuing education, including a master’s degree. Chronic pain consultations are now a routine part of his practice.He was also exposed to Cognitive Behavioural Therapy for Insomnia (CBT-I) during his PharmD training and now works with patients to reduce or eliminate sedative use and improve sleep. “Many pharmacists in primary care will develop these kinds of subspecialties, depending on the needs of their team and patient population,” he notes.His practice has expanded to include anticoagulation management, deprescribing of high-risk medications such as opioids and benzodiazepines, and chronic disease management for diabetes, hypertension and hyperlipidemia—work that’s particularly valuable in a rural setting with limited access to providers.Reaume emphasizes that effective team-based care doesn’t happen automatically. “You can’t just put people together and expect them to collaborate,” he says. Trust builds over time, through shared patient care and consistent communication. Once that trust is established, pharmacists can become fully integrated members of the team.Even after more than a decade, he still encounters patients surprised to learn a pharmacist works in primary care. “I had a gentleman say to me recently, ‘I had no idea someone like you worked here,’” he says. “There’s still that traditional view of what pharmacists do.”A different path to the same destinationPharmacist Adam Bleik took a more intentional route into primary care but holds a similar view about where pharmacy’s impact can be greatest. Now 27, he is a primary care clinical pharmacist with the Hamilton Family Health Team and also practises in Hamilton’s first Shoppers Drug Mart Pharmacy Care Clinic. Working across both settings has given him a front-row view of how patients move through the healthcare system—and where pharmacists can help bridge gaps.“Each role informs the other,” he says. His work in primary care helps him better support patients seen in the pharmacy clinic, while community practice keeps him grounded in real-world considerations like medication availability and coverage.Like Reaume, Bleik didn’t set out planning a career in primary care. An early co-op placement at a pharmacy connected to a family practice changed his trajectory. “That unexpected detour changed everything,” he says. “I enjoyed clinical problem-solving, patient education, and being a trusted point of contact for patients with complex needs.”During his PharmD training at the University of British Columbia, Bleik worked at the UBC Pharmacists Clinic and helped support the integration of pharmacists into primary care networks, including co-developing a virtual hypertension management program that gained national recognition.He went on to complete a primary care pharmacy residency at University Health Network—one of only a handful of accredited programs in Canada focused on ambulatory care. The residency confirmed what he was looking for: relationship-based, longitudinal care within interdisciplinary teams.At the Hamilton Family Health Team, Bleik works closely with physicians, nurses, social workers and other providers to support medically complex patients—often those transitioning out of hospital. “My role is to step back, review the entire medication history, and help create a safe, coherent and realistic plan moving forward,” he says.Despite different career paths, both pharmacists describe FHTs as an ideal environment for finding a meaningful niche in pharmacy practice.Why primary care teams workSimilar team-based primary care models are also evolving in other parts of the country. In British Columbia, for example, the provincial government began working with the University of British Columbia’s Faculty of Pharmaceutical Sciences in 2018 to integrate clinical pharmacists into Primary Care Networks as part of its broader primary care strategy. The Pharmacists in Primary Care Network (PCN) program launched in 2020 with the goal of integrating up to 50 Primary Care Clinical Pharmacists (PCCPs) into team-based practices across the province. Over the three years of the program, PCCPs were involved in almost 25,000 patient encounters. In fact, in reviewing program results, researchers found perceptions of the PCCP’s contribution to IPTs were overwhelmingly positive. A recently published article, Unpacking the value of pharmacists in team-based primary care in British Columbia, Canada: a qualitative evaluation revealed that PCCP’s specific role in addressing aspects of patient care that other healthcare providers may overlook—and their possession of knowledge, expertise, and skills which fall outside other team members’ scope of work—has made them recognized an essential team members. However, more research is needed to look beyond the pharmacist’s impact on providing longitudinal medication management, as perceived by all members of the primary care team. Alberta’s PCNs also include pharmacists, although their roles can vary. The Calgary Foothills PCN, for example, employs pharmacists to support medication management and chronic disease care, while the pharmacists at St. Alberts and Sturgeon PCN provide smoking cessation support, chronic pain resources and coordinate care across providers. In fact, the province’s roughly 40 Primary Care Networks now serve most Alberta residents and include more than 1,000 interdisciplinary providers working alongside family physicians.For Reaume, the appeal of working in an interdisciplinary model lies in being able to follow patients over time, particularly those with chronic disease, and adjust therapy as circumstances change. For Bleik, it’s the ability to practise as a true primary care clinician, managing complex cases rather than offering one-off recommendations.Both also point to the quieter but critical role pharmacists play in supporting prescribers. Informal, real-time consults—choosing an antidepressant, adjusting therapy, navigating coverage—are woven into daily practice and help reduce fragmentation of care.Primary care pharmacy isn’t for everyone, they add. It requires comfort with uncertainty, strong communication skills, and the ability to work independently while remaining deeply collaborative.“Primary care pharmacy is its own clinical pathway,” Bleik says. “It rewards pharmacists who enjoy complexity, long-term problem-solving and working closely with a team.”For those who find their niche there, the rewards are clear. “I genuinely enjoy coming to work every day,” Reaume says. “What I love about this role is not only being able to share my knowledge with other providers but learning from them as well.” Working alongside family physicians, he says, has deepened his understanding of their day-to-day realities—and strengthened his own practice in the process.

Finding your niche in primary care teams

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