Ontario’s pharmacist scope expansion means they’re helping more patients—but is that really easing pressure on the system?

Ontario’s decision to let pharmacists prescribe for more minor ailments is bringing more people into the healthcare system, but perhaps not in the way the provincial government had hoped.A study by University of Toronto researchers in the Journal of Health Economics found that 2023 policies expanding pharmacists’ scope of practice led to an increase in visits to pharmacies, but not a decrease in visits to other health providers—despite Premier Doug Ford framing the move as a way to ease pressure on the healthcare system. Pharmacists and physicians are divided on what the study’s results mean, with the former saying expanded prescribing powers help guide patients to the appropriate care, while the latter argue they add another access point without reducing the demand physicians face.In January 2023, Ontario allowed pharmacists to prescribe for 13 minor ailments such as pink eye, urinary tract infections and dermatitis. That list of ailments was expanded to 19 conditions in October 2023 to include issues like acne, canker sores and yeast infections. The study looked at anonymized mobile phone location data from Advan between 2022 and 2024 to measure how the policies affected foot traffic to pharmacies, and whether it changed visits to non-pharmacy medical facilities, including hospitals, emergency departments and outpatient clinics. The researchers found the policies led to a 16% increase in visits to pharmacies, with one type of neighbourhood seeing the most significant rise—as much as 25%. "Interestingly, these increases were concentrated in regions with high material deprivation but low racial and immigrant-based diversity, suggesting that the policy generated the largest impact among disadvantaged non-minority Canadian citizens," the study read. However, the study also found that over that same period of time, there had been a 3% increase in visits to other health providers. Roughly 23% of new pharmacy visits resulted in additional visits to non-pharmacy health providers like family physicians and outpatient clinics—though they also found hospital and emergency room visits fell by about 7%.Mina Tadrous, an associate professor of pharmacy at the University of Toronto, said that while a drop in physician visits has not materialized, it was never something experts expected.“There’s a very common phenomenon in healthcare—when you add more access, it’s like a balloon. It just builds up more,” he said.Tadrous said the policy has added another pathway to care for patients, increasing the overall amount of care being delivered rather than reducing demand elsewhere.“What we are hoping is that the access is sooner and better,” he said. “We can triage patients better. You have another point of care that’s more open, with better hours—really just another option for patients—and take a little pressure off wait times.”The study, however, found visit increases to be uneven, with pharmacy visits declining by about 14% in neighbourhoods with the highest concentrations of immigrants and racialized residents. The authors note these declines “may be attributable to limited supply of pharmacies and to patient substitution across pharmacies”—meaning some patients may have shifted to other locations rather than accessing care locally.Ontario Medical Association CEO Dr. Zainab Abdurrahman said the findings highlight the limits of expanding the scope of non-physician health professionals without better integration across the entire healthcare system.“It’s leading to siloed and duplicated care, which I think costs the system more without improving care for patients,” she said.Without shared records and coordinated followup, she argues, patients moving so much between providers risks further fragmenting an already strained system. “These quick fixes—such as adding prescribing, assessment or other clinical responsibilities to professions that do not have the same education, training and experience as physicians—can lead to patient safety issues and worse outcomes,” Dr. Abdurrahman said. “Patient safety—not convenience—should always come first when we’re thinking about this issue and access.” For Neighbourhood Pharmacy Association of Canada CEO Sandra Hanna, the study points less to a failure of policy than to the scale of unmet need in the system.“The goal and the value of pharmacist expanded scope is not to move people between systems,” she said. “It’s to expand capacity—to get the right care at the right place from the appropriate provider at the right time.”She said pharmacists are already addressing numerous health concerns directly in pharmacies, citing a 2019 study by researchers at the University of Alberta which found pharmacist-led care for uncomplicated urinary tract infections was successful in about 89% of cases. “We are resolving issues in pharmacy,” Hanna said.Another Ontario study from researchers at the University of Waterloo found that between about 11% and 57% of emergency department visits could potentially be managed by pharmacists, depending on the conditions studied.“If there is something more complex, we’re catching red flags and referring them onward to get the appropriate level of care,” Hanna said, adding that some of the increase in visits elsewhere may reflect appropriate followup.That doesn’t mean pharmacists aren’t facing the same strain as physicians. A 2023 national survey found nearly four in five pharmacists were at risk of burnout, underscoring the growing workload and pressure on front-line providers even as their role in the healthcare system expands.Hanna acknowledged that pressure, but said the broader takeaway remains unchanged. Rather than shifting patients away from physicians, she said expanded pharmacist scope is bringing people into care who may not have sought help otherwise. “If more people are getting care, that’s not a bad thing,” she said.

Ontario’s pharmacist scope expansion means they’re helping more patients—but is that really easing pressure on the system?

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