As other provinces expand pharmacy care, advocates say Manitoba is falling behind

Soon after graduating from the University of Manitoba's PharmD program in 2023, Christine Vaccaro left the province to complete a year-long primary care residency in Ontario. To the Winnipeg pharmacist’s surprise, she learnt she could do far more in the province where she was training than she ever could back home. In the three years prior, Ontario had steadily expanded pharmacists' scope of practice, allowing them to renew prescriptions for up to 12 months, administer more vaccines and perform certain point-of-care tests. The year Vaccaro moved to attend her program at the University of Waterloo, Ontario had earlier that year rolled out one of its biggest expansion to date, allowing pharmacists to assess and prescribe for 13 common ailments. “I was amazed at the things that an Ontario pharmacist could do,” she said. “When I went through the [primary care] program, my intention was always to come back home and bring everything I learned home.”“But as you've likely heard, there's not a lot we can do in Manitoba." Vaccaro’s experience reflects those of many pharmacists in the province who fear a growing divide in scope of practice between Manitoba and the rest of Canada. While provinces across the country have steadily expanded pharmacists' responsibilities over the past decade, Manitoba has moved much more slowly.In Manitoba, pharmacists are currently authorized to provide for 14 (soon 15) common ailments—the fewest in the country, according to advocacy organization Pharmacists Manitoba. By comparison, pharmacists in neighbouring Saskatchewan can provide more than 30 services, while those in Alberta, which has Canada's broadest pharmacy scope, can assess and prescribe for more than 40 common ailments. Britt Kural, the organization’s pharmacy practice advisor, says the gap makes it harder for the province to recruit and retain pharmacists. According to her, surveys conducted by the advocacy group found that 60% of pharmacy students nearing graduation said they had seriously considered leaving the province because of its limited scope of practice. “It's quite alarming to know that there are that many recent graduates or soon-to-be graduating students who are considering leaving the province,” said Kural. And it’s not just graduates, she added. Another survey found that 85% of practising pharmacists felt that Manitoba's current scope represented a significant problem.Today, Vaccaro lives in Winnipeg but provides virtual consulting to patients in Ontario. She still picks up shifts in a community pharmacy in Manitoba, practising in two provinces with vastly different scopes.For example, in Manitoba, Vaccaro cannot assess and prescribe for patients with strep throat or cold sores, leaving her to refer patients in her community elsewhere for care. “Right now we're in tick season, so lots of folks coming back from the lake are worried about a potential bite,” she said. “Others come in hoping to get the shingles vaccine, but we can't do any of those things in Manitoba.”Yet just a two-hour drive east, in northwestern Ontario, pharmacists can provide those same services, she said. “I'm trained to do those things, but because of my physical location, I can't help my community."That doesn’t mean the province has no plans to expand the professionals’s scope. Earlier this year, the Manitoba government passed legislation that would allow pharmacists to perform therapeutic substitutions during drug shortages. Beginning Aug. 4, pharmacists who complete the required authorization process will also be able to assess and prescribe hormonal contraceptives. Kural welcomes those developments, but said Manitoba still has considerable ground to make up.“We're talking about one or two activities when we really need to be looking at 10, to 20, to 30 to catch up to the rest of the provinces in Canada, because that's what pharmacists are trained to do. We're not using them to their full potential. That has real implications for the care Manitobans are receiving."She points to existing gaps in care in the province: more than 130,000 Manitobans do not have a primary care provider, she noted, and yet pharmacists remain unable to provide many of the services they are trained to deliver. “What I find most frustrating as a practising pharmacist myself is when I get a phone call from a client on a Sunday morning and they say, ‘I have a child who has these symptoms, and I read that pharmacists can prescribe for strep throat,’” Kural said. “I have to tell them, ‘I'm sorry, but in Manitoba we're not allowed to do that. Other provinces can, but in your case, you'll have to go to an urgent care walk-in centre today to have that addressed.’” Kural believes expanding pharmacists' scope would allow physicians, nurse practitioners and pharmacists to each focus on the care they are best equipped to provide.“There's enough work for everybody to do,” she said. "We're not trying to take work from anybody. It's a moment where all hands need to be on deck to really address this access-to-care problem that we have in Manitoba.”

As other provinces expand pharmacy care, advocates say Manitoba is falling behind

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