Who's Scope is it Anyway?

We have pharmacists doing doctor’s work and doctors doing pharmacist’s work. Where’s the efficiency in that?

As of January 1st, Ontario pharmacists have the ability to prescribe for 13 ailments, including heart burn, pink eye and uncomplicated urinary tract infections. This is an effort to help reduce wait times for patients needing these services, as family physicians are in short supply and hospitals are overrun. Is expanding the scope of pharmacists in this way the key to alleviating pressure on our primary care system?

No. It is a step in the wrong direction. Don’t get me wrong; I love pharmacists. I am one. Let me explain.

In Alberta, where I have been a practicing pharmacist for the last 9 years, pharmacists have had the ability to prescribe since 2006. At that time, pharmacist prescribing was seen as a way to enhance chronic care management; patients with diabetes, hypertension and other ongoing disease conditions could be managed by a prescribing pharmacist who then refers to a family physician when needed. As chronic care patients use up 80% of the healthcare system’s resources, this would offload physicians and free them up for more time-sensitive and complicated matters.

This makes sense. Pharmacists, as medication experts, would take on chronic care, which is primarily medication management. Physicians would see people who need more urgent care and diagnosis.

However logical it seems, that is not what happened. More than 15 years later, pharmacists in Alberta are not managing chronic care. We have been pushed to take on the same tasks now assigned to pharmacists in Ontario – urgent conditions requiring diagnosis and assessment that we have no formal training in. It is a step away from chronic care, what we know best, and that is why it is in the wrong direction.

But why do pharmacists find themselves trying to fill in for family doctors? It is because the doctors are too busy seeing patients who could be helped by a pharmacist. Family doctors are seeing patients for prescription refills and medication-related concerns that could be fully addressed by pharmacists.

My pharmacy gets an overwhelming number of requests for help from patients that need to see a family doctor but can’t. I had a phone conversation with a mother of a two-year-old who had been vomiting mucous for the past 24 hours due to an ongoing sinus infection. The soonest they could get in to see a doctor was 10 days. Unable to help, I referred her to the emergency room. As I hung up, I overheard a patient in the store grumbling about how he had to take time off work to get a new prescription from his doctor for a medication he had been on for 3 years.

This isn’t right. It’s backwards.

It is estimated that 1 in 4 Albertans lack a dedicated primary care doctor. If pharmacists took over medication management from family physicians, would that free them up to see more patients that need a doctor NOW?

Pharmacists do not need to expand their scope to include prescribing for infections or diagnosing heartburn versus a heart attack. We need to be utilized for the skills we already have. To help create an efficient and accessible primary care system, we need to collaborate and let healthcare professionals do what they do best.

I am asking family doctors to let me do my job so you can do yours. It won’t fix the system, but its a darn good start.

Anita McDonald is a Master’s student at the University of Calgary’s School of Public Policy. This article was published in the Edmonton Journal on March 14th, 2023.