With about a quarter of Ontarians expected to be without a family doctor by 2026, nurse practitioners are urging the provincial government to create a public funding model for their profession “as soon as possible.”
The call comes after federal Health Minister Mark Holland told provinces and territories in early January that medically necessary care, whether provided by a doctor or a “physician equivalent,” which would include nurse practitioners (NPs), should be covered by public health insurance.
NPs are nurses that have completed additional education and can offer many of the same services as family doctors, including treating patients, referring them to specialists, ordering diagnostic tests and writing drug prescriptions.
Currently, most NPs in Ontario are salaried. There are more than two dozen NP-led clinics which the province already funds, while many NPs are employed at hospitals, long-term-care homes and community health centres. Some run their own private clinics and charge patients for care, which Holland says the public health system should now pay for if they are providing the same medically necessary care as doctors.
“Premier Doug Ford and Minister of Health Sylvia Jones must focus on creating a funding model to support nurse practitioners in providing comprehensive care, especially in primary care, because the primary-care crisis is urgent and real,” said Lhamo Dolkar, an Oshawa-based nurse practitioner and president of the Registered Nurses’ Association of Ontario (RNAO). “The time to act is now.”
Under the Canada Health Act, only medically necessary care provided by physicians and hospitals is considered eligible for coverage by Canada Health Transfer payments to the provinces and territories. Enacted in 1984, the Act does not address care provided by other health-care providers, such as NPs, or contemplate the provision of virtual care.
In his long-awaited interpretation of the Act sent to provinces on Jan. 9, Holland said there has been an expansion in the scopes of practice for many health professionals, such as NPs, pharmacists and midwives, who deliver some of the same services as doctors. As such, patients should not be charged out-of-pocket for medically necessary services when those services would otherwise be covered if provided by a doctor, the minister says.
Holland is giving the provinces and territories until April 1, 2026, to incorporate the changes into their public health-care plans.
Ema Popovic, a spokesperson for Ontario Health Minister Sylvia Jones, said the health ministry is reviewing Holland’s new interpretation “to understand how it will impact the delivery of high-quality, publicly funded care in Ontario and across the country.”
Last year, Jones warned Holland that the Canada Health Act’s silence on non-physician health-care professionals providing medically necessary care created a loophole that some were taking advantage of “knowing there is no legal consequence or risk of getting shut down.”
In March 2024, the Ontario government announced $110 million in funding to launch an expansion of interprofessional primary-care teams across the province, such as nurse practitioner-led clinics and family health teams.
“Continuing to allow non-physician providers to operate in fee-charging primary-care clinics will undermine our public investment in these new teams and our expansion of publicly funded primary care across the province,” Jones wrote to Holland last April.
NP Michelle Acorn, CEO of the Nurse Practitioners’ Association of Ontario, said whatever funding model for her profession the province decides on, flexibility is key. This could mean integrating nurse practitioners into OHIP and having a schedule of benefits for insured services provided by the profession; allowing a fee-for-service payment model in which nurse practitioners are paid for each patient visit, much like doctors are paid; or an expansion of NP-led clinics or community health centres in which NP salaries are paid by the province, she says.
Acorn also said NPs who provide care virtually should be covered by provincial funding.
In recent years, Canada has witnessed the arrival of companies offering for-profit medical care, including care delivered online, in which patients are charged a fee to access primary care from both doctors and NPs.
Holland’s office said the minister’s new interpretation of the Canada Health Act leaves it up to the provinces and territories to decide if virtual health services are incorporated into their public health plans.
“If people have an opportunity to connect with their primary-care provider, whether that’s an NP, physician or NPs that do specialization, it shouldn’t matter how,” Acorn said. “People have a choice of what provider they want to see. They should also have a choice of how they wish to be seen.”
