Commission on the Reform of Ontario's Public Services

Optimize Human Resources Capacity
Chapter 5: Health
Recommendation 5-18: Where feasible, services should be shifted to lower-cost caregivers.
Across the spectrum of caregivers, full scope of practice needs to be exercised.
There should be a net shift in responsibilities from physicians to nurses and others in health
teams, including physician assistants. This should be supported by changes to fee schedules;
for example, by not paying physicians for interventions like vaccinations that could be done
by nurses.
There is a significant number of cases where there are minimal risks of complications and
nurses or physician assistants can play a more independent role; however, there is an equally
significant number of cases where there is a somewhat higher but not extreme risk of
complications where nurses or physician assistants would require a doctor to be nearby to
deal with any potential issues. Family Health Teams have optimized a model that could be
transferable to other settings as nurses are often in close proximity to doctors.
Recommendation 5-19: A broader perspective should be applied to decisions that are made
on the scope of practice of health professionals. Government should play a more active role in
working with the professional colleges to apply a system-wide approach rather than dealing
with individual professions in isolation.
Doctors and nurses may discuss among themselves what activities they should retain or give
up, but there is no mechanism to put these internal dialogues together and get some action on
changes that both agree would be beneficial.
Recommendation 5-20: Maximize opportunities to use nurse practitioners with the aim of
efficiency, while maintaining excellent care.
Seven of the controlled acts authorized to physicians are also authorized to nurse
practitioners, for example: periodic health examinations (“full physicals” for children, women
and men); assessment and clinical management of acute episodic illness, for example,
respiratory tract infections; and monitoring stable chronic health conditions, such as
hypertension and diabetes, etc.
Recommendation 5-21: Recognize the increased demand for nurses in the capacity of
nursing programs at colleges and universities and their ability to train more nurses.
There are already severe labour shortages for nurses and various technicians, with some
reports of a 20 to 30 per cent attrition of nurses within the first year after nursing school. There
is a desperate need to increase supply and improve retention. If this is not addressed quickly,
demand-supply imbalance will blow up labour costs and compromise overall restraint.
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