This fall Ontario pharmacists will be able to prescribe medicines for a greater number of conditions. However, some pharmacists are warning that the current demands are too onerous in a high-volume pharmacy environment and they lack the incentive to take on prescribing work.
In January, the Ontario health ministry kicked off its program to allow pharmacists to prescribe medications for 13 minor ailments, including allergies, acid reflux, hemorrhoids, insect bites and sprains.
The ministry will add six more minor ailments in October, enabling pharmacists to prescribe for conditions including mild acne, canker sores and yeast infections.
“I feel for my colleagues at the large chain stores,” said Adam Silvertown, who owns Pace Pharmacy, a compounding pharmacy in Toronto. “Some pharmacies may have to find a way to better balance their staffing.”
Silverton’s words echo what other pharmacists have told Canadian Affairs. Some spoke off the record for fear of harming their employment opportunities.
Pharmacists lack financial incentive to prescribe for minor ailments
The province pays $19 for each patient consult, a bit less for virtual appointments, Silvertown said. The ministry did not respond to a request to confirm those numbers.
“That’s not a lot when a consult could take 30 minutes,” said Silvertown. Pharmacists make around $50 per hour, according to Statistics Canada data and current Shoppers Drug Mart job postings, suggesting that a pharmacy may record a loss on a half-hour consult.
Moreover, individual pharmacists don’t see this money, says Clara Ong, a pharmacist who worked at Shoppers Drug Mart for a decade. “Certainly [they are] not getting paid for it. The pharmacy is getting paid for it.”
Shoppers’ pharmacists, who are generally paid a fixed hourly rate, have little incentive to take on the additional work of prescribing for minor ailments, Ong says, since “everybody is swamped.”
“You’re working without lunch breaks, washroom breaks. You’re already exempt from labour laws. And now anyone can walk in and you’re expected to respond on the spot. So the general feeling is ‘I don’t want more to do.’”
But Ong is confident pharmacists at Shoppers will feel corporate pressure to make money. “I’m sure at Shoppers, the moment pharmacists were able to bill for a minor ailment, they were expected to do so.”
Shoppers did not respond to requests for comment by press time.
‘It just requires a bit more triaging’
At least one co-owner of a Shoppers Drug Mart store sees it differently.
“This is something that pharmacists have been taking part in in terms of recommending different therapies to patients all along,” said Nader Ibrahim, an associate owner of a Toronto Shoppers Drug Mart. “We’re just being recognised as actual authorized prescribers.”
Ibrahim said a bit of juggling goes into making the new system work, but it’s not that unusual for pharmacists to do that. He cited taking time to help patients with vaccinations and medication reviews.
“It’s just about working with it within the workflow,” he said. “It just requires a little bit more, you know, triaging. But so far the uptake has been great and patients have really appreciated our availability.”
Nurse practitioners, pharmacists capable of easing demands on doctors
The Ontario health ministry did not answer questions posed about this new system, including why pharmacists were chosen for the new duties rather than nurse practitioners.
“It’s a good question,” said Dana Cooper, executive director of the Nurse Practitioner Association of Ontario. “It seems like a good fit for nurse practitioners, already within their scope of practice.”
Cooper said the health care system has traditionally under-used nurse practitioners — an issue his organization continues to struggle with.
Anita McDonald, a prescribing pharmacist in Cochrane, Alta., agrees that treating minor ailments is a better fit for nurse practitioners.
But, McDonald said, pharmacists could still have a role in easing family doctors’ heavy workload by taking over management of chronic illnesses, such as diabetes and high blood pressure.
Ong believes the decision to enable Ontario pharmacists to prescribe for minor ailments “for sure makes sense” from the perspective of improving access to health care, as it’s something pharmacists are “definitely capable of doing.”
But she thinks pharmacists should be required to undergo more rigorous training before providing this service.
“The only mandatory course we had to do [in response to the minor ailments change] was on the laws we had to follow: what can we prescribe, what scenarios, what do we have to do to complete the circle of care,” Ong said. “But there’s no mandatory training on the actual therapeutics.”
With files from Lauren Heuser
Editor’s Note: This article was updated to include information about pharmacists’ hourly rates.
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