Monday, September 22 – As the health care system eagerly awaits the second call for proposals on primary care expansion, the Ministry of Health announced sweeping consultations last week aimed at expanding the scope of practice for a number of professions. A Board of Arbitration, chaired by veteran lawyer William Kaplan, also released its ruling on the Physician Services Agreement, settling compensation for the physicians of Ontario for 2025, 2026, 2027 and Spring 2028.
Here’s what happened:
- The Ontario College of Pharmacists are developing regulations to allow pharmacists to prescribe medications for more illnesses and administer publicly funded vaccines. They are also providing consultations for point-of-care testing for common ailments.
- The Ontario government is seeking feedback on proposals aiming to expand the scope of practice for Optometrists, Psychologists and other professions. Feedback on the proposals is due November 3, 2025 (see links below).
- The Ontario government and the Ontario Medical Association (OMA) agreed on a 7.3% increase in physician compensation for Years 2-4 of the 2024-28 Physician Services Agreement (PSA).
Scope of Practice Expansion
On Wednesday, the Ontario Ministry of Health provided direction to the Ontario College of Pharmacists to develop regulatory changes that would further expand the scope of practice for pharmacists . These changes will allow them to prescribe medications for an additional 14 ailments, including sore throat, shingles, dry eye, and calluses.
The changes would also allow pharmacists to administer additional publicly-funded vaccines, including respiratory syncytial virus (RSV), pertussis, tetanus, diphtheria, pneumococcal, and shingles, as well as buprenorphine for opioid use disorder.
The Ontario College of Pharmacists will also be consulted on the administration of point-of-care tests by pharmacists to support implementation of common ailment prescribing like strep throat testing.
Interestingly, the government is further actively seeking stakeholder input on proposals that would dramatically expand what various regulated health professionals can do with the goal of improving access to care and reducing system pressures.
Key consultation areas include:
- Optometrists: Minor surgical procedures, laser therapy for cataracts/glaucoma, ordering diagnostic tests, and independent glaucoma treatment.
- Psychologists: Prescribing authority for antidepressants and other mental health medications (with specialized training), plus ordering/interpreting select diagnostic tests.
- Multiple Professions: Authority for dental hygienists, physiotherapists, chiropractors, and others to order/perform diagnostic imaging (X-rays, MRIs, CTs).
The accompanying regulations have also been posted, and feedback on these three proposals can be submitted until November 3, 2025 via the following links:
- Consultation on proposed changes to scopes of practice for several regulated health professions to support greater access to diagnostic imaging
- Consultations on proposed changes to certain psychologists’ scope of practice to advance access to certain mental health services in Ontario.
- Consultations on proposed changes to optometrists’ scope of practice.
OMA Arbitration Outcome
On September 18, the Ontario government and the Ontario Medical Association (OMA) came to a mutual agreement awarding a 7.3% increase in physician compensation for Years 2-4 of the 2024-28 PSA. The full ruling is available here.
Accountability concerns were a key reason for the time it took to arrive at a decision. For Family Health Organizations (FHOs) specifically, the Board mandated a 75% minimum continuity of care threshold for FHO physicians. Those who fall below this threshold will face a 15% reduction in their capitation rate on a quarterly basis, but only after being notified and given an opportunity to improve. Family Health Groups will also see their premiums increase from 10% to 15% on April 1, 2026, and then to 20% on April 1, 2027.
The award also included:
- Targeted funding for Academic Health Science Centres (AHSCs), including an additional $50 million for SickKids and the Children’s Hospital Academic Medical Organization, an additional $45 million for other AHSCs, and an additional $6 million for the Northern Ontario Academic Medicine Association.
- An additional $5 million in additional compensation for radiation oncologists.
- $1.5 million for gynecology oncologists to increase shadow billing rates effective April 1, 2026.
- $2.5 million for neuro-oncologists for compensation improvements (implementation to be mutually decided on by the two parties).
- An additional $15 million in targeted funding was awarded for Year 4 for technical fees (effective April 1, 2027), specifically for undervalued fees, new equipment, and technologies. The Year 4 general increase will be combined with this funding to be allocated strategically.
- An award to change virtual care payment rules to allow physicians in shared care models to bill comprehensive virtual care codes.
If an agreement can’t be reached on any outstanding issues, the parties may go back to the Board by January 1, 2026.
Santis Insights
Last week’s slew of health policy announcements indicates that the Ford government and Health Minister Sylvia Jones are leaning full-tilt into their health priorities not only for this fall, but for the next four years of the government’s third mandate.
The calls for scope of practice changes for pharmacists, optometrists, psychologists, and other targeted professions have been months and years in the making, and likely became unstuck over the summer once the PCs were through the election. Scope of practice expansion continues to be a salient issue for the government as they look to find ways to rein in costs, drive efficiencies, and improve community-based care to reduce the pressures on hospitals and family doctor’s offices.
Unsurprisingly, patient convenience also emerges as a central theme in health care reform discussions. Expanded scopes of practice for allied health professionals reduce the need for patients to shuttle between multiple providers to address a single health concern. Similarly, prioritizing continuity of care allows patients to build lasting relationships with their family physicians—professionals who maintain comprehensive medical histories and understand their unique health journeys, sparing patients from repeatedly recounting their stories or navigating fragmented care across multiple systems.
The OMA arbitration decision is timely, as it arrives in advance of the next call for Interprofessional Primary Care Teams, which Minister Jones previewed over the summer as coming before the end of September. Arriving at labour peace with the physicians enables the Ministry of Health to re-focus needed time and attention on other critical priorities and future planning. Additionally, the government is hoping the deal will lead to more family doctors staying in the profession, higher patient attachment rates, more in-person consultations, and ultimately, better care for patients closer to home. Time will tell if those goals will be achieved with these targeted investments.
Have a question about scope of practice? Interested in Ontario’s primary care expansion plans? Reach out to one of our Ontario government affairs experts.
- Clare Michaels, clare.michaels@santishealth.ca
- Dylan Brenneman, dylan.brenneman@santishealth.ca
- Nabiha Paracha, nabiha.paracha@santishealth.ca
Further Reading
Read the announcement of the expanded scope of practice for certain health professionals here.
Read the announcement from the Government of Ontario about the OMA arbitration award here.
Read the OMA news release about the arbitration award here.
Read the OMA arbitration decision here.