ONTARIO —Across Ontario—and nowhere more visibly than in rural and Northern regions like Manitoulin—the face of health care is changing fast.
The provincial government is moving to expand the powers of paramedics, pharmacists, psychologists, optometrists, and other allied professionals in what it calls an effort to provide “more connected and convenient care.” But critics say the changes reveal something else: a system under strain, shifting duties downstream as family medicine and hospital care continue to buckle.
Under the new proposals, pharmacists could soon prescribe medications for 14 additional ailments, including sore throats, mild headaches, sleep disorders and shingles. Optometrists would gain authority to perform minor surgeries under local anesthetic, use laser therapy for cataracts and glaucoma, and order diagnostic tests. Psychologists with specialized training in psychopharmacology could prescribe antidepressants and order lab work.
At the same time, Ontario has given paramedics expanded authority to assess, treat, and even refer patients without hospital transport—especially in palliative, mental health and chronic care situations. The aim is to ease pressure on overburdened emergency departments.
On Manitoulin, where physician shortages and limited hospital capacity have left many communities functionally underserved, these changes could feel like lifelines. Pharmacies often act as de facto clinics; paramedics are first—and sometimes only—responders for both crisis and chronic care. Mental health supports have recently expanded for first responders themselves, a necessary step given the trauma exposure paramedics and firefighters face.
But for many, the larger question is: What happens when a lifeline becomes the system itself?
The Ontario Medical Association (OMA) warns that the proposed expansions—though well-intentioned—could risk patient safety and further fragment care. “Physicians train for years to provide assessment, diagnosis, management, and oversight,” said OMA president Dr. Zainab Abdurrahman. “You can’t really delegate these responsibilities without the same rigorous training.”
She added that what’s classified as a “minor ailment” may in fact be an early sign of a serious disease. A sore throat could be cancer. A urinary infection could signal renal issues or sexually transmitted infection. “We see patients who get treatment for a minor ailment but it’s actually something else,” she said.
Supporters counter that the status quo is untenable. Pharmacists, psychologists, and paramedics already serve as the most accessible health professionals in many small towns. Justin Bates, CEO of the Ontario Pharmacists Association, said more than one million Ontarians have accessed timely care since pharmacists gained limited prescribing powers in 2023. “Building on that success,” he said, “the addition of services like strep testing will make care even more convenient.”
Yet convenience cuts both ways. Dr. Abdurrahman said the 2023 expansion increased administrative burden on physicians, who must now cross-check prescriptions and manage medication conflicts—further eroding time for patient care and increasing burnout.
And then there’s the question of cost. Will patients have to pay out-of-pocket for these expanded services, especially those outside OHIP coverage such as psychology or optometry? The Ministry of Health has yet to clarify. “We want access,” said Dr. Abdurrahman, “but under the publicly funded umbrella. Otherwise, we risk creating a two-tier system by stealth.”
In the absence of coordinated reform, Ontario’s health care system appears to be evolving by patchwork—one stopgap after another. Paramedics fill ER voids. Pharmacists cover for family doctors. Psychologists step into psychiatry’s breach.
On Manitoulin, where even getting a referral can mean months of waiting or a long drive off-island, the expansion of these roles may feel like pragmatic progress. But as each professional group shoulders new duties once reserved for physicians, the broader question looms: Are we expanding access, or simply passing the buck? If these new measures are meant to be stop-gaps, where are the conversations as to the root of the problem happening and who’s voices are being included?
In the North, where distances stretch and doctors are few, the landscape of care now resembles the geography itself—fragmented, improvised, stitched together with good intentions and thin resources. What was once a system of coordinated medicine is becoming a constellation of stopgaps, held together by the dedication of those still standing on the front line. Whether this marks a new model of resilience or the slow acceptance of abandonment remains to be seen.
