I am fed up with healthcare. So many broken areas with patients falling through cracks . I have been a NP now for 20 years and my compensation model has remained unchanged yet my scope has grown exponentially. And I have stayed, when it could have been easier and more profitable to go back to be a RN. Also, a lot of people do not know that we do not have benefits, pension plan or sick days etc. like other healthcare workplaces . I take my career very seriously and work my butt off for my patients.
It’s time our society speak up and say that the primary care situation is unacceptable ! Where will my 1500 + patients go for care if I leave?
Ontario’s Health-Care Crisis: Nurse Practitioners Are Part of the Solution—If We’re Allowed to Be
To the Editor,
Recent reports that Ontario will miss the federal deadline to publicly fund all medically necessary services provided by Nurse Practitioners should concern every Ontarian. At a time when access to primary care is in crisis, this delay represents a missed opportunity to act on a readily available solution.
Ontario’s health-care system continues to face well-documented and worsening gaps in access, particularly in primary care. In the SDG and Cornwall, Ontario region alone, more than 20,000 patients remain unattached to a provider. Emergency departments are strained, and wait times continue to grow. Yet there is an underutilized solution already in place: Nurse Practitioners (NPs).
As a Nurse Practitioner practicing in Ontario for over 20 years, I autonomously manage a roster of approximately 1,500 patients. I assess, diagnose, treat, prescribe, and provide comprehensive, ongoing care—functioning in every practical sense as a primary care provider. However, despite this responsibility and capacity, I am not permitted to operate independently within the current funding model.
To be compensated for the care I provide, my patients must be formally rostered under a physician. In reality, this means I function as a subcontractor, despite delivering the majority of front-line care. This arrangement does not reflect the scope, training, or realities of modern NP practice, nor does it support a sustainable model of care delivery.
The absence of a dedicated fee-for-service or alternative billing structure for Nurse Practitioners is a critical barrier. We are trained, regulated, and fully capable of independently managing primary care practices, yet the system prevents us from doing so. This is not a question of competence—it is a question of policy.
The consequences of this gap are significant. Without meaningful reform, many NPs—myself included—are being pushed to reconsider the viability of continuing in community-based primary care roles. If I am forced to close my practice, 1,500 additional patients will be displaced into an already overwhelmed system, further increasing pressure on emergency departments which is another area of care in our region that also does not employ Nurse Practitioners.
Failing to meet the federal deadline sends a troubling message: that despite the urgency of the primary care crisis, enabling Nurse Practitioners to work to their full capacity is still not being prioritized.
At a time when access to primary care is one of the most pressing issues facing Ontarians, it is difficult to understand why the system continues to restrict a workforce that is both ready and willing to help. Enabling Nurse Practitioners to practice independently, with appropriate billing mechanisms, would immediately expand access, improve continuity of care, and reduce strain across the health-care system.
The solution is already here. What is needed now is the political will to act.