A 1998 review 33 indicates that since 1996 three provinces have amended legislation to recognize nurse practitioners and advanced practice nurses, and several more are working in it. This is further supported by a number of pilot projects funded by Health Canada's Health Transition Fund in the area of primary care, which encourages the incorporation of multidisciplinary provider models. In the US, Cooper 34 has documented the dramatic growth in what he has described as nonphysician clinicians, which he defines to include 10 nonphysician disciplines that most strongly overlap the scope of medical and surgical services preferred by physicians. In making future determinations of scopes of practice of health professions it would be helpful to develop a set of principles or criteria to aid in such decisions. The foregoing are only examples, and many other issues need to be considered as well.
Further detail is contained in the discussion paper.
The core councils and committees identified a number of driving forces in the areas of society, the economy, politics, technology, the environment, ethics and education. By assessing the implications and the likes and dislikes of these alternative scenarios it is possible to identify those enduring clear characteristics that are highly valued. Based on the work of the three meetings that were noted above, a series of value statements were identified and reviewed at the April 1999 meeting of the core councils and committees. One area where there is a clear gap in Canada is that of a broadly shared vision for the health care system. Since then the federal government has discussed adding home care and pharmacare programs, and the February 1999 social union framework lays the groundwork for elaborating a future vision.