FIQ, Quebec reach agreement to clarify patient registration under specialized nurse practitioners

A file photo in a doctor's office.

Santé Québec has a big job ahead of it now to find agreements with each family medicine group (GMF) in the province so specialized nurse practitioners can directly register patients under their own names, a practice previously reserved for physicians.

This comes after the Fédération interprofessionnelle de la santé du Québec (FIQ) and the Quebec Health Ministry definitively clarified and defined the role of specialized nurse practitioners within the GMF framework on on March 16.

The approved change is part of Bill 19, which ensures that GMFs will implement the change.

“The bill was quite general, intentionally. There weren’t really any clear, defined ways to enforce or ensure that this would actually be done,” said Jérôme Rousseau, vice president of the work organization and professional practice sector, as well as the negotiation sector, at the FIQ.

He explains that though the Health Ministry provides resources to the public health system, it is up to Santé Québec to enter into agreementd with each of the GMFs, private companies working within the public system.

Those working in specialized nurse practitioner clinics can already register patients under their own names, but Rousseau laments this represent a minority of the approximately 1,400 specialized nurse practitioners working in Quebec.

“The vast majority of front-line specialized nurse practitioners work in GMFs. This is currently the largest pool,” he said.

The number of patients a specialized nurse practitioner could register to themselves varies depending on the complexity of the cases, but the estimate is that a total of 700,000 to 1.4 million patients could be taken off the waitlist.

All the same, many patients are already being treated by specialized nurse practitioners despite being registered under a doctor’s name.

It will be up to GMFs to decide how to handle the transfers.

The agreement reached with the FIQ stipulates that Santé Québec must have the necessary tools to intervene if a GMF objects to the enrollment of patients with specialized nurse practitioners.

“We ensured that GMFs must respect the working conditions of specialized nurse practitioners because they are unionized employees under the authority of Santé Québec. So, in previous versions, before Bill 19, this wasn’t clear. There were many elements that contradicted this,” said Rousseau.

“The other part — and this is the truly significant gain for specialized nurse practitioners — is that we’ve recognized that the role of specialized nurse practitioners will be clearly defined," he continued.

“We’re truly in a collaborative dynamic with physicians. There’s no longer a hierarchy. This will truly allow specialized nurse practitioners to register patients under their own names, and they will determine, together with the doctors, the best way to share these patient registrations — and that is what we have agreed upon with the ministry. Santé Québec is responsible, in the coming days and weeks, for finalizing agreements with all the GMFs.”

He notes that while it was clear on paper that specialized nurse practitioners have autonomy in patient care, that wasn’t the case in practice.

Rousseau says he believes this change could attract future nurses to pursue specialization.

“Now, frontline specialized nurse practitioners truly have autonomous practice and are capable of managing patient cohorts on par with physicians,” he said. ”From a professional perspective, this is very interesting. It is finally recognizing the role of specialized nurse practitioners.”

The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.

This report by The Canadian Press was first published in French on March 20, 2026.