Physicians, nurse practitioners (NPs) and nurses all deliver care in British Columbia, but each is a separately regulated profession with its own training, legal scope of practice and degree of independence.
With many British Columbians still without a regular primary care provider, understanding these roles matters. It also reveals something many patients don’t realize: for everyday primary care, a nurse practitioner can be your main provider, with outcomes that research shows are comparable to those of physicians.
Who sets the standards in BC
Since April 1, 2026, BC’s health professions have been governed by the Health Professions and Occupations Act (HPOA), which replaced the older Health Professions Act. For patients, day-to-day care has not changed; the new law mainly reshapes how regulatory colleges operate.
Two colleges matter here. The College of Physicians and Surgeons of BC licenses doctors. The BC College of Nurses and Midwives (BCCNM) licenses nurse practitioners, registered nurses, registered psychiatric nurses and licensed practical nurses. In BC, only people holding practising registration with BCCNM may legally call themselves a “nurse.”
What is “scope of practice”? It is the set of activities a profession is legally authorized to perform, such as diagnosing, prescribing or ordering tests. In BC, practice is shaped by four controls: legislation, college standards, employer policies and the individual’s own competence. A professional may perform an activity only when all four allow it.
Physicians (Doctors)
A physician completes an undergraduate degree, a four-year medical degree (MD), and then a residency. Family medicine residency takes two years; specialty training such as surgery, cardiology or psychiatry takes four to six years or more.
Physicians have the broadest scope of the three roles. They diagnose and treat illness, prescribe medications, order and interpret tests, perform procedures and surgery within their training, and admit patients to hospital. Family physicians provide ongoing primary care, while specialists handle complex or organ-specific conditions, usually by referral.
Nurse Practitioners (NPs)
A nurse practitioner is a registered nurse who has gone on to complete a graduate-level (master’s) NP program and pass national and BCCNM licensing requirements. Most NPs bring years of hands-on RN experience before entering advanced practice.
In BC, NPs practise autonomously. They do not need a physician’s order or supervision to:
Assess patients and make diagnoses
Order and interpret lab work, imaging and other diagnostic tests
Prescribe medications, including controlled substances
Refer patients directly to specialists
Manage chronic conditions such as diabetes, hypertension, asthma and mental health concerns
Serve as a patient’s main, ongoing primary care provider
In practical terms, an NP can do most of what a family physician does in a primary care setting. NPs are trained to recognize when a problem falls outside their scope, such as surgery or highly specialized care, and to refer or consult accordingly. Their nursing foundation also shapes their approach, with a strong emphasis on prevention, education and whole-person care.
Why NPs are a strong fit for primary care
Primary care is where most health needs are met: prevention, screening, early diagnosis and long-term management of chronic conditions. It rewards continuity, time and clear communication, all core strengths of NP training.
The research supports this. A 2018 Cochrane systematic review, among the most rigorous forms of evidence, pooled studies comparing nurses (including NPs) with doctors in primary care. It found nurse-delivered care probably leads to similar or better patient health outcomes and higher patient satisfaction. Nurses also tended to spend longer with patients, while prescribing and test ordering were about the same.
NPs have been licensed in BC since 2005, and their role has steadily grown. Today they are an increasingly important part of how the province connects patients to ongoing primary care.
Nurses: RNs, RPNs and LPNs
“Nurse” covers three distinct designations in BC, each regulated by BCCNM.
Registered nurses (RNs) typically hold a four-year Bachelor of Science in Nursing. They assess patients, plan and deliver care, give medications, monitor treatment, educate patients and coordinate care across teams. RNs can perform some activities on their own authority, but diagnosing conditions and prescribing generally require an order from a physician or NP. RNs who complete BCCNM certified practice can independently manage a defined set of conditions, such as contraception or sexually transmitted infections.
Registered psychiatric nurses (RPNs) specialize in mental health and substance use care. Licensed practical nurses (LPNs) complete a diploma of about two years and provide direct care, particularly for patients with stable, predictable needs.
Which provider is right for you?
For most everyday health needs, such as checkups, new symptoms, prescriptions, chronic disease management and mental health support, a nurse practitioner is an excellent choice as your main provider. NPs diagnose, treat, prescribe and refer independently, and often have more time per visit.
When you need surgery, a hospital admission or specialized treatment for a complex condition, a physician, often a specialist, leads that care, and your NP can refer you directly. Nurses deliver much of the hands-on care, monitoring and education throughout.
