Who Minds the Gate? Comparing the role of non physician providers in the primary care division of labour in Canada & the U.S

The gate-keeping role of primary care has been the most fiercely defended of the health care jurisdictions, but more recently it has become a less attractive form of medical practice. This has created an open market for the expansion of a variety of „substitute providers?. In this paper, I present comparative documentary and interview data from Canada and the U.S. on the changes and composition of the primary health care division of labour. What is revealed from this analysis is that: 1) there is a greater reliance on substitute health labour in the U.S. as evidenced by the greater number of and different kinds of primary care providers; 2) there is also a greater propensity in the U.S. towards specialization even of substitute providers; and 3) in both countries, substitute providers resist that label focusing instead on their own model of practice or niche within the primary care division of labour.