Systematically expand the role of Advanced Practice Nurses (APNs) and other non-physician clinicians in primary care, backed by mandatory quality monitoring, to close the primary care capacity gap without waiting for physician pipeline expansion.

Reform package: (1) Full practice authority legislation — APNs permitted to practice without physician supervision for 85% of primary care encounters (evidence shows equivalent outcomes); (2) Team-based care payment reform — change fee-for-service codes to team-based panel payments, removing physician billing monopoly that blocks task-shifting; (3) Quality monitoring infrastructure — all primary care practices regardless of clinician type must report standardized quality metrics quarterly; poor performance triggers graduated support, not shutdown; (4) APN training expansion — government-funded accelerated APN training programs with service obligations in underserved areas.

Evidence base: Vermont, Oregon, and Washington (US) full APN practice authority shows no measurable quality decline and 40% improvement in rural access. Canada's nurse practitioner-led clinics serve 500,000 patients with equivalent outcomes to physician-led practices. Implementation: 5-year phased rollout with annual quality monitoring and evidence reviews.