Why your walk-in clinic visits could mean trouble for your family doctor, and you

You’ve woken to a throat so sore you can barely swallow. Time to find a nearby walk-in clinic? Sure, it will probably be easier than trying to get in to see your family doctor. But if you live in Ontario, that walk-in clinic visit could hurt your doctor and put you at risk of being “de-rostered.”

Many don’t realize it, but when patients enrolled with a family doctor go to walk-in clinics, their GPs gets dinged. The docs receive a clawback on their “access bonus” -- a small fee Ontario doctors are paid for making themselves available to patients, even after hours.

Dr. Cathy Faulds, a family doctor in London, Ont. who served as president of the Ontario College of Family Physicians in 2014-15, says the way family doctors are paid in Ontario is complicated, but it is meant to encourage the creation of one-stop “medical homes” for patients to meet all their regular health care needs.

Most family doctors in Ontario now enrol patients onto a roster and then receive a lump annual sum for each patient. The system encourages doctors to offer full, continuous care to patients, rather than ask them to make separate appointments for each medical issue, the way they did in the old, fee-for-service model.

“Being rostered means a better doctor-patient relationship,” says Faulds. “...The model allows more time with the patient; it’s less of a bean-counting model.”

When a patient joins a doctor’s roster, that physician’s team commits to being available by phone and through extended office hours during evenings or weekends. In return, patients sign forms promising to call into the office when they have a sudden health issue so they see one of the doctors on the team.

But when a rostered patient goes to a walk-in clinic, the province has to pay the clinic’s doctor for the service. To recoup that money, it claws back the family doctor’s “access bonus.”

(Emergency room visits are a separate issue and don’t affect family doctor’s payments.)

Of course, patients have the right to choose to go to a walk-in, but it’s likely many don’t realize that the visit causes headaches for their family doctor. Doctors who believe that patients are going to walk-in clinics too often instead of calling them first can choose to de-roster that patient.

Being de-rostered doesn’t mean being “fired,” Faulds says. “They are not losing access to the doctor; it’s not the same as termination,” she says.

But it would mean that a patient could no longer access the other services at the family health group, such as consultations with clinic dietitians or social workers, or take advantage of special health programs such as diabetes or diet management.

The problem is that many patients are signing roster contracts at their doctor’s offices without fully understanding them.

Faulds says ideally, all doctors would sit down and explain how the roster system works, including its benefits, the patient’s obligations -- and the patient’s right to opt out altogether. But Faulds is not sure that’s happening.

“I agree there are patients who don’t understand their side of the equation,” she said. “And I don’t think the Ministry of Health has done much public education on this either.”

In fact, until recently, the province ran ads promoting walk-in clinics -- without mentioning the importance of calling on your family doctor first.

The CD Howe Institute agreed in 2013 that Ontario’s Ministry of Health should “expend more effort” promoting the roster model and explaining that patients have to do their part to make it work.

They even suggested that perhaps patients should pay part of the cost of their care “if they choose to go to an outside provider purely for reasons of convenience,” but noted that idea would be controversial.

Walk-in clinics aren’t going anywhere and they remain a good alternative for patients who need care fast and who can’t get in to see their family doctors. But as more family doctors move to working in groups through family health organizations, some patients are finding that securing same-day appointments with their family doctor has become easier.

The system is not perfect, says Faulds, but she believes the government has a role in getting the word out to patients about the most efficient ways to get care.

“From a patient perspective, I think we can do better. We can always do better, particularly at educating patients about the resources and how to use our health care system wisely. That falls on physician shoulders, but I think it also falls on the ministry.”