In the past 30 years there have been major changes in family practice. In the past, people generally had their own family doctor who managed all of their medical concerns. With the tremendous growth of walk in clinics we have seen a significant change in the way patients access care. We sometimes hear from patients that they go to walk in clinics for their “quick” items, but attend our office for complicated problems. This creates a lack of continuity of care and the current payment system is not set up to differentiate between simple and complicated care.
Continuity of care is extremely important and cost efficient. All the doctors in our office have access to your electronic medical record. Because we know your medical and family histories, we often have much more insight into the likely causes of a symptom than a physician at a walk-in clinic. This leads to less duplication of tests and less waste of precious health care dollars.
In an effort to provide continuity of care, family doctors have traditionally provided many services for which they are not paid. These free services are rarely provided by physicians in a walk in clinic setting.
These include:
- Keeping track of all your ongoing health issues. If you are seen in emergency, by a specialist or another doctor at our clinic, we make a point of keeping track of this and following up on ongoing concerns.
- Communicating information from any of your interactions with the health care system (specialists, hospital visits, pharmacists, etc.) to you and to other practitioners
- Maintaining and storing your medical chart . We collect reports from all other practitioners you see, tests that are done and your previous physicians. We maintain a comprehensive medical history and detailed patient summaries in your chart and keep this up to date. We are responsible to review and act on the information that is sent to us and to store it for at least 16 years after you leave the practice.
- Organizing your preventive health care. This includes keeping track of all the recommended preventive health interventions including PAPs, mammograms, colon cancer screening, immunization and cholesterol and diabetes testing.
- Providing emergency care 24 hours a day, 365 days a year – there is always a doctor on call at any time for urgent problems. Although the government has funded nurse line and on-call pay for specialists, we do not get paid for being on call!
- Participating in out of office care. All of our doctors see patients in hospitals, at home and in nursing homes.
- Completion of forms. The volume of forms to be completed has increased exponentially in the last decade.
- Dealing with your medical questions by phone. In a family practice we field dozens of phone calls each day with medical questions. We either answer the calls ourselves or provide an answer to your question to our staff, who then pass the information on to you. We will ask you to come into the office if we feel that we need to see you to answer the question.
Family doctors and walk in clinic physicians are paid the same fee per visit regardless of how many problems are addressed in the visit or how much time you spend with the physician. What has happened is that the complexity of care provided in each visit to a family physician has increased considerably. As a result of this vast differential of pay for the same number of hours of work, there has been a mass exodus of family doctors providing full service care and huge growth in the number of walk in clinics. Many patients now find themselves without a family physician at all. When full service family doctors retire, they are usually unable to find someone to replace them.
Selectively visiting walk-in clinics when it is convenient has made traditional family practice virtually unsustainable in an urban setting. We ask our patients to make a choice. For those individuals where the convenience of walk in clinic care outweighs the benefits of continuity of care provided in our traditional family practice, we ask that you transfer all of your care to the walk in clinic, so that we can give your space in our practice to one of the many patients on our waiting list.