In the past 15-20 years we have seen major changes in family practice. When we started practising, most patients in Canada had a family physician. People generally saw their own physician for most medical problems-big and small. With the tremendous growth of walk in clinics we have seen a significant change in the way patients access care in our community. We sometimes hear from patients that they go to walk in clinics for their “quick” items, but attend our office for complicated problems, lists of problems, when they are in distress, or when they need physical exams, PAP tests and ongoing care.

This does not work for two reasons:

Lack of continuity of care The payment system is not set up to differentiate between simple and complicated care

Continuity of care is extremely important and cost efficient. Because we know our patients well and are familiar with their past and family medical histories, we often have much more insight into the likely causes of a symptom than a physician who is just meeting you for the first time. Seeing different physicians leads to the duplication of tests and wastes 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: As your family doctor we feel responsible to keep up to date on your health concerns. 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. The family doctor has the central role in ensuring that information from any of your interactions with the health care system (specialists, hospital visits, pharmacists, etc.) is communicated to you and to other practitioners who need to know this information. We often know 2 or 3 generations of a family which provides us with a rich context in which to understand our patients’ concerns. Maintaining and storing your medical chart –we collect reports from all other practitioners you see, tests that are done and your previous physicians. 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. We give you reminder calls when you are overdue for a test. Maintaining a comprehensive medical history-when you join the practice we often spend considerable time documenting your medical and family history. We may spend even more time reading through all charts from previous doctors –sometimes these are 2-3 inches thick! We maintain detailed patient summaries in your chart and keep this up to date. Providing emergency care 24 hours a day, 365 days a year –the six of us share the responsibility of being available 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, while walk in clinic physicians see a series of patients with less complex problems and earn considerably higher income. Walk-in clinic physicians are asking the government to cancel the policy preventing them from getting paid for seeing more than 65 patients a day. At Bayswater Family Practice we are rarely able to see more than 25 patients even on the busiest days because of the complexity of the problems we are dealing with during a typical office visit. 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. We liken the situation to what happens to your neighbour corner store when Walmart comes to town.

We recognize that there are times when people feel that a walk in clinic provides the convenience of being seen for routine care on a weekend or “right next to their office”. However, this pattern of selectively visiting walk in clinics when it is convenient has made traditional family practice virtually unsustainable in an urban setting. We ask that our patients 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.

The Doctors of Bayswater Family Practice