The Question: My child had a severe eye infection and I did not feel comfortable waiting nine days for the next available appointment with my family doctor. I took him to the local walk-in clinic and received much-needed antibiotics. My family doctor said if we go to a walk-in clinic again, we will no longer be his patients. He said we can only go to the emergency room. What's the real reason my doctor won't let me go to a walk-in clinic?
The Answer: The reason has nothing to do with concerns over the quality of medical care your son received at the walk-in clinic. It simply comes down to money. When you go to a walk-in clinic, instead of a hospital emergency department, your doctor gets financially dinged for it.
If that clinic billed Ontario for an intermediate assessment done on your son, for example, your doctor would lose $33.10 from his so-called access bonus because he's in a family health network; or in a family health organization or on a blended salary model. That, however, does not give him the right to threaten to fire you from his medical practice and it is highly inappropriate for him to suggest as much.
I called Ontario's Health Minister Deb Matthews about your question and she's heard other stories of doctors suggesting to patients they go to an emergency instead of a walk-in clinic, though not necessarily threatening to fire them.
"That is disappointing," Ms. Matthews says in a telephone interview, "the doctor would put their compensation ahead of the best possible care for their patient."
The health-care system, she said, is built for patients and they have a choice about where they go for treatment; new models of care aim to provide continuity of care by the same health-care provider or group of providers. However, Ms. Matthews added: "I know there is an issue in many practices still with getting the timely access to an appointment."
Patients sign rosters – where they agree to stay with a physician in a medical practice – typically to receive increased access to care through a team that provides treatment after hours and on weekends. Doctors are paid for a basket of services for each patient. While many other provinces are moving to systems similar to Ontario's, none have a formal rostering system.
According to Rick Glazier, a practising family physician at St. Michael's Hospital in Toronto, in that roster "there's no written requirement to see your patient in a timely way."
If you go to a walk-in clinic, it's as if the government paid for the service twice, so it takes that money out of the doctor's access bonus. If patients habitually obtain care outside the medical practice, doctors can remove them from the roster, but that does not mean patients are fired from the medical practice, said Dr. Glazier, senior scientist at the Institute for Clinical Evaluative Sciences.
Doctors, he said, can still provide care to patients off the roster by billing the Ontario Health Insurance Plan on a fee-for-service basis.
So that's the real reason why your doctor scolded and threatened you for going to a walk-in clinic: money. His behaviour is appalling. You may wish to seek further guidance from the College of Physicians and Surgeons of Ontario on how to deal with him in future.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.