Walk-in clinics have become the new normal for many Torontonians seeking care for their day-to-day and chronic medical concerns. This growing trend puts cash in clinic operators’ pockets but creates a negative feedback loop for patients and doctors who both miss out on a key tenet of medicine: the continuity of care.
“Although walk-in clinics are certainly useful in a jam and are very helpful, they are not meant to be used in place of a family doctor,” says Dr. Leigh Grant, a family doctor practising since 2000 and based in midtown.
“A walk-in clinic is there to solve an immediate time-sensitive problem such as a throat infection. But a lot of what takes place in family medicine is preventative. We manage routine screening tests, vaccinations, discussions about lifestyle measures.”
As Dr. Grant explains, a family medicine record is also the one place where all notes from specialists, test results, imaging, vaccinations should be gathered. It is difficult to chase records down from walk-in clinics if needed in the future.
“The family doctor has the most complex job out there,” says James Maskalyk, an emergency medicine and trauma physician at St. Michael’s Hospital. “They are responsible for synthesizing vital information and helping the patient both understand the different vernacular of the specialist and integrating it into their patient’s daily life. It’s easy for the specialist to say it’s not my problem, but everything is the family doctor’s problem.”
The excessive demands on family physicians make it difficult for them to make room for new patients and receive adequate remuneration.
Many family doctors feel they aren’t being adequately compensated for the face time, follow-up and paperwork required, and many young family doctors choose to work longer shifts in hospitals instead of opening up a family practice because it’s more lucrative.
Canadian Family Physician, the official medical journal of the College of Family Physicians of Canada, reported last year that burnout is estimated to afflict as many as 50 per cent of physicians and is more prevalent in disciplines such as emergency, critical care and family medicine.
Factors that negatively affect the enjoyment of practice include budget constraints, increasing workloads and system inefficiencies.
“It’s difficult to capture the cognitive work that is involved in doing general family care because it is more abstract,” says Maskalyk.
“Whereas it is pretty clear to say a gastroenterologist does a gastroscopy, the fee schedule neglects the work of being a general practitioner: finding out not just if medication is taken properly, but if what stands in the way is social difficulty, unemployment, or if the patient doesn’t have a cellphone, calling the pharmacy. It’s a lot more complex than it gets credit for.”
Maskalyk and other physicians argue that the current system is flawed and the pay structure rewards short-term medicine.
According to the Ontario government, more than 95 per cent of registered patients in the central Toronto area seeking a new family physician between February 2009 and March 2019 were connected to one. On the flip side, five per cent were not connected.
These are figures measuring the Ontarians who register in the voluntary Health Care Connect program. According to Statistics Canada, 89.2 per cent of residents in the Toronto area had regular access to primary care in 2016.
Dr. Sohail Gandhi, president of the Ontario Medical Association, the representative body of Ontario’s physicians, says there are many family physicians in Toronto accepting new patients.
The Ministry of Health operates Health Care Connect, where patients can find out which family physicians in their area are taking new patients.
“The priority of Ontario’s doctors is the health and well-being of every resident in the province,” he explains. “There are currently about 31,500 practising physicians in Ontario, including general and family physicians and specialists, who care for more than 340,000 patients a day. I understand the desire to look at numbers like physician to population ratios. But these are not the only measure of access or physician supply.”
Dr. Gandhi notes other factors, such as population density and need, and physician and practice characteristics are equally important.
Where a patient lives and what kind of care that patient requires impacts how readily that patient can access the doctors they need.
“For example, Toronto has a large number of homeless people, who require more intensive care and intervention,” he says. “Without factoring actual patient needs, it is difficult to do a direct comparison of whether needs are met.”
For those who haven’t found their preferred family doctor, Toronto has options for people with deep pockets. Private health and wellness programs, like Medcan’s M Care, charges a premium to have a consistent health team — same doctor, same nurse and same administrators — as well as same-day or next-day medical support throughout the year.
Dr. Elaine Chin, founder of a personalized medicine practice in Toronto, uses genetic medicine and other diagnostic tools to help patients get ahead of disease — think proactive rather than reactive medicine.
“One solution is to try to stay healthy and need to access the family physicians less often. That’s what our team does best. By using precision medicine diagnostics, we are better able to predict risks around onset of disease conditions and nutrient deficiencies, which can both impact optimal physical and mental health,” says Chin.
It’s become a point of pride for Canadians to boast about our health-care system. Critics of the system say our model, in reality, deserves a “sick-care” title instead.
“Family physicians use up a lot of their time outside of work reflecting and processing and following up with patients,” says Maskalyk. “That time and energy is not venerated in society nor supported by government nor admitted by the specialist.”