Research Paper on "Analyzing Canadian S Choice for Walk in Clinic Visits or Continuity of Care by Family Doctors"

Research Paper 18 pages (7314 words) Sources: 8 Style: APA

[EXCERPT] . . . .

d.).

The Ontario policy that physicians are responsible for offering all their patients longitudinal care, encompassing all the regular health checks raised a lot of concern among stakeholders. This prompted the provincial college's registrar to respond; she did so by explaining that the new policy was a combination of several other policies that were already in use. Moreover, that the policy does not mean that a single visit to a clinic is sufficient to lock the facility as the visitor's primary care provider. However, for reference purposes, it is assumed that such a facility would be providing the visitor or patient with long-term care.

One might have to wait for a few minutes at the reception, but he or she will have his or her sore throat or runny nose checked in a few minutes (Mertl, 2015). That is not the problem, in fact, in that way one can see how useful such walk-in clinics are. However, at what point should a regular visitor to such walk-in clinics be forced to register as a patient? Now that these facilities are handling almost the same healthcare duties as hospitals, should they be regulated in the same way?

Report

One of the biggest healthcare headlines in 2012 was the declaration by the Ministry of Health in B.C. (British Columbia). that everyone would have a family doctor by 2015. This was a big headline because millions of Canadians do not have the services of family doctors and if a provincial government can make evidence-based plans to tackle that problem in only three years with very little cost, then such a declaration would definitely be a noteworthy event (Picard, 2012). However, a closer look at the press release by the Ministry of Health reveals what the minister really promised. He said that every resident of the province who is looking for a family doctor, would have one. This reveals the situation underlying the current problem. The problem is not that Canada has a shortage of doctors. The problem is that most of the people without a physician are not specifically seeking one. Thus, the solution is not simply training or hiring more physicians.

In numbers, about four million Canadians do not have a family doctor. However, Statistics Canada argues that over 54% of the people in this group are not actually looking for one (Picard, 2012).The rest who are looking for a physician and have not found one have cited three main reasons:

Their doctor recently retired or moved;

The physicians in their areas are not registering any new patients; and That there are no doctors offering care services in the areas where they live.

However, the majority of individuals who apparently cannot find a doctor, said that they have access to community health centers, walk-in clinics and hospital emergency departments (Picard, 2012). While emergency departments and walk-in clinics are not the best ways to deliver primary care, the situation is that only less than 350,000 Canadians have no place to go to when in need of care. Thus, the situation is not as dire as is perceived. This is in fact a very good position for a country of more than thirty million individuals and this provides a much different reality from the often cited four million Canadians. However, back to what the B.C. Health Ministry promised. Apart from what the ministry promised, it is crucial to look into what it didn't exactly say (Picard, 2012). The ministry did not say that it was going to recruit more physicians neither did it say that the existing physicians were going to have to take more patients under their care. In fact, the ministry emphasised the opposite, that its new policy did not mean any physician would have to work for more hours or that they would have to increase the patients they take in. So it is interesting to ask, in which way is the province going to provide family doctors to those who are looking for one without forcing doctors to increase their patient numbers or to do more work?

Issues causing Policy Concern

Family Doctors:

For the past few years, the number of physicians in Canada on government payroll has been increasing. For instance, in 2012, Canada had at least seventy-five thousand doctors working and the federal government was paying them approximately 22 billion dollars for their services. The number of physicians per every hundred thousand people has also been increasing, and as of 2012, the figure was 214 doctors for every 100,000 Canadians (Andreatta, 2013). According to Andreatta (2013) number of doctors is expected to rise significantly as Canadian medical schools continue to graduate record numbers of doctors, and more physicians from abroad relocate their services here. The growth in number of doctors was highest in rural provinces, having highest shortages. For instance, statistics show that in the last five years, the number of doctors in rural provinces has risen over five times faster than the national population growth. However, according to the researchers at Statistics Canada, the growth has not matched the rural population i.e. despite the percentage of people in rural Canada standing at 18%; only 8.5% of Canadian doctors serve this population.

For the majority of people in rural Canada, getting a family physician is a choice and not a must. The majority of these individuals have their needs met at walk-in clinics. However, quite a significant proportion of the 4.4 million Canadians in rural areas reported that they do not have a place to get continuing care. According to Professor Tom Noseworthy (as cited by Andreatta (2013), the problem is not really shortage of doctors but their distribution. Furthermore, the professor argues that the kind of training received in Canadian medical schools is not well-matched with the current market needs -- And that this has led to an undersupply of family physicians in the country.

In a recent study published in the Canadian Family Physician, the journal interviewed 18 residents of Ontario who had recently lost their family doctor. The study established that most of these individuals were frustrated in their search for a new doctor. One of the interviewees stated that he felt like he was applying for work and that he knew that he could have problems finding a doctor if a person's care needs are too many or with regards to the burden one was going to add to a practice (Milne, et.al, 2014). Various medical colleges around the country have reported receiving complaints about clinics not accepting patients and only picking those with the least problems, despite these colleges having standards and policies against such practices. Such issues have brought about heated discussions on the common introductory meeting, with some wondering whether it is opportunity for physicians to screen potentially time-consuming patients or for them to present their services and to look whether the patient could benefit from it. It is also known that new healthcare funding models will likely be favoring pick-and-choose like the old ones did. Thus, it is important to investigate how deep does this issue run? And, what can be done to turn the tide?

Physician payment models in Ontario are part of the problem. Capitation, which was introduced in the last few years, has become quite popular. More than four thousand of Ontario's family doctors are already on this payment model, which reimburses physicians based on the number of patients they treat per year and not per visit (Milne, et.al, 2014). In the conventional payment model, the doctors were paid for service. According to Mark Dermer, a family physician in Ottawa, fee-for-service did not provide much incentive for physicians to cherry-pick as the new model of pay does. Under the new model, the pay is only adjusted based on the gender and age of the patient but not how severe his or her illness is. This means that doctors would be paid the same amount of money for a 50-year-old patient who came to their facilities once a year as for a one who came to their facility every month of the year. Doctor Dermer concludes that the new system is flawed, since it provides doctors with the incentive to cherry pick.

Why some Canadians do not have doctor challenges

As mentioned before there are a myriad of factors, why some Canadians are not attached to a family physician, including: lack of planning; increase in population through immigration and closure of practices. However, it must be said that patients can get regular health care even as they remain unattached to a family physician. This is exactly the case for those who regularly visit walk-in clinics. In Canada, much like in the United States and Australia, walk-in clinics provide care without appointments (Crooks, et.al, 2012). In other words, anyone can simply walk-in a get the care they need. While some of these clinics might allow their visitors to ask for specific doctors, most of them do not do so.This is owing to the fact that the walk-in clinic… READ MORE

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