Cream skimmers

I expected a deluge of hate mail from the “cream skimmers” in response to my letter in the September BCMJ (2004;46[7]:322) suggesting that the walk-in clinician’s per visit fee be reduced to allow for higher per visit GP fees. My ego was in pain when there appeared to be no reaction at all. I was therefore most grateful to read Dr J.R. Dale’s letter in the November BCMJ (2004;46[9]:441-442) which attacked both me and my proposition.

I am unaware of any scientifically conducted study which compares the role of the walk-in clinician with that of the family doctor. That leaves me with anecdotal evidence only. I recall a young physician’s bragging to me that he had seen 60 patients in the walk-in clinic during one 5-hour session. I thought about the wonderful care that I receive from my GP who probably sees fewer than 20 patients in the same period of time and my interest was piqued.

I talked to a number of colleagues who, like Dr Dale, worked for years in family practice and then became walk-in clinicians. They were unanimous in one conclusion—that their financial reward/time-effort-worry rates had increased significantly.

I asked dozens of my referred patients for their views on the issues. Their most consistent response was that they attended a walk-in clinic for convenience when they regarded their problem as minor, but otherwise booked an appointment with their GP.

I agree with Dr Dale that there are good and bad walk-in clinics as well as good and bad family practices. I agree also that quality of care is the most important consideration. But, alas, these things cannot be controlled with a fee schedule. The problem which I intended to address in my September letter was the serious shortage of general practitioners. (I am fairly sure that there is no such shortage of walk-in clinics.) I must therefore repeat my proposition that walk-in clinic per visit fees be reduced and that the money saved be used to increase the per visit fee of the GP. Something has to be done to attract more family physicians and keep them in general practice.

—A. Krisman, MD
Vancouver