Re: The crisis facing family doctors

Dr A.M. Krisman of Vancouver wrote, “the walk-in clinics are cream skimmers…. (To) strike at the heart of the problem I would suggest…that without further delay walk-in clinic fees be reduced significantly and that the money saved be used to prop up the per visit fees of family doctors.” (He does not define what “the problem” is.)

I have worked in both walk-in clinics and in a family practice setting. Patients come to a walk-in clinic for different reasons. Some patients prefer the convenience of a walk-in clinic and have not tried to find a family doctor. Some patients can’t find a family doctor who will take them. Many patients who go to a walk-in clinic have a family doctor, but the doctor’s office is not open in the evening or the weekend, or the doctor’s office won’t give the patient an appointment for weeks. A couple of weeks ago, in Victoria, my patients were telling me that an emergency room was telling patients to go to any walk-in clinic because the ER was too busy.

A tragic situation occurred in Quebec 2 years ago due, at least in part, to a shortage of staff in an ER. In June 2002, a 51-year-old man with chest pain was turned away from the nearest ER. By the time he got to the next ER, 20 minutes later, he was dead (CMAJ 2004;171:321). The Ministère de la Santé is now proposing that all family practitioners sign up to work in the nearest ER. FPs who do not agree to the ministry’s proposal will receive 70% of their normal billings.

One problem that patients face is getting to see a doctor outside office hours. Walk-in clinics alleviate this problem, thereby diminishing delays in the ER. If Dr Krisman’s suggestion were enacted, fewer doctors would agree to work evenings and weekends in walk-in clinics, and more patients would go to the ER. Such congestion could interfere with the ER’s ability to manage patients with true medical emergencies. The implementation of Dr Krisman’s suggestion would cause more harm than good.

—Robert Shepherd, MD
Victoria