Jeff Purkis’ letter in the March issue ("Please fix walk-in problem" [BCMJ 2001;43(2):71]) describes very clearly the urban family practice reality. During my last 7 years of practice I coordinated the UBC Department of Family Practice Residency City Site. All of the residents received training in the urban practices of community family doctors. Although they enjoyed working in these practices and had great respect for their teachers, who they felt practised family medicine as it should be practised, very few of these new doctors were prepared to become committed to the financial realities of a quality full-service family practice.
We urgently need a new payment system that values continuity of care. My bias is for medicare to pay only for services rendered by the clinic in which patents are registered. In other jurisdictions where this occurs there is experience in defining the exceptions to this rule such as for emergencies, referrals, specialty care, and travel.
—Arthur Van Wart, MD
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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