The College remains very concerned about the circumstances of people who are unable to access a primary care physician. However, the College’s legal authority and mandate are limited to the conduct and performance of individual physicians. Its role in promoting system improvements is supportive.

It is important to consider Dr Keith White’s quote from the College standard, Access to Medical Care, in context. The advice not to charge for initial visits appears in a section headed “Refusal to Accept a Patient,” and refers specifically to introductory meetings with prospective patients for the primary purpose of determining whether to accept them.

The Inquiry Committee of the College does receive complaints from patients who have been rejected by physicians on the basis of screening visits, usually alleging discrimination. Article 16 of the CMA Code of Ethics outlines the requirements, which must be met when physicians establish fees for uninsured services, including consideration of both the nature of the service provided and the ability of the patient to pay. On that basis, charging for screening visits may be considered unprofessional.

The College recognizes the significant upfront investment required when a new patient joins a practice, but must look to Doctors of BC and the Medical Services Commission to ensure that this is adequately compensated. Attachment fees seem to be a step in the right direction. Charging privately for screening visits, perhaps contrary to the College standard and CMA Code of Ethics, cannot be a substitute for thoughtful amendments to the insurance payment schedule to support continuity of care.
—Gerrard A. Vaughan, MD
President, College of Physicians and Surgeons of BC
—Heidi M. Oetter, MD
Registrar and CEO, College of Physicians and Surgeons of BC