In Ontario, do walk-in clinics complement—or compete with—primary care?

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  1. Graham W S Scott

    The only justification for Walk-in Clinics is the failure to have in place readily available Primary Care clinics. This is a serious policy failure in Ontario. Ontarians should have ready access and their engagement with a clinic should be recorded as part of their medical record. digital access and telemedicine all can provide effective solutions. Tthe problem rests in not having the policy flexibility and payment incentives that encourage primary care clinics that provide 24/7 access and appropriate record communication with the rest of the healtjh care system.

    • Lilian

      Here, here. Convenient office hours for family doctors are often inconvenient for patients and / or their caregivers. Quite frankly, family docs should take a page out of community pharmacy playbooks. If I can see a pharmacist at 8 PM on a Friday night, why can’t I see a family doctor? Maybe doctors should start to have offices in pharmacies and be more accessible to the public. We need interprofessional primary care hubs in places that are accessible to patients.

  2. Ed Weiss

    I’m a family doctor who practices in Toronto. I do think there is a role for walk-in clinics in our system, especially if it is to fill gaps in access, but only if they are done right. I completely agree with Dr. Glazier that in the context of an existing patient-physician relationship, the lack of continuity between walk-in clinics and a patient’s own family doctor can lead to serious trouble down the line. And while we all have horror stories about patients who were seen at a walk-in clinic only to be given an grossly incorrect diagnosis, this is not to say that walk-in docs are inherently inferior — only that without the insight that a patient’s history and context provides, it can be easy to be led astray and come to the wrong conclusion.

    I think, at minimum, that walk-in clinics should:

    1. Have access to the Ontario Laboratory Information System (OLIS) and ConnectingOntario (hospital record database) so that previous results can be accessed and duplication avoided.

    2. Maintain a list of family doctors in the area taking patients, so that those people who use a walk-in clinic and do not have a family doctor can find one.

    3. Identify a patient’s family doctor and communicate with them about the visit (unless the patient specifically requests otherwise).

    4. Avoid underhanded techniques, like asking patients to fill out rostering forms, which effectively “deregister” the patient from their family doctor.

    5. Avoid promotion of volume-based service. It’s not uncommon to see advertisements for walk-in clinics seeking doctors to “see up to 20 patients an hour.” This is not good medicine, even if it’s very lucrative.

    • Sheila

      What you say is true but continuity of same dr is not there in all the family practices . I’m seen by a different resident at each visit who have no clue what I came with during last visit. They have access to everything but never able to put it all together. Lots of things are missed unless I keep pointing out & then they go like “oh yes, I didn’t even see you had this”. Yes, residents need training but what about quality & continuity of care for me, the patient

    • John

      Do you suppose it’s okay to go to a walk in clinic if you’ve already talked to your family doctor over the phone about prior events and signs and symptoms, regarding a current medical issue, but they’ve disregarded alternative etiologies and diagnosis and have stated that they don’t want to run any tests or do further investigation? Would getting a second opinion be a problem?

  3. Paul Anderson

    Unfortunately, yes. Ontario does need walk-in clinics. If it were the case that the local GP’s office could always see patients in a timely manner, we wouldn’t need walk-in clinics. If it were the case that the local GP’s office was always able to take on new patients, we wouldn’t need walk-in clinics. If your GP never became burned out from working too large a practice, or less attentive or even somewhat blasé from treating the same patients for too many years, we wouldn’t need walk-in clinics. Walk-in clinics are an unfortunate necessity. Were it not for the quick action of doctors I have met in in walk-in clinics over the years, I might have lost a leg or even died by now.

  4. PS Bregmam

    Many people think of primary care as 1 or 2 doctors. Patients worried about convenience or travel time may be more interested in looking for a primary care practice if info about office hours and any arrangements for after hours or need urgent care. If a practice has a large number pf patients who commute an hour between work and home a link to an urgent care or walk in clinic.

  5. Vivian

    I’d like to offer a patient perspective on walk-in clinics. When I don’t feel like tolerating my family physician’s impolite behavior and ignorant comments, I am willing to wait two hours and take my chances at the walk-in clinic because there is a chance I may get a kind, curious person who will listen intently without interrupting and do a few tasks for me. Since our health system treats us like children and we need a GP to make specialist referrals for us, if my family GP refuses to do a referral for me, then I will ask for a referral from the walk-in GP. There are many advantages for patients to going to a walk-in clinic that is not at all connected to the family GP and there are advantages for patients to not having a central electronic health record system. If a doctor I see thinks I’m an anxiety ridden mess that is wasting their time, even if that is far from the case, and they write that opinion in a central system, every doctor I see after that who reads that note will be swayed by that opinion and likely not take me seriously and then my health suffers. If I want an independent, second opinion, I’ll go to a walk-in clinic. I’ve had some good experiences at walk-in clinics, but sometimes the provider will not help me with anything and will just say, “See your family doctor for everything”, which is hardly realistic and wastes my time and the doctor’s time. I don’t like the FHO, FHT system at all because it makes me feel trapped and if I decide to go to a walk-in clinic, they get mad at me. It’s an awful feeling. I don’t think they have the right to trap me and force me to sign enrolment forms when it takes three weeks to get an appointment and they don’t have extended hours at their office. They stop answering the phones at 4:00 PM for heaven’s sakes and the phone hours on Friday are almost non-existent. Right now, I see my family doctor on a fee for service basis even though she is in a FHO because I don’t want to feel trapped and she doesn’t want to be penalized for outside use. It works for us and I would encourage other patients to do the same if they feel trapped by the current system.

    • J

      You are so right! Thank you. My relationship with my family doctor is tainted because she got mad I went to a clinic. I’ve lost confidence in my family doctor as a result and no longer feel comfortable.

      • T

        I tried to get an appointment with my family doctor for an injured knee that took occurred at my place of work so had to fill out WSIB forms before I could return to work. Of course my family doctor didn’t have a appointment open so directed me to see a doctor in their “pool” of doctors.. I took time off work to see him and he refused to fill out my WSIB forms as he claimed it had to be my family doctor that filled them out… So long story short I went to the clinic and they filled out my forms and I returned to work. Shortly after this action my family doctor dropped myself and my 2 grown children from their practice (via letter) due to the fact I hadn’t been in to see her in 6 Ummmmm I had tried to see her but she forwarded me onto a doctor in their pool so how is this my fault??… I think in this case my family is a little too healthy to fund her lifestyle as I know both my kids haven’t been seen in years and I hadn’t been this year myself.

  6. Wendy Agardi

    In the past year I visited a walk in clinic i had some on going issues brought them to my Dr and tgey were passed by I took it to the walk in clinic and they actually found what was wrong and it changed my lufe. I was diagnosed with NAFLD non alcoholic fatty liver disease. My Family Dr brushed it off My symptoms were a full year running and he never persued my complaints. Im so Very greatful for walk in clinics and I choose to go to one before I even think of my Long term Family Dr.

  7. Bud

    I finally got a family doctor and had to sign a paper saying I would not use a walk-in clinic as it would cost him money. He only works 3 1/2 days a week. Phones aren’t answered after 4 p.m. No access on weekends or evenings. When I asked him what I should do if I needed medical care outside his hours, he said “Go to the emergency room at the hospital”. What a waste of taxpayers money. Maybe that is one of the reasons emergency rooms are full. What does a visit to the emergency room cost the health system? $500??? And how much money would my doctor lose if I used a walk-in clinic…$33. Sickening.

  8. Nat Jones

    Maybe if family doctors listened to their patients and were not afraid to send you for tests instead of saying you are just fine when really you have stage 3 Hodgkin lymphoma ppl would not go to walk in clinics but unfortunately my doctor thought he was God and missed my son’s cancer.

  9. John

    Walk in clinics help prevent Family Doctors from burning out.

  10. Beth

    I am currently sitting at a walk in clinic. I came at 10 a.m when it opened and granted it is a Sunday. There were 40 people here by 10:10. Many parents with small children – both parents and 1 child – most of these kids happily watching their shows on their iPads or parent’s phone. Sniffles and runny noses do not justify a trip to the walk in clinic. We have no patience anymore. It’s all about quick fix. Many parents can’t afford a day off for a child with a common cold but maybe need a note for work? This is how I have justified it anyway. I am here (as you may be wondering) for my eye that 36 hours ago was itchy and red and I thought it was a sty. I tried all of the famous remedies including warm compresses, antibiotic drops and Benadryl where it started swelling. This morning eye is closing. Even more red and now a pocket of fluid below the eye. Not good. I want to know what it is. I can’t wait until 2 weeks from now for the next family doc appt. We are a society that wants immediate results. As I am standing in line with 20 others and people who have checked in are actually leaving and told to return later – I notice the woman who is taking registration and calling people in and leading them to the back office is ALSO dabbing a Q tip in the test tube probably doing a swab for STREP. Are you kidding me right now? I am completely floored. She used her hand cleanser comes back to the keyboard and wants to take my health card ( in addition to the others she already handled). At the point I wonder why everyone isn’t walking around with eye infections. Just not acceptable. Almost left but only option is another walk in with longer wait time or hospital which then I will feel “guilty” cause I don’t feel that I am dying or going into cardiac arrest (almost did when she came back). I actually did ask her if she was going to wash her hands. She was taken aback – would not make eye contact (DUH then she would have saw my eye) and told me she used the hand wash which is more effective. OK WHATEVER!!! Had she been Pinocchio I would have had my other eye poked out! God please be a nice doctor and not make me feel like an idiot when I already feel like one for actually staying!

    • Beth

      Oh and now she is wearing a glove.

  11. Sandra Patterson

    I agree with your comment about a walk-in clinic usually being used by younger people with minor problems. My sister has told me that when I have a health problem I should find a local health clinic and go in. I wonder what I should do when I have bigger problems and what the worst a walk-in clinic will take before I am sent to somewhere like urgent care.

  12. Diane Anderson

    I am 68 years old and what started out as a family practise is no 90% walk in. It is not unusual for me to wait 3 to 4 weeks for an actual appointment to see my Dr. There have been times when I realize that my BP meds were getting low but the alternative is to sit in the walk in fo over 3 hours. He would only give 3 months prescription at a time until I challenged him for 6 months. Been seeing him for 25 years and there is wait time. He only see his patients one day a week and strictly does physicals one day. Absolutely no renewals by telephone. Incidentally I have used the same pharmacist for the same amount of time. If you want a physical it takes 2 to 3 concern is that Dr.s don’t necessarily like to take on seniors, they prefer young families. So my chances of getting another doctor while I still technically have on is slim to nil. I am not high maintenance, go 2X a year for prescriptions. This is unacceptable

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