Megan Diaz* started visiting the walk-in clinic at the mall near her apartment in Toronto after moving to the city for university a few years ago. She goes about twice a year, whenever she feels something is “off” with her body—a bad headache or diarrhea, or when she has a yeast infection. A couple of years ago, she went into the walk-in with what she thought was an anxiety attack; the physician who saw her thought differently, and referred her to a neurologist. “It turned out to be a seizure,” says Diaz, who now sees a specialist every six months for follow-up.
Walk-in clinics started cropping up in the U.S. in the mid-1970s as commercial “free-standing emergency centers,” but soon morphed mainly into an alternative to primary care. By 1979, they had migrated into Canada, with the first opening in 1979 in Edmonton. In 1986, Ontario had 12, and by 1988, there were more than 100 in the province. Today, the number is unknown; the province doesn’t track them. Many family practices offer walk-in services during regular business hours both to their own patients and to the public, and there are also after-hours clinics that are both attached and unattached to rostered practices (in which patients have signed an enrolment form and are assigned to a specific family doctor). And then there are urgent care clinics, which do not keep a roster of patients, are typically open outside business hours, and have the additional feature of being able to provide diagnostic services such as blood work and imaging on site.
Early literature on walk-in clinics in Ontario suggests that they were used by patients who considered their symptoms too serious to wait for an appointment with their GP but felt uncomfortable presenting in the emergency department. In the late ’90s and early 2000s, when there was a shortage of family doctors, walk-in clinics helped fill gaps in service. But what is their role today? Are they a critical complement to primary care or are they a duplication of service? Are they a symptom of “McMedicine,” a drive within the health care system to favour convenience over connection between patients and doctors? There is a dearth of data on walk-in clinics in Canada; the most recent study on quality of care and patient satisfaction is a decade-and-a-half old. A 2017 Cochrane Review seeking to compare quality of care and patient satisfaction in walk-in clinics against physician’s offices and emergency departments found no studies on which to base their research.
Still, walk-in clinics are looking more and more like a permanent fixture in Ontario’s health care system, with an ever-evolving role. Here’s a look at some of what we do know about them.
How walk-in clinics work
A “true” walk-in clinic sees patients with whom they (typically) have no ongoing relationship and without requiring an appointment. On the whole, they deal with acute and episodic issues such as urinary tract infections or pink eye, rather than preventive (such as cancer screening) or chronic (such as managing diabetes) ones. Many are owned by private businesses that provide physicians with physical and administrative infrastructure; doctors are paid by OHIP on a fee-for-service basis and direct a percentage of their payments to the clinic, which employs reception and nursing staff as it considers necessary. Some walk-in clinics, such as those owned by MCI The Doctors Office, which has more than 20 locations in the Greater Toronto Area, also have family practices on site, though Geena Sakellaris, a regional manager at MCI, estimates that about 70 percent of the business is comprised of walk-in services. Sakellaris describes the physicians who work at MCI walk-in clinics as running the gamut from new graduates trying to decide where and how they want to practise to veteran family physicians who have closed their own practices but want to keep working.
When patients enrol with a family practice, they sign a form agreeing not to visit walk-in clinics, though nothing prevents them from doing so, and they do not pay for these visits. However, if a patient is enrolled with a practice that is funded on the capitation model—in which their doctor receives a flat fee for a “basket” of services the patient is considered likely to need—the doctor is penalized for that walk-in clinic visit. A walk-in clinic visit about a cold, for example, for which the fee is $33, will cost their family doctor $33. There is a ceiling on how much a doctor can be penalized for each patient, but the system does create competition between family practices and walk-in clinics.
Why do people use walk-in clinics?
Rick Glazier, family physician at St. Michael’s Hospital and researcher at the Institute for Clinical Evaluative Sciences in Toronto, suggests there are four main reasons patients go to walk-in clinics: 1) They don’t have their own family doctor (about 800,000 Ontarians do not, according to the Ontario Medical Association); 2) they commute long distances between work and home and cannot get to their family practice within the hours that it’s open; 3) they aren’t able to get an appointment soon enough with their own doctor; 4) they choose to for reasons of convenience, frequently without calling their own family doctor first. A review of OHIP data from 2011-12 found that patients enrolled in rostered practices made 1.7 million visits to “outside” physicians. About 93 percent of these visits happened on weekdays, and in at least half of cases, the patients’ own practices had appointment times available when the outside visits took place.
The primary inefficiency with walk-in clinics, says Glazier, is that people often turn up at their family doctor’s office the next day. “They’ll say: ‘I got these orange-and-red capsules; I brought them with me. Do you think I should take them?’” says Glazier. “That happens very frequently.”
Glazier sees walk-in clinics as having a legitimate role in Ontario’s health care system, especially given that they are primarily used by younger people for minor problems. “It’s appropriate at that age and stage of life,” he says. It would be nice if walk-in clinics were affiliated with specific primary care groups, he says, and “it would be even nicer if they were linked to the whole system.” In the absence of electronic medical records that patients can access themselves and also provide access to, Glazier says it would be helpful if walk-in clinics even just sent him a fax. “A simple one-pager, ‘I saw the patient for a sore throat, took a swab, and prescribed this antibiotic,’” he says. “In my experience, that’s extremely rare.”
Do walk-in clinics increase access?
Leo Liao thinks walk-in clinics can significantly increase access, and in a very specific way: through the use of telemedicine. Over the past two years, Liao’s company, Good Doctors, has opened more than 20 walk-in clinics in Ontario. Patients come into a small bricks-and-mortar facility—perhaps two rooms adjacent to a pharmacy—without an appointment, and are assessed by an RN or RPN who then emails the assessment to one of five or six doctors (often in Toronto or Ottawa) on shift. The doctor “sees” the patient through the Ontario Telemedicine Network, a secure technology that is free to physicians. The presenting symptoms are typically “simple things,” says Nicole Anderson, the RPN who runs the Good Doctors clinic in Thunder Bay—rashes, UTIs, prescription refills.
Anderson sees between 10 and 20 people a day, most of whom, she says, don’t have a family doctor. And in the very small communities Good Doctors is hoping to enter—right now they are speaking to several north of Thunder Bay, and already have a clinic in Aamjiwnaang, a First Nation community of about 2,300 outside Sarnia —primary care isn’t even available. Clinicians—often nurses—fly in every few weeks, but, as Liao points out, it might be a different person each time. “It’s much harder to build a relationship,” he says. “If you have someone local to guide you through the system, it makes the whole encounter a lot easier.”
So is walk-in telemedicine a potential solution to reaching underserved, isolated settings? Not a long-term one, according to Sarah Newbery, a family physician in Marathon, Ont. “Some access is better than no access,” she says. “But we should be working to ensure that people have equitable access to the kinds of primary care services that we know actually create an effective health care system.”
First and foremost, for Newbery, this is about continuity. “It’s important for us to be aware of the importance of convenience for people,” she says. “[And] you don’t need a relationship with a patient to treat their UTI or their pink eye. But the value of treating those things in the primary care setting is that it builds the relationship so that when the problem is a cancer diagnosis, or a child who’s committed suicide, or a partner who’s got a terminal illness, [then] you can see someone with whom you’ve built your relationship over time.”
Megan Diaz has never told the walk-in clinic she visits about her follow-up with the neurologist. The doctor who made the original referral has since left the clinic, and “it just hasn’t come up in regards to what I’ve gone there for,” she says. Diaz still has a family doctor in her home town—the same one since childhood—and she still sees him once in a while. She’s no longer in school and plans to stay in Toronto. On the question of whether she will look for a family doctor there, she is on the fence. The familiarity of seeing the same person “is really comforting,” she says, “but it’s just the inconvenience.”
*Name has been changed to protect privacy
The comments section is closed.
Walk in clinics MCI are the absolute worst in Toronto. None of the front line staff speak proper english, they don’t udnerstand you, you can’t understand them, the doctors are casual, dismissive and cocky. At least 99% of them anyway. It’s a travesty that the politicians have ruined our health care system to this degree that I don’t think we can ever recover. It just keeps getting worse. these bad doctors should all be fired.
Family doctor system in Ontario is very controlling – like the doctor owned my body and I had no choice about anything and if I dared to question why was so sick and getting no help – I was penalized. This system destroyed my life and allowed for doctor negligence to my brain disorder to the point of killing me. When doctor forced me to take drugs that I knew would help but he scared me by saying he’d fire me and get my pension cut off if i did not take it – I did and went into shock, rushed by ambulance to hospital where he illegally incarcerated me. Only by a friend in Toronto calling the Sudbury Hospital and threatening police did I get release and it took me 22 years with the help of Americans to discover that I had Parkinsonism since 1947 and by negligence it simply became terminal. Make a long story short – I am prescription drug free over 30 years, refuse to have a family doctor and use the clinics for hospital emergency dept when necessary and would rather die than ever have a family doctor in Canada again.
correction I new THE DRUG WOULD NOT HELP THAT I WAS FORCED TO TAKE.
We are getting a new Urgent Care in Oshawa on Bond Street W. Do they take private patients?
How does someone who has never had a family doctor get their medical records?
I’ve been 23 years on a provincal list. My youngest son has never ever had a doctor.
On PEI the wait is about 11 years, to get a primary health care provider, Northern Ontario is worse.
I’ve spoken with PEI health and been assured that the ONLY access to medical care I have, a walk-in clinic, is NOT my “primary health care provider”. I wonder who is? What records do they keep? Who reads them?
How can I access preventative health care with only walk-in clinics available to me? How do I get any of my medical records? Who would look at them once I get them? Who would they even go to?
Are there any regulations for the walk-in clinic to keep my records?
So far the “system” has failed alot of people and created significant stratification of access. It’s a two tired system of “have and have not”. Add to that the difference in care when you don’t have medical insurance for drugs.
Doctors at a walk-in clinic always ask aboutinsurance. They won’t prescribe any maintenance medication if you don’t have any insurance, even for schizophrenia (also personal experience).
My father went to the same neighbourhood walk-in clinic 10 different times over the course of a year before he went to a hospital. The hospital diagnosed terminal bone cancer (with a stale date of less than 4 months).
So, complaining about medical records seems to be the most minor of concerns in the walk-in clinic disaster.
If you have a doctor, count you blessings. If you have insurance, you’re part of the “have” not the “have not” class.
It’s 3rd world medical care for the rest of us.
Our primary care doctor has at least 2 registered practical nurses assisting him, and yet still in times of this pandemic we can wait a month to get a video appointment.
How can they justify this ?
My current family doctor I found after moving to the city works out of a walk-in clinic and my visits with her feel very much like a walk in. Often she doesn’t remember what we spoke about previously, she doesn’t ask about the results of tests she requested, and when I go to her, I am only allowed to have 1 concern to speak to her about. I don’t feel that I have that therapeutic relationship with her and I often don’t book appointments with her regarding certain things I think are important because of this.
While I agree that there is a place for walk-in clinics, it really seems that, at least in the larger cities like the GTA, they are the majority, and the holistic approach to patient care is left to hometown doctors in rural areas. I very much agree with Ed Weiss in that practices need to change to allow the exchange of information and the facilitation of patient care across the offices.
My current family doctor I found after moving to the city works out of a walk-in clinic and my visits with her feel very much like a walk in. Often she doesn’t remember what we spoke about previously, she doesn’t ask about the results of tests she requested, and when I go to her, I am only allowed to have 1 concern to speak to her about. I don’t feel that I have that therapeutic relationship with her and I often don’t book appointments with her regarding certain things I think are important because of this.
While I agree that there is a place for walk-in clinics, it really seems that, at least in the larger cities like the GTA, they are the majority, and the holistic approach to patient care is left to hometown doctors in rural areas. I very much agree with Ed Weiss in that practices need to change to allow the exchange of information and the facilitation of patient care across the offices.
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 years.my 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
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.
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!
Oh and now she is wearing a glove.
I decided to stop reading after this comment. Getting sick in Canada sounds like the worst thing to happen to you…I think I would just take a flight out to India or Cuba
Walk in clinics help prevent Family Doctors from burning out.
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.
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.
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.
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.
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.
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 months..lol. 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.
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.
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.
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.
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
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?
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.
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.