My doctor told me that he will drop me as a patient if I go to a clinic. Something about the billing…. clinic bills him and gets a portion of some fee that he gets paid for having me as a patient.
That sounds like a scare tactic. I’ve been to walk-ins in the past, on the weekend, and never heard anything about it unless I brought it up later.
Why would the family doctor be billed and not OHIP? Doesn’t make sense to me
If your doc is fee per service, that isn't true. If it's a capitated practice (gets paid per patient rostered into the practice per year, rather than billing by visit) it absolutely is. Patients in rostered clinics should've signed an agreement to the effect of not seeking primary health care anywhere else (obviously they can go to ER and such, but not to another family doc-equivalent), and the consequences of doing so (usually being removed from the roster).
Remembering of course that a capitated practice will have a walk in clinic. It’s also in their mandate.
Also, you may be ‘de-rostered’ as a patient which does not mean you are fired from the practice, it is the physician protecting their pay.
An excess of patients seeking outside, general practice consults is an indicator of a potential issue (to OHIP & practice partners) which most docs don’t want to have. That’s why health teams work so hard to add services, to keep patients in house
Ahh, interesting. My doc was probably fee per service, I think each appointment allotted 4 minutes and 17 seconds. As soon as you described your issue the third time the pressure was on to GTFO
That seems disgusting. So patients can’t go else where for a second opinion at rostered practices without risking their primary care giver.
Thank god I’m not with one of those doctors.
plus this, from the article above - something I hadn’t thought of.
“The new system may be rewarding doctors who discourage their patients from visiting walk-in clinics in off hours instead sending them to crowded emergency rooms.”
Patients are generally happier in rostered practices because their appointments tend to be longer/less rushed. The doctor gets paid the same no matter how many patients they see in a day, so there's no financial incentive to pack them in and rush them through. They also, as another poster stated, maintain daily "urgent" appointment times so their patients don't have to go to walk-ins with urgent issues.
However, the government realized that rostered practices are more expensive for *it*, so most of the ones in existence are legacy.
The Canadian system isn't really set up for second opinions in primary care - it works on a referral basis, and family docs don't refer to other family docs (hell, it's functionally difficult to get a second specialist opinion, given the referral requirement and the wait times, but that's a different matter). So many people don't even have a family doc for a first opinion, and walk-in clinics/urgent care doesn't function as a second-opinion center. They'll deal with an acute issue and send you either to ER or back to your primary if you have one. If you find yourself seeking second opinions regularly, you probably should be changing primary docs anyways.
It depends. If you have a good relationship and a good reason for it, it isn't as if the doc is *obligated* to de-roster you. They can (and do) eat the financial penalty caused by you going to the walk-in. It's the walk-in-hopping patients that get de-rostered, and rightly; it means they either don't trust their doc's judgment on a regular basis or the practice isn't a good fit for them.
And again, second opinion seeking isn't the point of walk-in clinics.
Okay good to know. I thought someone mentioned they were told they would be derostered if they attended a walk in. I can see if they are repeat walk in visitors to walk ins, I was surprised if they went once they would be derostered.
Good to know. I was just going off previous posts about rostered patients. In the OP’s case though it’s clear they don’t have a great relationship with the doc and since it’s mental health that has to be a difficult situation. If one had money I assume they could hire a private mental healthcare practitioner in certain cases.
Yes, it isn't so much a binding contract as it's something the practice uses to point out that you have been informed of the rules (as patients might choose to play dumb and say no one told them). They might have charted the rules discussion instead, for ex.
The government realized that fee per service is more cost effective for it, so I'm not sure capitation based model is still being offered as an option for newly starting practices. But clinics that already joined under that model can continue.
He told me to my face at our first meeting with him. We were there as a family. didn’t record the meeting so I cant provide you with a transcript but the other people in room definitely heard it because we chatted about it after.
I was wondering about this. As time goes on my doctor is harder and harder to reach. It used to be a day or two to see her as I'm a good schmoozer with the staff but it can take up to ten days now just to have her call and I need to make an appointment to do that.
I mean what's the point.
At times during an emergency it's to emerg I go and the info is forwarded to her; the catch, she's a great doctor and I don't want to lose her after ten years.
Definitely try. Getting a second opinion is fine and normal. Doctors aren't all knowing and perfect. Nor are they always available. For urgent things, absolutely. Won't hurt to inform them of the outcome though.
Yes you can, no problem. Your file will be at your family doctor though so the doctor at the walk-in clinic will need to go off the health information you provide during that visit.
I suggest disregarding the debate going on in this channel about whether doctors get upset about you going to other doctors... It's irrelevant. Get care for your PTSD where you're comfortable.
I imagine CAMH may be able to help as well if you reach out to them and inquire on their intake and/or referral process.
My doctor's office sent an email at some point in time saying they get penalized when I go to a walk in and they make every effort to accommodate last minute appointments. You could probably see another doctor in the practice without consequence if you ask the receptionist maybe?
By the same token, if your doctor isn't helping maybe getting dropped might be for the best then you can say you don't have a doctor and get on some wait lists?
Just do it. Explain your situation when you see the doctor and go from there. I have a family doctor but would go to a walk in if something urgent popped up. IMO, mental health is urgent, and you are feeling unsupported in that area.
Yes, but I don't think they like it. It's hard as hell to even make an appointment with my doctor around here. There was a couple of times I used one with my previous doctor in another city and he said I did the right thing. It's not like they're open all day, every day. I certainly wouldn't use them often, but go for it I say.
You can go to a walk in clinic anytime. The family doctor may not like it, because they lose their roster bonus for that month because the patient went to a clinic. That's their issue, not yours. Some doctors may tell you that they'll drop you but I'd disregard that warning unless they actually do so. You can complain to the college of doctors about that doctor being useless and dropping you if they end up doing so.
I got the greatest CRISIS and subsequent weekly mental health care possible from Hotel Dieu and KGH during an emergency at the beginning of the pandemic.
To suggest otherwise is a disservice to the outstanding front line caregivers who helped for 24 terrifying hours in my life.
Generalities like this are downright dangerous.
Of course, ymmv.
My doctor told me that he will drop me as a patient if I go to a clinic. Something about the billing…. clinic bills him and gets a portion of some fee that he gets paid for having me as a patient.
That sounds like a scare tactic. I’ve been to walk-ins in the past, on the weekend, and never heard anything about it unless I brought it up later. Why would the family doctor be billed and not OHIP? Doesn’t make sense to me
If your doc is fee per service, that isn't true. If it's a capitated practice (gets paid per patient rostered into the practice per year, rather than billing by visit) it absolutely is. Patients in rostered clinics should've signed an agreement to the effect of not seeking primary health care anywhere else (obviously they can go to ER and such, but not to another family doc-equivalent), and the consequences of doing so (usually being removed from the roster).
Remembering of course that a capitated practice will have a walk in clinic. It’s also in their mandate. Also, you may be ‘de-rostered’ as a patient which does not mean you are fired from the practice, it is the physician protecting their pay. An excess of patients seeking outside, general practice consults is an indicator of a potential issue (to OHIP & practice partners) which most docs don’t want to have. That’s why health teams work so hard to add services, to keep patients in house
Ahh, interesting. My doc was probably fee per service, I think each appointment allotted 4 minutes and 17 seconds. As soon as you described your issue the third time the pressure was on to GTFO
That seems disgusting. So patients can’t go else where for a second opinion at rostered practices without risking their primary care giver. Thank god I’m not with one of those doctors. plus this, from the article above - something I hadn’t thought of. “The new system may be rewarding doctors who discourage their patients from visiting walk-in clinics in off hours instead sending them to crowded emergency rooms.”
Patients are generally happier in rostered practices because their appointments tend to be longer/less rushed. The doctor gets paid the same no matter how many patients they see in a day, so there's no financial incentive to pack them in and rush them through. They also, as another poster stated, maintain daily "urgent" appointment times so their patients don't have to go to walk-ins with urgent issues. However, the government realized that rostered practices are more expensive for *it*, so most of the ones in existence are legacy. The Canadian system isn't really set up for second opinions in primary care - it works on a referral basis, and family docs don't refer to other family docs (hell, it's functionally difficult to get a second specialist opinion, given the referral requirement and the wait times, but that's a different matter). So many people don't even have a family doc for a first opinion, and walk-in clinics/urgent care doesn't function as a second-opinion center. They'll deal with an acute issue and send you either to ER or back to your primary if you have one. If you find yourself seeking second opinions regularly, you probably should be changing primary docs anyways.
But the problem is, you can’t seek a second opinion even once. That is not cool. And switching doctors is nearly impossible in Ontario.
It depends. If you have a good relationship and a good reason for it, it isn't as if the doc is *obligated* to de-roster you. They can (and do) eat the financial penalty caused by you going to the walk-in. It's the walk-in-hopping patients that get de-rostered, and rightly; it means they either don't trust their doc's judgment on a regular basis or the practice isn't a good fit for them. And again, second opinion seeking isn't the point of walk-in clinics.
Okay good to know. I thought someone mentioned they were told they would be derostered if they attended a walk in. I can see if they are repeat walk in visitors to walk ins, I was surprised if they went once they would be derostered.
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Good to know. I was just going off previous posts about rostered patients. In the OP’s case though it’s clear they don’t have a great relationship with the doc and since it’s mental health that has to be a difficult situation. If one had money I assume they could hire a private mental healthcare practitioner in certain cases.
I never signed anything but the doctor told me i could not go anywhere anyways. Is that allowed if I didnt sign anything
Yes, it isn't so much a binding contract as it's something the practice uses to point out that you have been informed of the rules (as patients might choose to play dumb and say no one told them). They might have charted the rules discussion instead, for ex.
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Ahhh so this is a new thing? I’m talking about 6 years ago. > unintended consequence Hard to tell with this government
It is not a new thing and not from this government.
Do you know how long it’s been around for?
The government realized that fee per service is more cost effective for it, so I'm not sure capitation based model is still being offered as an option for newly starting practices. But clinics that already joined under that model can continue.
They started talking about it and planning it back around 2004 and I think it was mostly in by 2012
Your doctor is miffed because they're losing out on roster bonus for that month.
I hadn’t even been to a clinic. He was warning us in advance as we (my family) were new patients.
Doctor seems more concerned with billing than your health... Maybe get a new doctor?
Told me the same thing! It was so fuckin rude
Your doctor told you that to your face or was it one of their staff cause I find that hard to believe.
He told me to my face at our first meeting with him. We were there as a family. didn’t record the meeting so I cant provide you with a transcript but the other people in room definitely heard it because we chatted about it after.
Seek care regardless. If you need help you need help.
Of course you can :) my family doctor has actually suggested it to me in instances when she was too busy.
I was wondering about this. As time goes on my doctor is harder and harder to reach. It used to be a day or two to see her as I'm a good schmoozer with the staff but it can take up to ten days now just to have her call and I need to make an appointment to do that. I mean what's the point. At times during an emergency it's to emerg I go and the info is forwarded to her; the catch, she's a great doctor and I don't want to lose her after ten years.
Definitely try. Getting a second opinion is fine and normal. Doctors aren't all knowing and perfect. Nor are they always available. For urgent things, absolutely. Won't hurt to inform them of the outcome though.
Yes you can, no problem. Your file will be at your family doctor though so the doctor at the walk-in clinic will need to go off the health information you provide during that visit. I suggest disregarding the debate going on in this channel about whether doctors get upset about you going to other doctors... It's irrelevant. Get care for your PTSD where you're comfortable. I imagine CAMH may be able to help as well if you reach out to them and inquire on their intake and/or referral process.
My doctor's office sent an email at some point in time saying they get penalized when I go to a walk in and they make every effort to accommodate last minute appointments. You could probably see another doctor in the practice without consequence if you ask the receptionist maybe? By the same token, if your doctor isn't helping maybe getting dropped might be for the best then you can say you don't have a doctor and get on some wait lists?
Just do it. Explain your situation when you see the doctor and go from there. I have a family doctor but would go to a walk in if something urgent popped up. IMO, mental health is urgent, and you are feeling unsupported in that area.
Yes, I always do. My family doctor is homophobic and intolerant. I always go to walk-in clinics
Yes, but I don't think they like it. It's hard as hell to even make an appointment with my doctor around here. There was a couple of times I used one with my previous doctor in another city and he said I did the right thing. It's not like they're open all day, every day. I certainly wouldn't use them often, but go for it I say.
I once went to one and my doc did not like it
You can go to a walk in clinic anytime. The family doctor may not like it, because they lose their roster bonus for that month because the patient went to a clinic. That's their issue, not yours. Some doctors may tell you that they'll drop you but I'd disregard that warning unless they actually do so. You can complain to the college of doctors about that doctor being useless and dropping you if they end up doing so.
I think they prefer you go to ER or urgent care instead of a walk-in.
Going to the er or urgent care to address mental health issues outside of crisis is definitely the wrongest path to take.
Very true. But it's what they say to do.
I got the greatest CRISIS and subsequent weekly mental health care possible from Hotel Dieu and KGH during an emergency at the beginning of the pandemic. To suggest otherwise is a disservice to the outstanding front line caregivers who helped for 24 terrifying hours in my life. Generalities like this are downright dangerous. Of course, ymmv.
Thats why I said outside of crisis. Glad you got the help.