When patients lose their family doctor without knowing it

This article was translated from content from CTV News.

Dozens of Ontarians are expressing frustration with the province’s health-care system after their family doctor failed them or threatened to do so after they sought urgent care elsewhere.

Nearly 100 people contacted CTV News over several days in response to a call for personal experiences with the process known as “de-rostering”, or unsubscribe.

In other words, they were pushed out of their respective doctors’ patient numbers.

Many said they had no idea they might be abandoned as patients and only found out after visiting another clinic for care.

Ottawa resident Ashley Desrochers says in mid-January she decided to go to an after-hours clinic for urgent care after her legs began to seriously swell. Her family doctor agreed to see her, she said, but he was unavailable for about two months.

She decided to go to a walk-in care center associated with her primary care provider, and saw her own family doctor there – who quickly gave her an appointment a few days later.

However, she said her doctor warned her that if she had seen another doctor while at the other clinic, she would have been charged.

“If I showed up at the clinic again, he would drop me as a patient, even though it was my first time at the clinic for the year,” Ms. Desrochers said. “It took me by surprise. I know doctors need to be paid for their time and can’t afford to let their patients go elsewhere. But when we’re in a situation where we need to see our doctor and we can’t see them, we have no choice but to go elsewhere.”

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Many of those who contacted CTV News expressed concern over the threats of de-rosteringalthough the majority of them were not abandoned as patients.

In one case, a person suffering from mental health issues said they chose to make a virtual appointment for an assessment and prescription over the course of a weekend. She said that at her next appointment with her family doctor, she was informed that if she turned to someone else for care, she risked being deregistered.

The parent of a 15-year-old girl wrote to say her child received treatment while at a summer camp five hours away from her family doctor’s office. When she returned, she was removed from her family doctor’s patient list.

Jennie Carr of Mississauga told CTV News her doctor sent her a letter after she took her teenage son, who has a seasonal strep infection, to a walk-in clinic to have him take antibiotics. She said she was unable to make an appointment for that day.

“I received an email from my doctor chastising me for taking my son to a walk-in clinic because they are charged when you take them to a walk-in clinic and out of respect for my relationship with my doctor, I should wait until he is available. If it’s an emergency, we should take him to an emergency room,” Ms. Carr said.

Mr. Carr has since found a new primary care provider.

Many of the messages sent to CTV News were from patients seeking treatment elsewhere, either out of urgent need or convenience, for minor ailments.

North York resident Edward Chan, 36, said a few years ago he chose to see a doctor virtually to get orthotics because he knew it could take a while to get an appointment you with their primary care provider.

“It’s a nightmare trying to make an appointment,” Chan told CTV News Toronto.

“Even when you manage to get an appointment, you have to wait a very long time before you can see them.”

– Edward Chan

In 20 minutes, he got his prescription. But when he had to make an appointment with his family doctor for his annual checkup, the receptionist told him he had been disengaged. He eventually learned it was because he decided to seek treatment elsewhere.

“I joked with my friends and family and told them that my family doctor had just fired me,” Mr Chan said. “How can this happen in Canada?”

Mr. Chan says he doesn’t blame his family doctor because he has been seeing him for more than 30 years. He is rather angry at the system in place.

“We shouldn’t need to consult them for things as small as sick notes or prescriptions,” he said. “The fact that family doctors are being punished for this and we are being punished for this is ridiculous. It’s ridiculous.”

Why is this happening?

Family doctors in Ontario are paid under different systems. Some operate on a fee-for-service model, in which they are reimbursed by the Ontario Health Insurance Plan (OHIP) for each service they provide to a patient. The other is a billing system, in which doctors are paid per patient, regardless of how many times they see them.

However, under the registration system, each time the patient seeks treatment elsewhere, the family doctor is deducted a portion of the available funding.

“It ranges from 50 to 100 per cent (of the fee),” Toronto-based Dr. Fred Freedman told CTV News.

Dr. Freedman believes the roster system is beneficial because it allows doctors to provide care without worrying about the amount associated with it. However, he adds that this also means the Department of Health considers it a “failure” if they cannot meet a patient’s needs 24 hours a day, seven days a week.

“We are committed to providing full in-house practice services to everyone on our roster. But that doesn’t prohibit people on our list from going anywhere to get their primary care, and it’s considered a failure of our practice, of any practice on the list, if a patient goes elsewhere,” he said.

“So we have to be there every time they want care, but if they decide to go elsewhere, that’s their business and we have to pay for it.”

According to the Ontario Ministry of Health, more than 5,800 family doctors were registered with a family health organization in 2022.

Another 2,500 are part of a family health group, 224 are part of a family health network and just over 1,600 family doctors work under the fee-for-service system.

“Patients registered with a family doctor should always seek treatment there first. However, if they need immediate care and cannot access their family doctor, they can seek care at any primary care setting, such as a walk-in clinic,” said a spokesperson for the Minister of Health in a press release. “If they have to go to a walk-in clinic, patients are always encouraged to see their family doctor afterward.”

“In certain circumstances, when a patient receives care from more than one health care provider, a registered physician may decide to disenroll a patient, but may continue to provide services to the patient on a fee-for-service basis. ‘act.”

The government specifies that the deductions relate to “a potential bonus that may be earned by the group that registers.” The ministry specifies that this has no impact on the doctor’s base salary.

The ministry specifies that bonuses and bonuses represent 10% of a doctor’s remuneration.

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