"Walk-in clinic patient treatment equals family-MD&quot

[Guest Ian Wong]

Here's an article that was published in today's Globe and Mail stating that walk-in clinics can provide the same level of care as that given by family doctors.

 

I would really like to see the study itself, as I have a really hard time swallowing this story. True, I'm nothing but a lowly medical student, but I've worked in walk-in clinics as a student, used them as a patient, and in one instance, worked with a family doctor in his office, and then followed him across the street the next day to work in the walk-in clinic, and the type of medicine practised changed 180.

 

In the walk-in clinic, it was all band-aid quick fixes: please write me a refill of this prescription that my family doctor has been giving me for "x" years for my chronic "x" condition, I've got a sore throat/rash/headache/etc that isn't worth making an appointment to a family doctor's office, can I get an antibiotic/birth control pills/etc...

 

In the family doc's office, there was a lot more continuity of care, with the doc actually knowing patient's by name and part of their medical history just through long-term familiarity. Very important stuff when doing routine obstetrical visits, or filling out and following up on disability documentation or specialist referrals, or tinkering with long-term medication dosages, and all the other hundred and one things that family doctors do in a routine day.

 

Anyway, I'd love to see that study, and it'd definitely be interesting reading, particularly for those classmates of mine who are matching into Family Med this year.

 

Ian

UBC, Med 4

 

Link to article: Walk-in clinic's patient treatment equals family-MD care

 

Walk-in clinics' patient treatment equals family-MD care, study says

 

By ANDRÉ PICARD

PUBLIC HEALTH REPORTER

Monday, January 27, 2003 – Page A7

 

The widely held notion that walk-in clinics provide inferior medical care is unfounded, a study says.

 

Although the clinics are popular because they have longer hours and are readily accessible to the growing ranks of people without family physicians, the knocks against them include the criticism that care is poor because physician-patient continuity is lacking and the clinics are more costly.

 

But researchers at the University of Toronto found that the care offered in walk-in clinics is neither better nor worse than that offered by family practices. They found that physicians in clinics spend an average of 12 minutes with each patient, the same as traditional family practitioners.

 

The only significant difference they found is that walk-in-clinic physicians are happier about their work environments, in particular their more reasonable workloads.

 

Paul Williams, a University of Toronto professor of health policy, management and evaluation, said that although walk-in clinics are the subject of debate their reputation of providing little more than "fast-food medicine" is unfair.

 

Physicians who do not work at walk-in clinics have favourable impressions of them, and patient satisfaction is high, he said.

 

"The negative perceptions of walk-in clinics do not appear to be confirmed by the practising physicians we surveyed," Prof. Williams said.

 

"Our research demonstrated that primary-care physicians themselves judge the care provided in walk-in clinics to be comparable to that of family practice."

 

The research, published in this month's edition of the medical journal Family Practice, is based on a survey of 728 primary-care physicians in Ontario.

 

Walk-in clinics have existed in Canada only since the 1980s, when they sprang up to fill gaps in primary care.

 

In the paper, Prof. Williams notes that many assumptions about walk-in clinics are not based on research but on stereotypes.

 

The study found, for example, that there are few differences in the care offered by walk-in clinics, group practices and solo practices.

 

Although the clinics' principal attraction is that no appointments are required, a significant number of patients make them. Conversely, many family physicians offer care to walk-in patients.

 

Walk-in-clinic physicians frequently are criticized as being inexperienced and less-qualified than other doctors. The research did not bear this out.

 

The profiles of physicians in group practices and those in walk-in clinics are virtually identical, though solo practitioners tend to be older men.

 

Another complaint against the clinics stems from the belief that they lend themselves to costly abuses, such as doctor-shopping and visits to physicians that are not merited. But the research found that these problems are marginal, and there are no differences based on type of practice.

 

Although walk-in-clinic physicians offer less continuity of care than do family physicians, the study notes that patients using the clinics are younger and have few chronic conditions that require monitoring. And many people go to the clinics because they have no choice; family physicians rarely work evenings or weekends.

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<pagetext>Hi. I would be curious to hear the opinion of medical students on the issue of doctors earning a salary rather than a fee-for-service pay. I learned in my sociology of health class that this is economically more viable than fee-for-service and several countries have implemented this. Personally, I don't think all doctors should be salaried (considering some doctors will be performing a range of services in a day), but I imagine that there are certain situations in which a salary could be a good thing (ie. based on a number of patients per day in a particular specialty) Please share your thoughts on this.

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