Walk-in Clinics and Physician Billings (Part 1)

[Guest Ian Wong]

The Vancouver Sun printed a couple of interesting articles regarding the proliferation of walk-in clinics. The first article details a bit about how walk-in clinics can be significantly more lucrative than operating a traditional family practice. A large proportion of this stems from the fact that a basic office visit pays a certain fee ($26 in British Columbia), and that a doctor collects $26 for refilling a prescription in a walk-in clinic in under 30 seconds, whereas spending 15 minutes discussing strategies for managing diabetes or cholesterol at the family doctor's office is also worth $26. This really kills off any incentive to spend time with patients, or provide patient education on preventative health care.

 

Consequently, there's a fairly large amount of friction between family doctors and walk-in clinic doctors due to a perception that family doctors are being left with the more complex and difficult illnesses, and walk-in clinic doctors are treating the simple cases and making more money by dealing in a higher volume of patients.

 

www.canada.com/vancouver/news/story.asp?id={9D449258-6040-453C-8E62-E283F565863D}

 

<!--EZCODE BOLD START--> Patients 'were voting with their feet'<!--EZCODE BOLD END-->

 

Hayley Mick

 

Vancouver Sun

 

Friday, May 31, 2002

 

When Lauren Varney's doctor told her he was closing his solo practice to work at a walk-in clinic, she wasn't happy.

 

Escaping for a breath of fresh air during her half-hour wait at the Care Point walk-in clinic at Granville Street and 16th Avenue, Varney said she followed Dr. Robert Menzies to this new location because she knew he would give her the care she needed for her chronic arthritis. In exchange, she's willing to put up with not being allowed to book appointments.

 

"I've seen a lot of doctors here and they don't have a lot of the qualities that he does," she said. So she has adjusted to arriving at the clinic during his office hours and waiting to see him.

 

"If he's not there then I won't go," she said. "I'll just stick with Dr. Menzies."

 

As walk-in patients crowd the waiting room, Menzies slips out for a brief interview, pager strapped to his hip and stethoscope draped around his neck.

 

Leaning back on a chair in the office boardroom, he explains how he ran a private practice for 15 years on West Broadway, but had great difficulty building up his clientele. People moved away to different parts of the city and didn't want to commute, others found it convenient to go to walk-in clinics for the quick-and-easy medical problems.

 

"They'd only come to see me for the really hard stuff. I started to get bogged down," he said.

 

Rather than fight the trend, Menzies started working part-time at walk-ins, then last year he folded his practice into the new Care Point clinic.

 

"[Patients] were voting with their feet," he said. "It's really a development that is practical for me and practical for patients."

 

About half of his patients are new to him, the other half followed him from his old office, although the latter sometimes grumble about not being able to make an appointment.

 

Menzies' shift started at 3 p.m. this Wednesday afternoon, and almost exactly on the hour, the waiting room is transformed from a barren collection of empty chairs into a bustling office with a half-hour wait.

 

The sudden rush is no coincidence. Like Varney, most people have come for Menzies.

 

Sitting outside is Rudolf Muran, who is taking a quick smoke break while he waiting to be seen. A painter who came to Canada from Slovakia five years ago, he's been seeing Dr. Menzies for about a year. He sees walk-in visits as a compromise. What he really wants is a family doctor of his own -- but he says he hasn't been able to find one because few are accepting new patients.

 

"He's not a family doctor but at least he knows me," he said.

 

Like Muran, Danica Gillis arrived at the clinic because her own family doctor recently quit practising. She's now searching for a new doctor, but said she hasn't been able to find one. With daughter Sarah, 10, and son Johnathan, 12, she said she would rather have the continuity of a family doctor who knows her family's history, especially because her son has cerebral palsy.

 

"[Walk-in clinics are] handy in a way but I'd just rather have my own GP," she said.

 

Others interviewed at three different walk-in clinics around the Lower Mainland said they chose the clinics for convenience or because it's too hard to get an appointment with their family doctor.

 

After her appointment with Menzies, Julia Saunders, 32, said she has a family doctor whose care is excellent, but Saunders got tired of having to schedule her appointments weeks in advance.

 

Now she usually goes to walk-in clinics and sees the same doctor every time, adding that one of the things she likes about a walk-in clinic is the anonymity it allows her.

 

"When I go to see a GP, they give me a hard time about other parts of my life," she said, adding that the only time she goes to her female family doctor is for annual check-ups.

 

It's not uncommon for people to go to walk-in clinics for medical problems they find embarrassing, or want to keep secret.

 

At the Care Point clinic on Denman Street, anyone can see a doctor as long as they have a valid B.C. Care Card and picture ID.

 

The Denman clinic serves people of all ages, although most are seniors who live in the West End. One of the doctors there, Dr. Asae Tanaka, who only works at the clinic for three hours each Wednesday. Most of the patients she sees belong to the large Japanese population in the area.

 

Tanaka, who came to Canada with her family when she was eight years old, says the young Japanese women who see her during those three hours trust her and feel comfortable because she understands their culture and speaks their language.

 

"There's a high population of Japanese visitors that are living in the West End, and they get into trouble -- especially with STDs and pregnancy because they have very poor sex education in Japan," she explains.

 

Her work at the walk-in clinic is only a minor part of her week. Tanaka works four and a half days per week doing locums for general practitioners who are on holidays, and she says there are differences in the type of medical cases she sees at a walk-in clinic, as opposed to a family practice.

 

"If it's something that they know is complicated . . . they want to go to their own family doctor," she said, naming things like cholesterol, diabetes, and asthma as examples. If patients want a "quick fix" for an illness like a cold or minor injury, they're more likely to go to a walk-in clinic.

 

"For band-aid treatment, a walk-in clinic is good," she said, "But if you want prevention, if you want to change what is happening in your life, then it's better to go to the family doctor."

 

All walk-in clinics keep medical records, but if people go to different clinics, it's unlikely that their medical history will be available to the doctors.

 

Tanaka's colleague, Dr. Isabelle Fieschi, said there is a perception within the medical community that doctors choose to work in walk-in clinics so they can treat easy cases, fill in prescriptions and "make a buck."

 

"There's a lot of looking down by family practitioners on people who do this kind of stuff in walk-in clinics," she said, adding that that may be one of the reasons family doctors continue to own their own practice.

 

But Fieschi credits her decision to work at a walk-in clinic with saving her medical career.

 

After graduating from medical school at McGill two years ago, she owned a practice for a year and a half, until the stress of dealing with the long hours and high operating costs nearly did her in. "It was actually to the point where I wanted to quit medicine," she said.

 

She was constantly running an hour late, which would "anger everybody and stress me out tremendously." she said. "It was awful."

 

Now she says her stress load has been drastically reduced, and she can spend more time with her three year-old son, because she is working 30-hour weeks, and still making the same money she did working 50 hours per week at her own practice.

 

And one of the best things is that she can spend as much time as she needs working with patients -- without worrying about pushing her whole schedule off track.

 

These days Dr. Menzies works 45 hours a week -- a figure he hopes to reduce soon -- compared to the 60 or 70 hours and up that a family physician might work. "It's a better lifestyle and the facilities are better," he said. "This is the only way to have a reasonable life."

 

He insists he does get more complex work (chest pains, pneumonia, accident trauma) as well as the easy visits (flu complaints, rashes, sprains, abrasions and stitches, prescription refills) while working at a walk-in clinic. "I see both ends," he said. "Whereas in the (old) office you'd miss the easy stuff."

 

Ultimately, most of the patients interviewed while they left their clinics were happy with the service they received, and with the convenience that comes with the extended hours of walk-in medical services.

 

John Krokos, for one, left satisfied with the soft cast a doctor at the Lonsdale Avenue and 19th Street Medical Clinic in North Vancouver put on his broken hand.

 

He said that unless his illness is "internal or personal," a walk-in clinic will always be his top choice. "I think the quality of care is still great," he said. "They haven't let me down yet."