Setting up a walk in clinic

[almostmed]

Can any type of doctor set up a walk in clinic?

[Jochi1543]

No, you have to be eligible to practice as a family doc.

 

As a specialist, you may partake in some sort of rapid-access type of clinic in a specific area or in your general specialty. For example, I know a dermatologist who has a rapid-access clinic for a specific group of skin conditions where the waitlist is only two weeks (whereas general referrals may take over a year to be seen).

[almostmed]

So you can't even partner up with a family doc to set up a walk in clinic? I was thinking maybe if I went into emergency medicine and I burn out after 10-15 years I could set up a walk in clinic.

[Renin]

You can have psychiatry rapid assessment clinics, but they're not "walk in" per se.

[Ttoronto]

So you can't even partner up with a family doc to set up a walk in clinic? I was thinking maybe if I went into emergency medicine and I burn out after 10-15 years I could set up a walk in clinic.

 

If you anticipate a burn out in 10-15 years, it is probably best to go through the 2+1 route to keep your options open.

[mavrik13]

So you can't even partner up with a family doc to set up a walk in clinic? I was thinking maybe if I went into emergency medicine and I burn out after 10-15 years I could set up a walk in clinic.

 

Nope. Essentially, as I understand it (feel free to correct), but pretty much any physician who is not a GP requires a referral from a GP in order to get paid from provincial billings.

[BoyInTheBubble]

I've heard there is a dermatology walk-in clinic in Toronto. I've heard that it requires a visit to a family doc for a general referral letter and then that you have to line up at 5-6am to be seen...

[canmeds2014]

There appears to be an increase in interest for the PGY 3 opportunities. If one does sports medicine, palliative care, addiction medicine for instance, is there an increase in potential renumeration? Like is there a fee code as a 'specialist' fam doc that is slightly higher than a fm visit? I would imagine these physicians would need to dictate a note to the patients fam med? Can sports docs read ultrasounds for their patients if they recieve training in their pgy 3 years or an addiction med doc able to bill in between a psychiatrist and gp visit?

[Head Squeeze]

Don't need to set up a clinic these days: https://medeo.ca/

[justletmein]

There appears to be an increase in interest for the PGY 3 opportunities. If one does sports medicine, palliative care, addiction medicine for instance, is there an increase in potential renumeration? Like is there a fee code as a 'specialist' fam doc that is slightly higher than a fm visit? I would imagine these physicians would need to dictate a note to the patients fam med? Can sports docs read ultrasounds for their patients if they recieve training in their pgy 3 years or an addiction med doc able to bill in between a psychiatrist and gp visit?

 

Generally no, there is no increase in remuneration for doing an R3 in sports med/palliative. You cannot bill as a specialist. There are certain circumstances where a GP can bill a "consult" from another GP but it doesn't pay nearly what a specialist makes for a consult (Also, the billing varies from province to province). The 3rd year in EM may result in increased remuneration if you plan to work mostly in the ER.

 

As for ultrasound, it is widely used in the ER and also in sports medicine to some degree. In Quebec, for now, there is no billing code for ultrasound for family docs (this may be different elsewhere, and will probably change in the near future as it becomes the standard). Also, most FM-ER docs who use ultrasound have very informal training and use it mostly as a bedside "add-on" to the physical exam. Medico-legally, if you suspect an appendicitis for example, you will probably still ask for a formal U/S or CT scan to confirm the dx.

[Jochi1543]

So you can't even partner up with a family doc to set up a walk in clinic? I was thinking maybe if I went into emergency medicine and I burn out after 10-15 years I could set up a walk in clinic.

 

I think if you burn out from ER, walk-in clinic would be even worse. It'd be just like ER minus all the cool stuff.

[ploughboy]

I think if you burn out from ER, walk-in clinic would be even worse. It'd be just like ER minus all the cool stuff.

 

"Doctor, I've had this pain in my left earlobe for two years. I need some peeeeercocets!"

 

Lather, rinse, repeat.

 

 

 

 

As for ultrasound, it is widely used in the ER and also in sports medicine to some degree. In Quebec, for now, there is no billing code for ultrasound for family docs (this may be different elsewhere, and will probably change in the near future as it becomes the standard). Also, most FM-ER docs who use ultrasound have very informal training and use it mostly as a bedside "add-on" to the physical exam. Medico-legally, if you suspect an appendicitis for example, you will probably still ask for a formal U/S or CT scan to confirm the dx.

 

In Ontario the billing code for an ED ultrasound is H100, which gets you a princely $19.65. You need to be CEUS certified and provide some sort of image on the chart (a representative still frame printed off the ultrasound machine is sufficient) to bill that code.

 

Appy isn't one of the CEUS indications for ED ultrasound.

[MD Consultants CA]

For the 5yr FRCPC EM programs, your 4th year is essentially a fellowship year where you can pursue various career development opportunities (ICU, anesthesia, MBA, M.Ed, etc). Maybe you can do a year of FM rotations and qualify as CCFP and set up a walk in clinic? Essentially you would have done all the off service rotations a FM resident has to do. Not sure if it's feasible but worth a thought.

 

So you can't even partner up with a family doc to set up a walk in clinic? I was thinking maybe if I went into emergency medicine and I burn out after 10-15 years I could set up a walk in clinic.

[justletmein]

For the 5yr FRCPC EM programs, your 4th year is essentially a fellowship year where you can pursue various career development opportunities (ICU, anesthesia, MBA, M.Ed, etc). Maybe you can do a year of FM rotations and qualify as CCFP and set up a walk in clinic? Essentially you would have done all the off service rotations a FM resident has to do. Not sure if it's feasible but worth a thought.

 

I highly doubt that you could swing that.

The only way to do both FM and EM is to go the 3-year route.

[ploughboy]

For the 5yr FRCPC EM programs, your 4th year is essentially a fellowship year where you can pursue various career development opportunities (ICU, anesthesia, MBA, M.Ed, etc). Maybe you can do a year of FM rotations and qualify as CCFP and set up a walk in clinic? Essentially you would have done all the off service rotations a FM resident has to do. Not sure if it's feasible but worth a thought.

 

Somebody a few years ahead of me in my program tried to do that, and was shot down by one of the colleges.

[almostmed]

I think if you burn out from ER, walk-in clinic would be even worse. It'd be just like ER minus all the cool stuff.

 

I was thinking working on more of the admin/managerial aspect. I would like to open up a walk in clinic in maybe an underserved population or part of town one day.

[Nearly there]

There appears to be an increase in interest for the PGY 3 opportunities. If one does sports medicine, palliative care, addiction medicine for instance, is there an increase in potential renumeration? Like is there a fee code as a 'specialist' fam doc that is slightly higher than a fm visit? I would imagine these physicians would need to dictate a note to the patients fam med? Can sports docs read ultrasounds for their patients if they recieve training in their pgy 3 years or an addiction med doc able to bill in between a psychiatrist and gp visit?

 

 

I just did a sports med elective in Alberta and the doc billed consult fees (family doc with extra training - not even an 'R3'). I don't know what the fees were relative to specialist consults but it was more than a normal family doc fee. The appointments were booked for 30 minutes so I imagine the fees were significantly higher. He also did in office U/S, which is what a large portion of his patients were referred for, but was not able to bill for it. In fact, in addition to this, he had to buy the U/S machine from his own pocket.

[BoyInTheBubble]

I just did a sports med elective in Alberta and the doc billed consult fees (family doc with extra training - not even an 'R3'). I don't know what the fees were relative to specialist consults but it was more than a normal family doc fee. The appointments were booked for 30 minutes so I imagine the fees were significantly higher. He also did in office U/S, which is what a large portion of his patients were referred for, but was not able to bill for it. In fact, in addition to this, he had to buy the U/S machine from his own pocket.

 

As long as another physician refers to you then you can bill a consult fee. Higher than a regular assessment that a family doc would do on their own patient or at a walk-in.

 

The tricky part is getting other family docs to refer to you for your special skills. You have to prove to enough of them that you can do something they can't, and that a specialist can't do better/faster.

 

As mentioned, you can bill for US in the ED. You need the training and only for certain things.