Amid the many challenges facing Ontario’s health-care system, some patients in the province are worried visiting a walk-in clinic or using virtual care services could impact ties to their family doctor.
A user took to Reddit to detail their concern after they had used the online medical service Maple to get a prescription, since their main doctor was on vacation.
“It didn't occur to me at the time that this may qualify as ‘walk-in’ visit,” Final-Buffalo-4081 wrote. “I’m now wondering if this could get me de-rostered from my family doctor.”
Rostering is a practice used in family medicine, where the patient registers with a family practice, physician or team as their primary care provider. The family doctor is then paid a flat yearly rate by the government for providing the care, rather than per visit. That patient also has access to the other services at the practice that are available, like nurses.
So when a rostered patient seeks treatment elsewhere, such as a walk-in clinic, their main doctor is charged for the visit.
On the Reddit post, many shared their outrage that a patient could potentially be de-rostered for seeking care outside their family doctor, especially when it’s hard to get in for an appointment.
“The first available appointment with my family doctor is 31 days away,” Kindly-Raspberry-661 wrote. “I don’t ‘decide’ to go to a walk-in with my issues, I am forced to.”
“You need to see a doctor, but you can’t get into your doctor because they’re on holidays or they’re booking three weeks out so you go to a walk in,” small_town_gurl wrote. “But your doctor then takes you off his patient list because you went to a walk in because you couldn’t get into their office.”
Expert says 'de-rostering' is unlikely after one walk-in visit
Michael Carter is a professor with the Centre for Healthcare Engineering at the University of Toronto. He said if a patient needs to visit a walk-in or pay out of pocket for a service like Maple as a result of their doctor not being available, they shouldn’t automatically be de-rostered from their family clinic.
“Going to a private clinic or walk-in doesn’t mean you’re de-rostered,” he told Yahoo Canada. “It is possible that OHIP will go back to the family doctor and deduct the cost from their monthly cheque. De-rostering only happens if that’s done regularly, since it’ll be costing the doctor more than they’re getting from the government.”
He added most family doctors likely get a few dozen charges a month as a result of patients visiting walk-in clinics, but don’t tend to think much of it unless it’s a regular occurrence.
Going to a private clinic or walk-in doesn’t mean you’re de-rostered.
“I suspect that a family doctor would have to say the client is abusing his rostering and it would have to be a lot to really be affecting it,” he said.
In the face of Ontario's crumbling health-care system, people who urgently need to be seen may be turning to a private service like Maple for immediate care. The virtual care provider, which includes a variety of specialized practitioners, allows patients to consult with a doctor 24 hours a day. The service is covered by some employers' benefits programs, otherwise the patient must pay for it out of pocket. It's a price many are willing to pay in the face of long emergency room wait times, doctors with limited amounts of availability or being unable to find a family doctor in the first place.
In September 2022, the Ontario College of Physicians found nearly 2.3 million Ontarians didn’t have a family doctor — up from 1.8 million in March 2020. That number is expected to spike to more than 4 million by 2026.
Reddit offers reassurance
In the Reddit thread, one person assured the original poster that they shouldn’t stress out over seeking medical help outside their main doctor, especially if it was out-of-pocket.
“It depends on the doctor,” SourWineDenial wrote. “Some don't care, and just eat the fines when their patients go to care elsewhere. Some only de-roster if it's a pattern of someone going to a walk-in without even trying to book with their own doctor. A really strict one may de-roster after one instance, but that's unlikely.”