Fee-for-service doctors earning less at walk-in clinics, more at their own offices

Island doctors who work at walk-in clinics will be taking a cut in their fees, but it remains to be seen whether it will lead to fewer doctors choosing to work at the clinics.

According to the latest fee agreement signed by the Island's medical society, the provincial government and Health PEI, the amount fee-for-service doctors are paid when they see a patient at a walk-in clinic has been reduced. In return, the amount physicians are paid per patient at their own office has increased. 

"This pilot was developed to encourage family physicians to see their own patients instead of the patient going to the walk-in clinic," medical society president Dr. Larry Pan said in an email to CBC.  

The patient is better served seeing their family physician who provides the continuity of care.- Dr. Larry Pan, president, Medical Society of P.E.I. 

Before the new fee structure took effect in October, doctors were paid $28 for seeing a walk-in clinic patient for less than 10 minutes, referred to as a "basic office visit," and $35 for a visit more than 10 minutes. 

Under the new structure, doctors now earn $25 per walk-in clinic patient, regardless of the length of the visit. 

On the flip side, physicians seeing their own patients have seen their earnings for a basic office visit go from $28 to $35.84. 

"It is felt that much of the walk- in clinic care is episodic care and the patient is better served seeing their family physician who provides the continuity of care," Pan said in his email. 

'More people that cannot be seen in a clinic'

No one else from the medical society was available for an interview to elaborate on the reasons for the fee change. 

Dr. Dawn Shea, a Charlottetown family physician who works some walk-in clinic hours each week, questions the logic behind it. 

Shea points out just a small number of family physicians on P.E.I. even work at walk-in clinics.  So, she says, even if they all cut back on their walk-in clinic hours and spent more time with their own patients, that would do little to ease the demand at the clinics. 

"The walk-in clinic is designed for those short little visits. That's what it's supposed to be for,"  Shea said. "But the reality of it is, we provide full-scale medical services there most days, when you're looking at the patients who do not have family doctors."

We provide full-scale medical services there most days- Dr. Dawn Shea, Charlottetown family physician

According to Health P.E.I., more than 8,000 Islanders are currently on its patient registry, waiting for a family physician. 

Shea said those patients often turn to walk-in clinics, as do others who have family doctors, but can't get in to see them quickly enough. 

"If you did take family doctors out of the clinics, and put them back in their offices, that means there'll be more people that cannot be seen in a clinic that are going to end up going to emergency, or having to wait longer to see their family doctor," Shea said. "And potentially, if you're not seen quicker, you could end up being sicker by the time you're seen."

Doctors continuing walk-in clinic hours 

The new fee structure has been in place for a few months now. 

Shea said so far, it doesn't appear to be having much of an impact at Island walk-in clinics. 

"I've spoken to one physician who has said they'll probably stop doing clinics as a result, but nobody else seems to have reduced their [clinic hours]," she said. 

The medical society says it will re-evaluate the fee structure with Health PEI and the provincial government in the spring of 2019.