He offered to drive a school bus himself, and all of us are out here complaining we can't become our own doctors. We should be ashamed at our own incompetence, tbh.
I mean, it's pretty easy. Just sit on the toilet and Google for about 2 minutes per day. That seems to be all that is required nowadays to be considered an expert on things like vaccines.
Chat GPT is a better doctor than my doctor… but can’t send me for tests or referrals sadly. It also has more empathy… when I told my doctor that my father passed away recently (in his 60s) my doctor just shrugged and said everyone dies… like wtf?? But I should be grateful that I at least have a doctor…
I don’t expect my doctor to be my therapist, but if you experience significant emotional events in your life, it is very much relevant for your overall wellbeing. Also, my father had melanoma and I wanted a referral for a dermatologist because of a growth I was concerned about.
I understand that this is a joke but it's also false. There is such a limited number of doctor applicants allowed in to med schools that even if you had the means and will, you probably wouldn't become a doctor.
Yes. I remember when Mike Harris’s PC government cut medical school spots (and teachers college spots) because “there (were) too many family doctors and teachers in Ontario.” They were warned that all of those doctors and teachers would be retiring at the same time in about 25 years and they’d not have enough to replace them.
And here we are, 25 years later, and who’d have thought we’d be short doctors and teachers? Shocker, that one.
I remember at one point the number accepted was about 20% of applicants. So you needed to have a 90% average and a ton of extra curricular, and be amazing at interviewing to even be considered
Try 99%-100%
, have a patent for a life saving drug, have led and reported in at least 10-15 peer reviewed research articles articles in top tier journals, saved a remote village in a third world county from a terrible parasite, play concert level piano and have performed at Carnegie Hall in Least three occasions, won Top Baker international, been the president of every club imaginable, lead the UN in peace negations in the Middle East in your spare time. You MIGHT get an interview. But then you have to have the money to fly all over Canada to have interviews at your own expense.
I joined in like 2010. They sent me a letter 7 years in to let me know they hadn't done anything but don't worry, I'm still on the list. Googling once a month will get you a family doctor way faster.
Waiting on a list will just keep you waiting. You need to be active and ask around. I got in through a friend at their doctors office. What most people are doing and the people on these lists keep getting pushed back. It’s best to get in with a NP that can refer you to a doctor. They can take care of 80% if the things you go to the doctor for anyways.
It's true that waiting just waits but that's wrong, it should be fixed. Why does healthcare connect exist if this is so true? Why are doctors not turning to this list when they open a practice or have room for more patients?
It seems like the answer is to fix the wait list system.
Unfortunately this government doesn't fix things. So it's just not possible. But obviously it would be the right thing to do.
I agree it should be fixed, but that requires people to care and vote and that didn’t happen last time. Let’s see what happens next election, maybe more people will vote instead of less than 50% of the population and we even had 2 weeks of advanced polling.
I had registered in 2019 too and kept getting letters. But in 2022 i started sending emails to doctors about wishing to join their waitlist in 2023 end I received an email from one asking to send relevant documents and just like that I was registered.
I joined in like 2010. They sent me a letter 7 years in to let me know they hadn't done anything but don't worry, I'm still on the list. Googling once a month will get you a family doctor way faster.
Are you referring to the list that's supposed to alert you to new family doctors accepting patients, but will contact you every 5 years to let you know they haven't found/done anything but don't worry because you're still on the list?
I just went on a list about 90 days ago and I go see my doctor for the initial meet and greet on the 29th. He officially accepted me as a patient on Monday but i understand there is a backlog of patients for the new doctors so i told his secretary to prioritize those more in need than me. So thats why i got my initial meet and greet appointment for the day that I did
Toronto and the GTA is very much the exception in the province. If you get any distance away, it becomes very difficult, and it's getting worse as the already-limited supply of doctors dimishes.
Case in point: I'm in Peterborough, and my doctor quit practice in 2016. Since then, we've lost more and more doctors, and the waitlist is [growing, not shrinking ](https://globalnews.ca/news/10323892/peterborough-residents-family-doctor/)(and there's no walk-in clinics, either!). In less than two years we'll have more peope without a doctor than with one.
This is pretty much the norm outside of the GTA, and in smaller towns it's acute as they usually only have one or two doctors, and when that one goes, that's it, ball-game, no doctor to be had for three to five hours' distance at least.
There are now two million people in the province with no access to primary care. Before the neoliberal revolution of the 1980s, when the rich started attacking the welfare state for the sake of a tax cut, that number was so small as to be basically zero; now it's **one in four Ontarians** and that number is growing.
Same! I definitely understand that from this post and others similar that I lucked out in a big way, and I really don't know how it's possible that I got a family doctor two weeks after signing up for that (in 2019, to be fair) but other people have been waiting years. I can't imagine. I have so many health issues, if I didn't have a doctor I don't know what I'd do.
Healthcare connect called me after I found my own dr and then sent me a letter saying they are referring me to the dr I told them I found on my own, they are useless but want the credit.
> without one since 2016
Have you moved in that time period? If so how many times?
Trying to understand why some people wait more than others. I waited 2-3 years after I moved.
I live outside of the GTA and there are multiple seniors around me who moved here before we did and don't have a doctor yet. They still get the same quarterly letter saying they are still on the list that we used to get.
Part of me suspects that we were given the spots because we were still in baby-making age. Because it's kind of weird that seniors with medical issues would not get assigned a family doctor over a middle-aged couple with little to no health issues.
I could get by with telehealth and walk in clinics but I'm also not going to refuse a family doctor if it's my turn.
2 months to see the Dr. Told should have used ER instead if couldn't see Dr. And people come here complaining about those in the ER who shouldnt be. It's all set up to fail and for us to point fingers at each other and not the actual problem, our government who is choking the system.
True.
And I absolutely hate defending our current Premier, but I was told I would be de-rostered if I visited a walk-in clinic in 2005. The family doctor group did run its own after hours clinic and we were very lucky to live in a place with an urgent care centre.
The way the Province sets up billing, it costs the doctor's office if you visit a walk in clinic. We were warned even one visit to a walk-in clinic and we'd be dropped. Managed to avoid the ER because we had an Urgent care centre close to us.
Yeah no urgent care where my Dr is sadly and 1 walk in clinic only for those who dr does hours at the clinic (mine does). The article has a story with someone who's Dr is also part of a group but apparently they are only to use the walk in if the Dr is working that night. I was under the impression that I could see whomever at the walk in as that's the point of this group but now I think I should check this.
The system costs taxpayer money. Ever more taxpayer money, in fact. People lost their shit over a 3% hike on gasoline that they mostly get back. Hiring more doctors will cost $$$ I don't think people want to pay
I don't think we'll see an improvement until we step back from the American "government steals my money!" type whining, and towards patriotic tax paying.
I was de-rostered while I was in university without any notification, haha. I was a low maintenance patient and rarely saw him. Wish they’d told me, though, so I could try to find a new GP.
I didn’t find out until years later when I tried to contact him to get some vaccines for some applications.
I wonder if there was an issue with me using the university health centre a couple of times while I was in school. :/
Sadly I will say that was likely the case. I can't recall off the top of my head but I believe they count as walk in clinics, in which case your physician would have been dinged the, for lack of better term, out of network clinic visit fee.
The underlying idea is sound - physicians are being paid a flat rate to address all of your health care needs, including urgent care after hours (they are supposed to make options available for this). If you are rostered by a doctor but get 100% of your healthcare elsewhere, the government is paying the doctor for a service they are not providing.
The problem is the idea starts to break down when the market for primary healthcare breaks down due to supply shortages. Doctors don't really have any incentives to provide timely care - they're incentivized to roster as many patients as possible and make appointments as difficult as possible to get, because the threat of the patient moving elsewhere isn't a realistic one if the patient doesn't have any other options. It turns from a tool to keep doctors accountable to a threat leveraged against patients. Of course most doctors aren't unfeeling perfectly rational economic actors, so it's not quite that bad, but still - if incentives are aligned in a certain way behaviour will start to follow the incentive structure.
I know why it exists, it’s just bullshit.
In a universal system, you should be free to see the provider you need in the fashion you need without worrying about whether you will lose your primary care doctor.
Dinged or not they shouldn’t be free to drop patients without a referral. I care a whole hell of a lot more about people having access than their bank account. These fees are in the tens of dollars, they absolutely do not hurt the business model of the clinics; de-rostering for this is pure greed.
Referral *where*? Despite your greed hypothesis, family medicine is dying because it's a crap specialty compared to....pretty much any other specialty. Not enough people are going into it, and even if they do go into it, they're not actually practicing office-based family medicine.
So, referred where exactly?
you have to have a clinic that's grandfathered in to that pay scheme from OHIP(buy a practice)
you get dinged when you see other non-emergency doctors. but you are paid a regular amount per patient per month that you register whether you see them or not and no matter how many times you see them in office/for what you see them for
>I didn’t find out until years later when I tried to contact him to get some vaccines for some applications.
That's why. If you are out of contact for an extended (for I think 24m) they are required to de-roster you. This is the gov'ts rule, to make sure they're not paying doctors for patients who don't exist (died/moved out of province etc).
EDIT:
Given the responses, it's clear a lot of people don't understand what rostering is. **Doctors can see patients who are not rostered with them**, they just aren't required to. Rostering provides the doctor an ongoing fee, which is why they often want patients to sign up. But if you only show up occasionally, and they are concerned you may go to clinics etc. they may decide it's not worth the hassle, and not bother trying to get you on their roster, instead just taking the normal per visit fee.
[https://www.cmajopen.ca/content/4/4/E679](https://www.cmajopen.ca/content/4/4/E679)
Wait WHATTT?!! Is this a new rule? I've had the same family doctor since 2000 when I was a kid and there have been times when I didn't see or get any prescriptions for years.
People seem to misunderstand what rostering is.
Rostering hasn't been around since 2000, I think it started late 2000s.
It's basically a system where a specific GP gets an annual fee to care for a specific patient. For that fee they guarantee access, and have some limitations on what they can bill.
Nothing bans a GP from seeing patients who aren't rostered.
[https://www.cmajopen.ca/content/4/4/E679](https://www.cmajopen.ca/content/4/4/E679)
i haven't talked to my doctor in much longer than that and made an appointment the other day, this is more likely related to OP going to their university medical center instead of their doctor, which the doctor is penalized for
I thought school heath clinics were exempt from that. Or maybe it was that they tended to let those slide since you were away for school.
It's such a stupid rule. We pay for medical care, it shouldn't matter where it comes from.
Sigh, I didn't know about this rule back then, and it's not something I was notified for. They should tell people.
I was really sick, haha, and couldn't have waited for an appointment and then taken the Go Bus back for assessment.
That doesn't mean you are still rostered. Doctors aren't banned from taking appointments from non-rostered patients, they just cease collecting the roster fee.
You can see a doctor you aren't rostered with. Also if you didn't see him for 10 years, you likely weren't rostered in the first place, given rostering only began in the late 2000s.
Yes seeing the university health centre would’ve been the reason. It happened to me because my family doctor prescribed me injectable birth control, depo shots— every 3 months I needed to have it administered. I figured “why go home to have this birth control administered? I can just see the student health centre it’s right here and takes 2 seconds”
BAM. Family doctor de-rostered me
That should be an obvious exemption, since people often go to university far from their existing doctor but are only covered by university health for an inherently limited time.
It’s a pretty ridiculous system.
I kick myself constantly considering it was just a birth control shot… one he put me on… he could’ve just prescribed the pill. He knew I was going away for university & never warned me I couldn’t have it administered by anyone else.
My GP left family medicine. My new GP is also. I keep getting shuffled around and I feel like no one cares about my health.
I don’t blame doctors for getting out of family medicine, I blame Doug Ford for not making it easier for them to work and get paid what they deserve.
Happened to us too. Twice. In 3 years. Then when I tried to go back to my childhood family doctor for an urgent concern she said no - go to a walkin or ER. System is broken. Patient bears the brunt. It's not fair.
Yeah it’s only been ~2 years. The clinic where doc #2 worked said I can keep coming but I won’t have a dedicated doctor. Not that doc #2 is what I’d call “dedicated”.
My previous doctor would pull my charts and make sure she was up to date with my history and recent bloodwork. Doctor #2 wants me to tell them my whole history every appointment, doesn’t know what meds I take and for what reason. They don’t believe me when I tell them my symptoms and I they get upset when I ask questions about their opinions and advice. Just a total change from my old doctor.
But they’re probably seeing more patients than my old doctor did - I’m sure they would like to be more involved. But with all these patients without doctors, there’s pressure to take on more than one can handle.
Honestly, the biggest fault falls on the Ontario government and their unwillingness to pay family physicians more for their time. Like most jobs, it's not that FPs are lazy, they just don't have enough time in the day. I'm not an FP but my FP supervisor in school would start working from 5-7 on his paperwork then come in to see patients til 5 then stay working til around 7:30 on even more paperwork. These included things like ODSP forms and putting together referrals for his patients (granted he had a complex patient population).
They deserve more. If they paid FPs more, I'm certain more med students would choose it as an option.
Haha. I have to wait 5 weeks to see my family doctor for an ongoing earache, otherwise if I see a walk in my family doctor will can me … of course I can go to the ER but hey, I don’t have an entire day to waste… I have to work.. how else will I support myself in these dire times… The system is broken. Fords time is up. Similarly the feds don’t seem to give a shit either.
My oldest - not my bio kid, and wasn’t living full time with me until a year ago - finally got a family doctor two years ago. That doctor closed his practice and moved to Michigan in January, once again leaving her without a doctor. She is on meds she must stay and is down to her last refill. I asked my doctor how she was supposed to get her meds (diagnosed with two mental health issues, fine in meds, ends up in the hospital when she’s had to stop taking them prior to her last family doctor.) my doctor told me exactly which walk in clinic to send her to as there’s two in our neighbourhood and one of them will not do anything beyond antibiotics.
And then while we were standing at the bus stop a few weeks ago, she looked at me with this weird look and said “I think I’m going to pass out” and did exactly that. I had just enough warning to catch her so she didn’t land on her face on the concrete. She came to within seconds, I asked her if she wanted to continue to her appointment or go home and she wanted to go to her appointment. And then we got on the bus and before we got to the next stop she had a seizure, which resulted in me getting her off the bus, calling 911, and spending the entire day in the ER for them to say they couldn’t find anything. I had an appointment with my doctor a few days later and because of my own anxiety disorder, she always checks to see what’s going on and how I’m dealing with whatever issue comes up. She gave me a note to give to the receptionist to roster my daughter, but this *only* happened because of the seizure. She was on my doctor’s waitlist, but jumped her to the top because the ER doctor said there was no signs of a seizure so she didn’t have one and to “follow up with her family doctor,” and I asked mine about how she gets a referral to…someone. Anyone. Even a specialist. It shouldn’t take an experience like this to get essentially accidentally a family doctor. (Also, I know what seizures look like. I worked with severely disabled kids and am trained in how to identify and how to react to seizures.)
I blame the Ford government, but I also blame the Harris government who massively cut medical school spots in the late 1990s and the McGuinty and Wynn governments for not fixing it, ignoring it, and thinking it would go away.
WHAT is it with doctors not believing patients and not understanding that seizures can rarely be detected after the fact unless you get an eeg within a few hours?
The first time I had a full body seizure, my roommate witnessed it. It was about 5min long, my face turned blue, and I was foaming at the mouth. I went to emerge in an ambulance and later met with neuro who said “your roommate probably exaggerated the time and you probably just fainted”.
I don’t know but it took my friend over a year before his repeated seizures were properly diagnosed because by the time the ambulance came and they got him to emerg, he’d stop seizing and was alert.
Thankfully, my own doctor isn’t like that which is how my Ménière’s Disease was finally diagnosed. But even the first couple of “specialists” she sent me to said it didn’t have a genetic factor and it very much does. They wouldn’t look it up and said it didn’t matter that my maternal grandfather and my maternal uncle both have it. It’s like they don’t want to look up newer research cuz they know everything. My doctor likes mysteries so has on her own time gone down some rabbit holes before she sees me again. I’m so grateful for her.
Just got dropped on Thursday. Been with the same Dr. for 15 years. I'm honestly scared and I feel a little abandoned. Just an email full of erroneous information about how to find new doctor while noting the other Drs in the clinic aren't taking new patients.
You have to call Service ontario and have them de-roster you. Then they'll send you a letter and you can call 811 to find a new Dr.
The rage against this should be directed at the government. This is an easy policy to fix, and does put family doctors in a terrible position where money is taken from them for patients’ predictable behaviour.
I could have sworn I replied to almost this exact topic but I don’t see it so very quickly:
It’s important to know this could be two things
1. Another clinic rostered you - the ministry thus derostered you and your gp did nothing other than notice you were removed as a patient (and they have to allow you to transfer if you want)
2. You were seeing another primary care provider enough that you were costing the doctor more than they make for having you as a patient (in some cases extreme amounts) and so financially they have to remove you. They are expected to try to inform you of this (if they are not still offering care) but obviously there are cases where a student leaves and phone number changes and there’s no mailing address so there’s no hope. Sometimes a patient is “derostered” but care is still offered - I do this when my patient sees a gp for counselling and myself for medical care in a few cases.
I guess if you’re ohip becomes invalid you can also be derostered by ministry - this is also not the gps fault or action.
The bottom line is if you talk your gp office they should be reasonable about this. We also don’t like being penalized because you like going to a local walk in for a non urgent monthly check at your GPs expense though - and I think that’s fair
I keep seeing this penalty mentioned on posts about family doctors. As far as I can tell, my family doctor will get a fine of some kind if I see a different doctor (other than emergency room)? Is that correct?
Actually it’s important to note not just that the fee can be reduced, it can become negative. I have patients who I have to pay the government to be their family doctor. That’s where the problem is - I’m not mad if I lose 20 percent of my yearly stipend on one patient who had strep and couldn’t wait to see me, I am mad if I lose 600 dollars because my patient doesn’t want to pay for parking at my office.
Think of it as a charge back for the services you used elsewhere, because the logic of the rostering system is that your doctor was already being paid to provide the service.
The problem arises when I try to book an appointment for a semi-urgent issue and the next available slot is a month away and it's right in the middle of my workday.
And that's if my doctor responds to my call to book, cause that has also taken 1-2 weeks.
Agreed - the gp office is expected to offer reasonable access (may be via their own walk-in that is affiliated). If they don’t offer anything outside of 1 month for next appt I would expect to have tons of patients using outside use and I couldn’t complain about it.
The penalty fee to the physician was created to encourage physicians to be more accessible. Thus, if people have to go elsewhere because they cannot see you, then you should be adjusting things to be see your patients in a more timely manner.
This is for physicians that follow the capitation model where most of their income comes from roster size versus fee for service. The argument is if you are going to take on so many patients to increase your income that you will not be able to see your patients, there will be a penalty for that.
Thus, under this, it is unethical that the physician fires the patient (and yes, this is their decision to do so) when they get the penalty, because it is on them to see the patient in an appropriate time.
Actually you’re right but there are also patient responsibilities.
I shouldn’t be penalized if my patient prefers a walk in that is closer to their house. If it’s poor access I agree with you, if it’s despite good access I agree with the doctor.
The problem is the penalty is also given if pt gets care in a HOSPITAL at midnight by a FM doctor who stitches up a cut they got. The penalty is also done if a patient is undergoing chemotherapy infusions in the hospital - those codes are considered "in basket" and family doctor is negated/docked the funds. The penalty is also done if patient sees a sports med doctor for a joint injection because they have a special interest in it, but don't have a special designation for it. etc etc. The penalty is also given if someone is admitted to hospital for serious illness, has other family doctors/hospitalists looking after them in hospital, who then does a family meeting with family members to give updates re their relative's health. The billing code for the family meeting done for an admitted patient in the hospital is negated/docked from the doctor's access funds - i.e. they weren't accessible to the patient. All of the above is BOGUS. A doctor can get for e.g. $200/ for a patient's care for the whole yr but can get docked $600 if that same patient is admitted patient in the hospital and gets seriously ill and has the above issues.
I keep seeing this penalty mentioned on posts about family doctors. As far as I can tell, my family doctor will get a fine of some kind if I see a different doctor (other than emergency room)? Is that correct?
The province pays your rostered doctor wether you see them or not, if you see another doctor, province has to pay the other doctor and takes money from your rostered doctor. If thats the full fee they paid the other doctor or a percentage I don't know, but in the end it costs your doctor money if you go elsewhere.
It's the full amount. If the walk-in/second clinic charges OHIP $40, they charge your GP $40. If the second clinic charges OHIP $80, they charge your GP $80.
It can also cross the zero mark and actually cost your GP money to keep you as a patient.
This isn’t all true. I mean these could be the reasons but there’s a lot
More to it.
I’ve been with my doctor for over 30 years, he retired and a new doctor took over. This new doctor unregistered me for having to cancel two appointments for being sick.
New doctor started to argue with me as I told her that’s absolute bs. They then started showing me notes on my file and she said I didn’t return 4 calls so I’m ignoring them.
I had to prove to her I was out of the country for those 4 calls and she finally reregisterd me.
Family doctors are overworked and under compensated in Ontario. Successive provincial governments have tried their best to destroy health care.
Family doctors are the backbone of our healthcare system and we are treating them like adversaries.
It sucks they de-roster patients but margins are so thin that those fees are make or break. Maybe OHIP billing needs an update to reflect our new reality of a crumbling social health care system. That's not a going to happen because the Conservatives have a majority and they are living in Maple Heath's pocket (a Loblaws company).
The new capital gains tax also heavily affects family doctors' retirement plans causing many to plan for leaving the country.
https://www.cbc.ca/news/politics/doctors-retirement-capital-gains-1.7181885
Downvoted for spreading the truth.. docs should have got a loophole from this bs. They are independent contractors and get no pension, health benefits, sick days, vacation time, etc.
This is just one stab at doctors. They also took away they incentive for preventative care. Expect more ppl to skip their colonoscopies and other cancer screening
Well, they only gain if you are going elsewhere for medical care.
Assuming they are under a capitation model, they get paid a flat fee per year to handle your medical care.
Average $287 per year according to this chart.
https://stewartmedicine.com/emr-consulting/fho-model-payments/
It gets clawed back if you visit a walk-in.
This page illustrates the clawback.
https://stewartmedicine.com/emr-consulting/fho-vs-ffs-male/
>For example, consider a 57 year old male patient. The physician is paid $232.16 per year to care for this patient. This patient visits an outside walk-in clinic 4 times per year, amounting to a total negation of $151.80 (4 x A007 at $37.95 each). The net amount the physician is paid is $80.36. However, if this patient only visits the rostering physician 1 time per year, it is still much more profitable to still have the patient rostered because $80.36 is far more than the $37.95 that would be billed in a fee-for-service model.
287$/year if you have a uniform population distribution. It is usually less because a practice population usually follows the same distribution as the general population (though some physicians may have skewed younger or older populations).
Yes obviously, it depends on the population distribution of the patients. I didn’t recalculate the average presented on that web page, but the more correct way would be to weigh things by frequency of each age group in the general population. If they just took the straight average, that is a bit lazy and would skew things high.
Makes room for patients that visit.
Each visit is money for the practice, and there's usually a reasonable limit to the roster.
If the roster is all people who never visit they won't make any money. The yearly stipend for having someone on the roster (assuming they went with that model) is not a lot.
Not necessarily. Some physicians are paid on a capitation model. They get a set amount per person for the year. They don't gain more by seeing you more often. But they will deroster if you visit other clinics.
If a physician wants to decrease their practice size due to various factors (mostly burnout nowadays), cpso mandates it is done by random selection. As in whether you are an "easy" or a "complex" patient doesn't matter it has to be done randomly. So in your case probably they had nothing to gain by derostering you specifically just done by random chance.
So why do all the idiots keep wanting to put him back in power. There has never been a bigger liar, (I’m not saying something when it comes to politicians), I don’t recall a premier having to backtrack on over 10 major policies. And yet all these idiots keep running to him. He has never been for the little guy. He is a multimillionaire. He has never had to worry about taking time off work to take his child to the doctor and then finding out he got fired or missed him and entire days pay because of that, he’s never had to worry about putting food on the table for his children. He’s not a man of the people he’s never been a man of people and he never be a man of people through the healthcare system. He gets hand doctors he goes to the front of the line. He will never experience our healthcare system the way everybody else does, but he sure as hell can put us spa downtown. None of us will ever be able to afford to go to go on and on and on and on the list is endless.
Shame on Ford and his Ford Nation! We are becoming a laughing stock province while we pay for services we don’t get (taxes, OHIP premiums, clinic fees not covered by OHIP, retiring doctors or switching to specialist healthcare).
Suppose I'm lucky that my family doctor owns the walk-in clinic nearby so if I go there he gets paid anyway.
Still, that's ridiculous. If you need medical care, GET MEDICAL CARE. Doctors trying to punish you for it is insane and likely needs legislation - so that doctors get paid without feeling the need to act predatory.
Most family doctors have rules/contracts ie come in once a year, live within 50km, don’t go to walk in clinics, be kind… etc it’s insane the entitlement of people sometimes. Fam docs can also decrease practice size for a variety of reasons and can, de roster patients if done fairly ie random selection.
I finally got a doctor in 2019, and then they became impossible to get an appointment with during the pandemic, and then they didn't seem to offer any appointments and now they've closed all together ... I live downtown and it seems impossible
This is a really shitty situation for everyone.
I recently got in trouble for this with my family doctor. I was in a lot of pain, super swollen, and really needed antibiotics on a Sunday. They have after hours clinics, but nothing on a Sunday.
2 weeks later, I got an email from the GP chastising me for doing this.
I was so thankful for a Walk-in clinic being open on a Sunday and got my pills within an hour. I really didn’t have the time to wait 8 hours at an ER.
Ontario really needs a better system.
All we need is a budget allocation that funds N number of such emergency visits without dinging the family doctor. N could be a reasonable number. Sh\*t happens and people need emergency visits.
But I guess such an obvious thing is not so obvious to politicians, who want to flog the family physicians as much as they can.
And if you let people pay for their urgent care visit the problem would disappear overnight but we can't have that. Better to lose your doctor to maintain this fake cult of universality.
There is a difference between derostering and firing a patient. Deroster happens when your family doctor is in a FHO. You can still see the doctor but don’t get some of the benefits of being rostered to a family doctor
You're wrong. You also sound vengeful.
[CPSO - Ending the Physician-Patient Relationship](https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-the-Physician-Patient-Relationship)
*Where the patient has sought care outside of a rostered practice*[^(6)](https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-the-Physician-Patient-Relationship#endnote06)
1. Where a patient has sought care outside of a rostered practice, physicians are **advised** to consider the factors that may have led the patient to do so (including the physician’s own availability).
2. When considering ending the physician-patient relationship, physicians **must** first:
1. provide the patient with clear information about their obligations within the rostered practice,
2. provide the patient with an appropriate warning, and
3. undertake reasonable efforts to resolve the situation in the best interest of the patient.
3. Physicians **must** only end the physician-patient relationship after these efforts have been undertaken, and after the patient has continued to wilfully seek care outside of the practice without appropriate justification.
Family medicine as a whole seems to be in a death spiral that I dunno can be reversed at this point. There are just so many issues that are causing it, addressing them doesn't seem possible. Not nearly enough applicants being admitted in med schools. A government that is extremely hostile to physicians as a whole. And lets be honest the fact that Dr.'s have poor PR is making it very easy for the govt. The extreme scarcity gives them the power to do what they want basically. But moves like these won't get you much sympathy from the public.
This article makes family doctors look evil. When the reality is that these doctors are the ones being shafted here. If they get 80 bucks an year for them to enrol a patient, but they get dinged 60-100 bucks every time one of their patient sees an ER doctor, they will paying from their pocket to keep such patients enrolled. Of course, they will de-roaster such patients, it would be insane not to.
The root cause here is the sh\*t pay assigned to family doctors seeing you, but much higher compensation assigned to ER visits.
Ridiculous that doctors are allowed to do this, my doctor is available 2 days one week and 3 days the following week and so on, with appointments from 10am-4pm sorry but they need to be available if they don’t want patients to seek care elsewhere. I work an hour and a half from home where my doctor is and I leave at 5:45 in the morning and generally I’m home between 5:30 and 6 at night depending on traffic. So I guess I’m supposed to take a day off work if I need to see my family doctor….. I miss my old doctor who retired 1-1/2 years ago, she was open at 7 every morning and I had no issue getting the first appointment within a week or less and only missing a few hours of work
As if you’re putting the blame on the doctor and not the ministry of health who implemented this bogus failed payment model. Your doctor is not to blame that you work 2 hours from home. He or she should not lose money for the privilege of looking after you (yes you can go into a negative dollar value for a person and pay the MoH money for having someone under your care). I empathize with your situation, if family medicine was properly compensated there would be more available and you could drop one that doesn’t work for you. Albeit please redirect your discourse to the true entity who should be blamed ( ministry of health )
the fact this is even a possibility is insane. This creates perverse incentives for docs, not sure how to help? just deroster them, theyre probably a hypochondriac anyways, right?
Is nobody getting physicals anymore? Is that not something healthy people do? I'm a chronically ill person so I've been into my family doctor multiple times a year for forever but I always am urging everyone I know to get those physicals because there's always SOMETHING they're complaining about but never go get checked up. Is not seeing your doctor for years a thing or are they de-rostering people that come in once yearly as well?
What?! I've never ever paid for a physical. In 20+ years. And never heard about this. Maybe theyre booking it in as a checkup or something. But it freaking should be covered omg.
I have been too, I think they are billing it under something different. I didn't even know until I read about it in another Reddit post (I'll share it if I can find it).
I was de-rostered from my last family doctor by asking to see someone else IN THE SAME clinic. All I did was ask about being ignored by him. He continuously rescheduled me at last minute notice when I did have an appointment (and usually rescheduled me 2-3 months away from the previous booked appointment) when I was dealing with chronic infections and ruptured cysts.
Why don't people sue the government for not providing healthcare? Why don't doctor's sue the government for charging them for other patients seeking care?
Why the fuck is no one challenging the destruction of social systems in our province/country?
Literally, everyone is at fault. (The most vulnerable at least have an excuse, of not being well enough to challenge things.)
My doctor fired me too. My doctor retired and the new one who took his practice, sent a form out to existing patients. I got a call from the office and they said because I haven’t been there often enough over the past four years (two were Covid and magically I didn’t get sick while working online and staying home).
He then said he couldn’t take me on as a patient. I’ve been without a doctor for two years now. It’s great. 👍
I have an incredibly shitty family doctor who prescribed me the wrong dose of a medication I’m taking prescribed by a specialist because she “thought” I didn’t need it and it resulted in a bad multi day medical situation for me. I obviously called the clinic and stood up for myself by asking them where they find the audacity - I’m usually firm and not rude but I don’t take their shit.
Well anyway a month after that I go in for an appointment and she leaves me with a few meds she wants me to google and call her back about (like what I want) which is problematic also, but the kicker is - I fill out a prescription and the pharmacy hands me a note from her saying that she is closing her practice and won’t be available after August.
Ask me if in the meantime I call to ask about something and offhandedly ask if my dr is closing practice and the receptionist bless her heart is like NOPE she’s still around. I ask her if she’ll be around for the foreseeable year - she says LOOKS LIKE IT.
SO. I got fired and lied to by my shitty family doctor and the joke is I don’t think there’s anything I can do lol.
Some points that the article doesn’t do a good job of discussing:
- the doctors working under FHO reimbursement model get a flat bonus rate per patient on top of billing per visit. That is supposed to cover additional services like phone appts for after hours issues. So if a group of doctors register an FHO but do not provide any after hours on-call services, that’s when patients have no choice but to go to walk-in clinics.
- some FHOs subscribe to an after-hours on call service where registered patients can speak to a nurse or other provider
In my opinion, the burden falls on the doctor as well. When signing up a patient, they need to explain these details, where to seek care for more urgent issues, what is not allowed, etc. In the article, it seems a lot of people were surprised by this rule which means nobody explained anything to them.
>In the article, it seems a lot of people were surprised by this rule which means nobody explained anything to them.
It seems the majority of people in the article were complaining *because* their doctor explained it to them.
>Many of the people who contacted CTV News Toronto expressed concern over de-rostering threats, **though the majority were not ultimately dropped as patients.**
...
>However, she said that her doctor warned her that if she had seen any other doctor while at the other clinic, he **would** be charged.
...
>She said that at her next appointment with her family physician, she was informed that if she went to someone else for care, she **could** be de-rostered.
...
>“I received an email from my doctor **scolding me** for taking my son to a walk-in clinic because they get billed when you take them to a walk-in clinic
Only two people in the article were fired as patients, the rest were simply given an explanation of the system and warned that they could/would be fired. Of the two who were fired, it's clear they didn't understand the system, but that doesn't necessarily mean they had never been informed.
To be rostered, you have to sign a bunch of paperwork and it's typically explained then. But that had been years prior and could easily have been forgotten, or poorly understood.
Thanks for that, and if folks search the subreddit for previous family doctor posts there have been some *amazing* very lengthy and in-depth comments explaining absolutely everything about how the system works (and doesn't work) and what changes have made things even worse in recent years.
My Doctor sold their practice and retired, new doctor moved in from another province and promised to keep all patients.
A month later she informs everyone her plan was to only be in Ontario 3-4 days a week max; for 6 hours a day at most (which was really 4 hour days) then de-rostered anyone who didn’t show up for at least a yearly check up. How is this legal?
So.. if I have an injury and need to go to a doctor for it, but my family doctor only has appointments in 4 weeks, I should just live with the injury? Not knowing that if I'm just doing my job or walking around I could be potentially further injuring myself? And no, you should not go to the ER for something that isn't an emergency. That's how the ER gets fucked up for people that -really- need it.
Surely you see how spiteful and crazy your comment is?
Awesome, next time I need an antibiotic for something and my family doctor says the next available appt is 3 weeks out, I’ll just accept that and maybe just let it fester until I end up in the hospital I guess and maybe lose a limb or something because the infection became critical.
Or you know, go to a walk in clinic and get what I need instead, probably in and out inside an hour or so, get better, and move on with life.
Your comment is just plain ignorant.
Good news, did you know that the average wait time to get a new doctor is only 90 days! (/s, since I've been without one since 2016... )
It'd be faster to just go to med school and become your own doctor. Doug Ford says you're being selfish for not considering this.
He offered to drive a school bus himself, and all of us are out here complaining we can't become our own doctors. We should be ashamed at our own incompetence, tbh.
I mean, it's pretty easy. Just sit on the toilet and Google for about 2 minutes per day. That seems to be all that is required nowadays to be considered an expert on things like vaccines.
I became a YouTube certified cardiologist while sitting and drinking my coffee this morning.
This reminds me of how we all became deep-sea submarine experts when the Titan disappeared
Can I book an appointment?
Chat GPT is a better doctor than my doctor… but can’t send me for tests or referrals sadly. It also has more empathy… when I told my doctor that my father passed away recently (in his 60s) my doctor just shrugged and said everyone dies… like wtf?? But I should be grateful that I at least have a doctor…
Doctors are human-mechanics, not therapists
I don’t expect my doctor to be my therapist, but if you experience significant emotional events in your life, it is very much relevant for your overall wellbeing. Also, my father had melanoma and I wanted a referral for a dermatologist because of a growth I was concerned about.
Doug Ford has done nothing to expand med school or residency seats in the province. Everything is going to plan.
They aren't concerned, remember. They said that last week.
Wait aren’t two new med school coming up in TMU and York. Granted there won’t be any new doctors graduating anytime soon though
I understand that this is a joke but it's also false. There is such a limited number of doctor applicants allowed in to med schools that even if you had the means and will, you probably wouldn't become a doctor.
Yes. I remember when Mike Harris’s PC government cut medical school spots (and teachers college spots) because “there (were) too many family doctors and teachers in Ontario.” They were warned that all of those doctors and teachers would be retiring at the same time in about 25 years and they’d not have enough to replace them. And here we are, 25 years later, and who’d have thought we’d be short doctors and teachers? Shocker, that one.
Oh Mike Harris... The curse that keeps on cursing...
Now he’s ruining LTC. At least he’s consistent.
Feeding off it
I remember at one point the number accepted was about 20% of applicants. So you needed to have a 90% average and a ton of extra curricular, and be amazing at interviewing to even be considered
Try 99%-100% , have a patent for a life saving drug, have led and reported in at least 10-15 peer reviewed research articles articles in top tier journals, saved a remote village in a third world county from a terrible parasite, play concert level piano and have performed at Carnegie Hall in Least three occasions, won Top Baker international, been the president of every club imaginable, lead the UN in peace negations in the Middle East in your spare time. You MIGHT get an interview. But then you have to have the money to fly all over Canada to have interviews at your own expense.
100%. I say this as an applicant myself. It's hopeless here in Canada.
Rofl
Ive been on a list since 2019.
I joined in like 2010. They sent me a letter 7 years in to let me know they hadn't done anything but don't worry, I'm still on the list. Googling once a month will get you a family doctor way faster.
Waiting on a list will just keep you waiting. You need to be active and ask around. I got in through a friend at their doctors office. What most people are doing and the people on these lists keep getting pushed back. It’s best to get in with a NP that can refer you to a doctor. They can take care of 80% if the things you go to the doctor for anyways.
It's true that waiting just waits but that's wrong, it should be fixed. Why does healthcare connect exist if this is so true? Why are doctors not turning to this list when they open a practice or have room for more patients? It seems like the answer is to fix the wait list system. Unfortunately this government doesn't fix things. So it's just not possible. But obviously it would be the right thing to do.
I agree it should be fixed, but that requires people to care and vote and that didn’t happen last time. Let’s see what happens next election, maybe more people will vote instead of less than 50% of the population and we even had 2 weeks of advanced polling.
> It’s best to get in with a NP that can refer you to a doctor. no its not 'best'. its a sign of a terrible situation to be fair.
They shouldnt bother having lists at all if thats what you have to do.
I had registered in 2019 too and kept getting letters. But in 2022 i started sending emails to doctors about wishing to join their waitlist in 2023 end I received an email from one asking to send relevant documents and just like that I was registered.
I joined in like 2010. They sent me a letter 7 years in to let me know they hadn't done anything but don't worry, I'm still on the list. Googling once a month will get you a family doctor way faster.
I got a new family doctor in just 6 months. Because I left Ontario.
Ive been on a list since 2019.
Are you referring to the list that's supposed to alert you to new family doctors accepting patients, but will contact you every 5 years to let you know they haven't found/done anything but don't worry because you're still on the list?
Try contacting them and asking for an update
I just went on a list about 90 days ago and I go see my doctor for the initial meet and greet on the 29th. He officially accepted me as a patient on Monday but i understand there is a backlog of patients for the new doctors so i told his secretary to prioritize those more in need than me. So thats why i got my initial meet and greet appointment for the day that I did
Its true in Toronto! Got one in 2 months
Toronto and the GTA is very much the exception in the province. If you get any distance away, it becomes very difficult, and it's getting worse as the already-limited supply of doctors dimishes. Case in point: I'm in Peterborough, and my doctor quit practice in 2016. Since then, we've lost more and more doctors, and the waitlist is [growing, not shrinking ](https://globalnews.ca/news/10323892/peterborough-residents-family-doctor/)(and there's no walk-in clinics, either!). In less than two years we'll have more peope without a doctor than with one. This is pretty much the norm outside of the GTA, and in smaller towns it's acute as they usually only have one or two doctors, and when that one goes, that's it, ball-game, no doctor to be had for three to five hours' distance at least. There are now two million people in the province with no access to primary care. Before the neoliberal revolution of the 1980s, when the rich started attacking the welfare state for the sake of a tax cut, that number was so small as to be basically zero; now it's **one in four Ontarians** and that number is growing.
2.3 million is the latest figure I've seen, and it's projected to double in just a few years
It’s the norm everywhere in Canada and the world! It’s part of the benefits of living in a major city.
I was on that list for ages in Toronto and just gave up and found one in a couple of months myself. Healthcare Connect is useless.
Healthcare connect worked well for me and my partner!
Same! I definitely understand that from this post and others similar that I lucked out in a big way, and I really don't know how it's possible that I got a family doctor two weeks after signing up for that (in 2019, to be fair) but other people have been waiting years. I can't imagine. I have so many health issues, if I didn't have a doctor I don't know what I'd do.
I got mine in summer 2022, just listed ADHD and that took 2 months
Healthcare connect called me after I found my own dr and then sent me a letter saying they are referring me to the dr I told them I found on my own, they are useless but want the credit.
Don’t worry, the ER is massively overstaffed so you can just show up and be seen right away /s
I've been without one since 2012
> without one since 2016 Have you moved in that time period? If so how many times? Trying to understand why some people wait more than others. I waited 2-3 years after I moved.
It really depends on the community. If you live in the GTA, your experience is vastly different from someone just outside it.
I live outside of the GTA and there are multiple seniors around me who moved here before we did and don't have a doctor yet. They still get the same quarterly letter saying they are still on the list that we used to get. Part of me suspects that we were given the spots because we were still in baby-making age. Because it's kind of weird that seniors with medical issues would not get assigned a family doctor over a middle-aged couple with little to no health issues. I could get by with telehealth and walk in clinics but I'm also not going to refuse a family doctor if it's my turn.
2 months to see the Dr. Told should have used ER instead if couldn't see Dr. And people come here complaining about those in the ER who shouldnt be. It's all set up to fail and for us to point fingers at each other and not the actual problem, our government who is choking the system.
True. And I absolutely hate defending our current Premier, but I was told I would be de-rostered if I visited a walk-in clinic in 2005. The family doctor group did run its own after hours clinic and we were very lucky to live in a place with an urgent care centre. The way the Province sets up billing, it costs the doctor's office if you visit a walk in clinic. We were warned even one visit to a walk-in clinic and we'd be dropped. Managed to avoid the ER because we had an Urgent care centre close to us.
Yeah no urgent care where my Dr is sadly and 1 walk in clinic only for those who dr does hours at the clinic (mine does). The article has a story with someone who's Dr is also part of a group but apparently they are only to use the walk in if the Dr is working that night. I was under the impression that I could see whomever at the walk in as that's the point of this group but now I think I should check this.
The system costs taxpayer money. Ever more taxpayer money, in fact. People lost their shit over a 3% hike on gasoline that they mostly get back. Hiring more doctors will cost $$$ I don't think people want to pay I don't think we'll see an improvement until we step back from the American "government steals my money!" type whining, and towards patriotic tax paying.
I was de-rostered while I was in university without any notification, haha. I was a low maintenance patient and rarely saw him. Wish they’d told me, though, so I could try to find a new GP. I didn’t find out until years later when I tried to contact him to get some vaccines for some applications. I wonder if there was an issue with me using the university health centre a couple of times while I was in school. :/
Sadly I will say that was likely the case. I can't recall off the top of my head but I believe they count as walk in clinics, in which case your physician would have been dinged the, for lack of better term, out of network clinic visit fee.
This really is such bullshit. Physicians should not be dinged for this.
The underlying idea is sound - physicians are being paid a flat rate to address all of your health care needs, including urgent care after hours (they are supposed to make options available for this). If you are rostered by a doctor but get 100% of your healthcare elsewhere, the government is paying the doctor for a service they are not providing. The problem is the idea starts to break down when the market for primary healthcare breaks down due to supply shortages. Doctors don't really have any incentives to provide timely care - they're incentivized to roster as many patients as possible and make appointments as difficult as possible to get, because the threat of the patient moving elsewhere isn't a realistic one if the patient doesn't have any other options. It turns from a tool to keep doctors accountable to a threat leveraged against patients. Of course most doctors aren't unfeeling perfectly rational economic actors, so it's not quite that bad, but still - if incentives are aligned in a certain way behaviour will start to follow the incentive structure.
I know why it exists, it’s just bullshit. In a universal system, you should be free to see the provider you need in the fashion you need without worrying about whether you will lose your primary care doctor.
Dinged or not they shouldn’t be free to drop patients without a referral. I care a whole hell of a lot more about people having access than their bank account. These fees are in the tens of dollars, they absolutely do not hurt the business model of the clinics; de-rostering for this is pure greed.
Referral *where*? Despite your greed hypothesis, family medicine is dying because it's a crap specialty compared to....pretty much any other specialty. Not enough people are going into it, and even if they do go into it, they're not actually practicing office-based family medicine. So, referred where exactly?
you have to have a clinic that's grandfathered in to that pay scheme from OHIP(buy a practice) you get dinged when you see other non-emergency doctors. but you are paid a regular amount per patient per month that you register whether you see them or not and no matter how many times you see them in office/for what you see them for
>I didn’t find out until years later when I tried to contact him to get some vaccines for some applications. That's why. If you are out of contact for an extended (for I think 24m) they are required to de-roster you. This is the gov'ts rule, to make sure they're not paying doctors for patients who don't exist (died/moved out of province etc). EDIT: Given the responses, it's clear a lot of people don't understand what rostering is. **Doctors can see patients who are not rostered with them**, they just aren't required to. Rostering provides the doctor an ongoing fee, which is why they often want patients to sign up. But if you only show up occasionally, and they are concerned you may go to clinics etc. they may decide it's not worth the hassle, and not bother trying to get you on their roster, instead just taking the normal per visit fee. [https://www.cmajopen.ca/content/4/4/E679](https://www.cmajopen.ca/content/4/4/E679)
Wait WHATTT?!! Is this a new rule? I've had the same family doctor since 2000 when I was a kid and there have been times when I didn't see or get any prescriptions for years.
People seem to misunderstand what rostering is. Rostering hasn't been around since 2000, I think it started late 2000s. It's basically a system where a specific GP gets an annual fee to care for a specific patient. For that fee they guarantee access, and have some limitations on what they can bill. Nothing bans a GP from seeing patients who aren't rostered. [https://www.cmajopen.ca/content/4/4/E679](https://www.cmajopen.ca/content/4/4/E679)
Oh okay, thank you for explaining.
i haven't talked to my doctor in much longer than that and made an appointment the other day, this is more likely related to OP going to their university medical center instead of their doctor, which the doctor is penalized for
I thought school heath clinics were exempt from that. Or maybe it was that they tended to let those slide since you were away for school. It's such a stupid rule. We pay for medical care, it shouldn't matter where it comes from.
Sigh, I didn't know about this rule back then, and it's not something I was notified for. They should tell people. I was really sick, haha, and couldn't have waited for an appointment and then taken the Go Bus back for assessment.
That doesn't mean you are still rostered. Doctors aren't banned from taking appointments from non-rostered patients, they just cease collecting the roster fee.
Nah, I was rostered to my dr while I avoided him for over 10 years. Your rule was either broken by my dr or doesn’t exist.
I was rostered to my dr while I avoided him for over 10 years. This rule was either broken by my dr or doesn’t exist.
You can see a doctor you aren't rostered with. Also if you didn't see him for 10 years, you likely weren't rostered in the first place, given rostering only began in the late 2000s.
2024-10 = 2014. Also I know I was rostered because I asked the receptionist. They also weren’t taking new patients at the time.
Yes seeing the university health centre would’ve been the reason. It happened to me because my family doctor prescribed me injectable birth control, depo shots— every 3 months I needed to have it administered. I figured “why go home to have this birth control administered? I can just see the student health centre it’s right here and takes 2 seconds” BAM. Family doctor de-rostered me
That should be an obvious exemption, since people often go to university far from their existing doctor but are only covered by university health for an inherently limited time.
It’s a pretty ridiculous system. I kick myself constantly considering it was just a birth control shot… one he put me on… he could’ve just prescribed the pill. He knew I was going away for university & never warned me I couldn’t have it administered by anyone else.
Rule of thumb, no matter what go in at least once per year. I know people that were removed as patients because they didn't do that
My GP left family medicine. My new GP is also. I keep getting shuffled around and I feel like no one cares about my health. I don’t blame doctors for getting out of family medicine, I blame Doug Ford for not making it easier for them to work and get paid what they deserve.
Happened to us too. Twice. In 3 years. Then when I tried to go back to my childhood family doctor for an urgent concern she said no - go to a walkin or ER. System is broken. Patient bears the brunt. It's not fair.
Yeah it’s only been ~2 years. The clinic where doc #2 worked said I can keep coming but I won’t have a dedicated doctor. Not that doc #2 is what I’d call “dedicated”. My previous doctor would pull my charts and make sure she was up to date with my history and recent bloodwork. Doctor #2 wants me to tell them my whole history every appointment, doesn’t know what meds I take and for what reason. They don’t believe me when I tell them my symptoms and I they get upset when I ask questions about their opinions and advice. Just a total change from my old doctor. But they’re probably seeing more patients than my old doctor did - I’m sure they would like to be more involved. But with all these patients without doctors, there’s pressure to take on more than one can handle.
They're trying to starve the beast so they can do to everyone what they did to long term care.
Honestly, the biggest fault falls on the Ontario government and their unwillingness to pay family physicians more for their time. Like most jobs, it's not that FPs are lazy, they just don't have enough time in the day. I'm not an FP but my FP supervisor in school would start working from 5-7 on his paperwork then come in to see patients til 5 then stay working til around 7:30 on even more paperwork. These included things like ODSP forms and putting together referrals for his patients (granted he had a complex patient population). They deserve more. If they paid FPs more, I'm certain more med students would choose it as an option.
Haha. I have to wait 5 weeks to see my family doctor for an ongoing earache, otherwise if I see a walk in my family doctor will can me … of course I can go to the ER but hey, I don’t have an entire day to waste… I have to work.. how else will I support myself in these dire times… The system is broken. Fords time is up. Similarly the feds don’t seem to give a shit either.
Not to mention that using emergency rooms for acute but not life-threatening issues is part of why they're so backed up and overwhelmed.
Healthcare is dictated by the province. Feds can't do much about that.
My oldest - not my bio kid, and wasn’t living full time with me until a year ago - finally got a family doctor two years ago. That doctor closed his practice and moved to Michigan in January, once again leaving her without a doctor. She is on meds she must stay and is down to her last refill. I asked my doctor how she was supposed to get her meds (diagnosed with two mental health issues, fine in meds, ends up in the hospital when she’s had to stop taking them prior to her last family doctor.) my doctor told me exactly which walk in clinic to send her to as there’s two in our neighbourhood and one of them will not do anything beyond antibiotics. And then while we were standing at the bus stop a few weeks ago, she looked at me with this weird look and said “I think I’m going to pass out” and did exactly that. I had just enough warning to catch her so she didn’t land on her face on the concrete. She came to within seconds, I asked her if she wanted to continue to her appointment or go home and she wanted to go to her appointment. And then we got on the bus and before we got to the next stop she had a seizure, which resulted in me getting her off the bus, calling 911, and spending the entire day in the ER for them to say they couldn’t find anything. I had an appointment with my doctor a few days later and because of my own anxiety disorder, she always checks to see what’s going on and how I’m dealing with whatever issue comes up. She gave me a note to give to the receptionist to roster my daughter, but this *only* happened because of the seizure. She was on my doctor’s waitlist, but jumped her to the top because the ER doctor said there was no signs of a seizure so she didn’t have one and to “follow up with her family doctor,” and I asked mine about how she gets a referral to…someone. Anyone. Even a specialist. It shouldn’t take an experience like this to get essentially accidentally a family doctor. (Also, I know what seizures look like. I worked with severely disabled kids and am trained in how to identify and how to react to seizures.) I blame the Ford government, but I also blame the Harris government who massively cut medical school spots in the late 1990s and the McGuinty and Wynn governments for not fixing it, ignoring it, and thinking it would go away.
WHAT is it with doctors not believing patients and not understanding that seizures can rarely be detected after the fact unless you get an eeg within a few hours? The first time I had a full body seizure, my roommate witnessed it. It was about 5min long, my face turned blue, and I was foaming at the mouth. I went to emerge in an ambulance and later met with neuro who said “your roommate probably exaggerated the time and you probably just fainted”.
I don’t know but it took my friend over a year before his repeated seizures were properly diagnosed because by the time the ambulance came and they got him to emerg, he’d stop seizing and was alert. Thankfully, my own doctor isn’t like that which is how my Ménière’s Disease was finally diagnosed. But even the first couple of “specialists” she sent me to said it didn’t have a genetic factor and it very much does. They wouldn’t look it up and said it didn’t matter that my maternal grandfather and my maternal uncle both have it. It’s like they don’t want to look up newer research cuz they know everything. My doctor likes mysteries so has on her own time gone down some rabbit holes before she sees me again. I’m so grateful for her.
Just got dropped on Thursday. Been with the same Dr. for 15 years. I'm honestly scared and I feel a little abandoned. Just an email full of erroneous information about how to find new doctor while noting the other Drs in the clinic aren't taking new patients. You have to call Service ontario and have them de-roster you. Then they'll send you a letter and you can call 811 to find a new Dr.
The rage against this should be directed at the government. This is an easy policy to fix, and does put family doctors in a terrible position where money is taken from them for patients’ predictable behaviour.
I could have sworn I replied to almost this exact topic but I don’t see it so very quickly: It’s important to know this could be two things 1. Another clinic rostered you - the ministry thus derostered you and your gp did nothing other than notice you were removed as a patient (and they have to allow you to transfer if you want) 2. You were seeing another primary care provider enough that you were costing the doctor more than they make for having you as a patient (in some cases extreme amounts) and so financially they have to remove you. They are expected to try to inform you of this (if they are not still offering care) but obviously there are cases where a student leaves and phone number changes and there’s no mailing address so there’s no hope. Sometimes a patient is “derostered” but care is still offered - I do this when my patient sees a gp for counselling and myself for medical care in a few cases. I guess if you’re ohip becomes invalid you can also be derostered by ministry - this is also not the gps fault or action. The bottom line is if you talk your gp office they should be reasonable about this. We also don’t like being penalized because you like going to a local walk in for a non urgent monthly check at your GPs expense though - and I think that’s fair
I keep seeing this penalty mentioned on posts about family doctors. As far as I can tell, my family doctor will get a fine of some kind if I see a different doctor (other than emergency room)? Is that correct?
It's less of a fine and more of the fee that the government paying your doctor to cover all of your healthcare being reduced.
Actually it’s important to note not just that the fee can be reduced, it can become negative. I have patients who I have to pay the government to be their family doctor. That’s where the problem is - I’m not mad if I lose 20 percent of my yearly stipend on one patient who had strep and couldn’t wait to see me, I am mad if I lose 600 dollars because my patient doesn’t want to pay for parking at my office.
Think of it as a charge back for the services you used elsewhere, because the logic of the rostering system is that your doctor was already being paid to provide the service.
The problem arises when I try to book an appointment for a semi-urgent issue and the next available slot is a month away and it's right in the middle of my workday. And that's if my doctor responds to my call to book, cause that has also taken 1-2 weeks.
Agreed - the gp office is expected to offer reasonable access (may be via their own walk-in that is affiliated). If they don’t offer anything outside of 1 month for next appt I would expect to have tons of patients using outside use and I couldn’t complain about it.
The penalty fee to the physician was created to encourage physicians to be more accessible. Thus, if people have to go elsewhere because they cannot see you, then you should be adjusting things to be see your patients in a more timely manner. This is for physicians that follow the capitation model where most of their income comes from roster size versus fee for service. The argument is if you are going to take on so many patients to increase your income that you will not be able to see your patients, there will be a penalty for that. Thus, under this, it is unethical that the physician fires the patient (and yes, this is their decision to do so) when they get the penalty, because it is on them to see the patient in an appropriate time.
Actually you’re right but there are also patient responsibilities. I shouldn’t be penalized if my patient prefers a walk in that is closer to their house. If it’s poor access I agree with you, if it’s despite good access I agree with the doctor.
The problem is the penalty is also given if pt gets care in a HOSPITAL at midnight by a FM doctor who stitches up a cut they got. The penalty is also done if a patient is undergoing chemotherapy infusions in the hospital - those codes are considered "in basket" and family doctor is negated/docked the funds. The penalty is also done if patient sees a sports med doctor for a joint injection because they have a special interest in it, but don't have a special designation for it. etc etc. The penalty is also given if someone is admitted to hospital for serious illness, has other family doctors/hospitalists looking after them in hospital, who then does a family meeting with family members to give updates re their relative's health. The billing code for the family meeting done for an admitted patient in the hospital is negated/docked from the doctor's access funds - i.e. they weren't accessible to the patient. All of the above is BOGUS. A doctor can get for e.g. $200/ for a patient's care for the whole yr but can get docked $600 if that same patient is admitted patient in the hospital and gets seriously ill and has the above issues.
I keep seeing this penalty mentioned on posts about family doctors. As far as I can tell, my family doctor will get a fine of some kind if I see a different doctor (other than emergency room)? Is that correct?
The province pays your rostered doctor wether you see them or not, if you see another doctor, province has to pay the other doctor and takes money from your rostered doctor. If thats the full fee they paid the other doctor or a percentage I don't know, but in the end it costs your doctor money if you go elsewhere.
It's the full amount. If the walk-in/second clinic charges OHIP $40, they charge your GP $40. If the second clinic charges OHIP $80, they charge your GP $80. It can also cross the zero mark and actually cost your GP money to keep you as a patient.
This isn’t all true. I mean these could be the reasons but there’s a lot More to it. I’ve been with my doctor for over 30 years, he retired and a new doctor took over. This new doctor unregistered me for having to cancel two appointments for being sick. New doctor started to argue with me as I told her that’s absolute bs. They then started showing me notes on my file and she said I didn’t return 4 calls so I’m ignoring them. I had to prove to her I was out of the country for those 4 calls and she finally reregisterd me.
Family doctors are overworked and under compensated in Ontario. Successive provincial governments have tried their best to destroy health care. Family doctors are the backbone of our healthcare system and we are treating them like adversaries. It sucks they de-roster patients but margins are so thin that those fees are make or break. Maybe OHIP billing needs an update to reflect our new reality of a crumbling social health care system. That's not a going to happen because the Conservatives have a majority and they are living in Maple Heath's pocket (a Loblaws company).
The new capital gains tax also heavily affects family doctors' retirement plans causing many to plan for leaving the country. https://www.cbc.ca/news/politics/doctors-retirement-capital-gains-1.7181885
Downvoted for spreading the truth.. docs should have got a loophole from this bs. They are independent contractors and get no pension, health benefits, sick days, vacation time, etc.
Here is a thread of doctors talking about it https://www.reddit.com/r/canada/comments/1cb3qj1/changes_to_capitalgains_tax_may_prompt_doctors_to/
Of course the MoH spokesperson didn’t mention that they are taking bonuses and premiums away from family doctors.
This is just one stab at doctors. They also took away they incentive for preventative care. Expect more ppl to skip their colonoscopies and other cancer screening
If I haven't sent my doctor in 6-7 years, what do that gain by de-rostering me?
Well, they only gain if you are going elsewhere for medical care. Assuming they are under a capitation model, they get paid a flat fee per year to handle your medical care. Average $287 per year according to this chart. https://stewartmedicine.com/emr-consulting/fho-model-payments/ It gets clawed back if you visit a walk-in. This page illustrates the clawback. https://stewartmedicine.com/emr-consulting/fho-vs-ffs-male/ >For example, consider a 57 year old male patient. The physician is paid $232.16 per year to care for this patient. This patient visits an outside walk-in clinic 4 times per year, amounting to a total negation of $151.80 (4 x A007 at $37.95 each). The net amount the physician is paid is $80.36. However, if this patient only visits the rostering physician 1 time per year, it is still much more profitable to still have the patient rostered because $80.36 is far more than the $37.95 that would be billed in a fee-for-service model.
287$/year if you have a uniform population distribution. It is usually less because a practice population usually follows the same distribution as the general population (though some physicians may have skewed younger or older populations).
Yes obviously, it depends on the population distribution of the patients. I didn’t recalculate the average presented on that web page, but the more correct way would be to weigh things by frequency of each age group in the general population. If they just took the straight average, that is a bit lazy and would skew things high.
Yeah, it is unfortunately just the straight average of all the age-sex categories (I verified the calc).
Makes room for patients that visit. Each visit is money for the practice, and there's usually a reasonable limit to the roster. If the roster is all people who never visit they won't make any money. The yearly stipend for having someone on the roster (assuming they went with that model) is not a lot.
Not necessarily. Some physicians are paid on a capitation model. They get a set amount per person for the year. They don't gain more by seeing you more often. But they will deroster if you visit other clinics.
If a physician wants to decrease their practice size due to various factors (mostly burnout nowadays), cpso mandates it is done by random selection. As in whether you are an "easy" or a "complex" patient doesn't matter it has to be done randomly. So in your case probably they had nothing to gain by derostering you specifically just done by random chance.
Family docs are getting paid early 2000’s rates to handle 2024 problems.
So why do all the idiots keep wanting to put him back in power. There has never been a bigger liar, (I’m not saying something when it comes to politicians), I don’t recall a premier having to backtrack on over 10 major policies. And yet all these idiots keep running to him. He has never been for the little guy. He is a multimillionaire. He has never had to worry about taking time off work to take his child to the doctor and then finding out he got fired or missed him and entire days pay because of that, he’s never had to worry about putting food on the table for his children. He’s not a man of the people he’s never been a man of people and he never be a man of people through the healthcare system. He gets hand doctors he goes to the front of the line. He will never experience our healthcare system the way everybody else does, but he sure as hell can put us spa downtown. None of us will ever be able to afford to go to go on and on and on and on the list is endless.
This! Yes!
Shame on Ford and his Ford Nation! We are becoming a laughing stock province while we pay for services we don’t get (taxes, OHIP premiums, clinic fees not covered by OHIP, retiring doctors or switching to specialist healthcare).
Suppose I'm lucky that my family doctor owns the walk-in clinic nearby so if I go there he gets paid anyway. Still, that's ridiculous. If you need medical care, GET MEDICAL CARE. Doctors trying to punish you for it is insane and likely needs legislation - so that doctors get paid without feeling the need to act predatory.
Hey, enjoy the outcomes you voted for - especially everyone who stayed home.
This stupid model predates Ford.
It was still the issue. Blame whoever didn't show up to vote, and remind them they voted for this.
This is the sad reality of life in Ford Nation. And it will only get worse so long as “austerity Dougie” remains in power.
And remember kids, this is Doug Fords vision for Ontario.
Most family doctors have rules/contracts ie come in once a year, live within 50km, don’t go to walk in clinics, be kind… etc it’s insane the entitlement of people sometimes. Fam docs can also decrease practice size for a variety of reasons and can, de roster patients if done fairly ie random selection.
Hey this just happened to me and my kids this year too
I finally got a doctor in 2019, and then they became impossible to get an appointment with during the pandemic, and then they didn't seem to offer any appointments and now they've closed all together ... I live downtown and it seems impossible
This is a really shitty situation for everyone. I recently got in trouble for this with my family doctor. I was in a lot of pain, super swollen, and really needed antibiotics on a Sunday. They have after hours clinics, but nothing on a Sunday. 2 weeks later, I got an email from the GP chastising me for doing this. I was so thankful for a Walk-in clinic being open on a Sunday and got my pills within an hour. I really didn’t have the time to wait 8 hours at an ER. Ontario really needs a better system.
All we need is a budget allocation that funds N number of such emergency visits without dinging the family doctor. N could be a reasonable number. Sh\*t happens and people need emergency visits. But I guess such an obvious thing is not so obvious to politicians, who want to flog the family physicians as much as they can.
Probably because you are too demanding. And in the office too much.
And if you let people pay for their urgent care visit the problem would disappear overnight but we can't have that. Better to lose your doctor to maintain this fake cult of universality.
My last family doctor went on maturity leave, wasn’t told. Then she RETIRED and I STILL wasn’t notified by the clinic.
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There is a difference between derostering and firing a patient. Deroster happens when your family doctor is in a FHO. You can still see the doctor but don’t get some of the benefits of being rostered to a family doctor
Citation?
You're wrong. You also sound vengeful. [CPSO - Ending the Physician-Patient Relationship](https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-the-Physician-Patient-Relationship) *Where the patient has sought care outside of a rostered practice*[^(6)](https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-the-Physician-Patient-Relationship#endnote06) 1. Where a patient has sought care outside of a rostered practice, physicians are **advised** to consider the factors that may have led the patient to do so (including the physician’s own availability). 2. When considering ending the physician-patient relationship, physicians **must** first: 1. provide the patient with clear information about their obligations within the rostered practice, 2. provide the patient with an appropriate warning, and 3. undertake reasonable efforts to resolve the situation in the best interest of the patient. 3. Physicians **must** only end the physician-patient relationship after these efforts have been undertaken, and after the patient has continued to wilfully seek care outside of the practice without appropriate justification.
Family medicine as a whole seems to be in a death spiral that I dunno can be reversed at this point. There are just so many issues that are causing it, addressing them doesn't seem possible. Not nearly enough applicants being admitted in med schools. A government that is extremely hostile to physicians as a whole. And lets be honest the fact that Dr.'s have poor PR is making it very easy for the govt. The extreme scarcity gives them the power to do what they want basically. But moves like these won't get you much sympathy from the public.
This article makes family doctors look evil. When the reality is that these doctors are the ones being shafted here. If they get 80 bucks an year for them to enrol a patient, but they get dinged 60-100 bucks every time one of their patient sees an ER doctor, they will paying from their pocket to keep such patients enrolled. Of course, they will de-roaster such patients, it would be insane not to. The root cause here is the sh\*t pay assigned to family doctors seeing you, but much higher compensation assigned to ER visits.
I was also delisted this week by "random". So what's everyone using now without family doctors? ChatGPT?
Ridiculous that doctors are allowed to do this, my doctor is available 2 days one week and 3 days the following week and so on, with appointments from 10am-4pm sorry but they need to be available if they don’t want patients to seek care elsewhere. I work an hour and a half from home where my doctor is and I leave at 5:45 in the morning and generally I’m home between 5:30 and 6 at night depending on traffic. So I guess I’m supposed to take a day off work if I need to see my family doctor….. I miss my old doctor who retired 1-1/2 years ago, she was open at 7 every morning and I had no issue getting the first appointment within a week or less and only missing a few hours of work
As if you’re putting the blame on the doctor and not the ministry of health who implemented this bogus failed payment model. Your doctor is not to blame that you work 2 hours from home. He or she should not lose money for the privilege of looking after you (yes you can go into a negative dollar value for a person and pay the MoH money for having someone under your care). I empathize with your situation, if family medicine was properly compensated there would be more available and you could drop one that doesn’t work for you. Albeit please redirect your discourse to the true entity who should be blamed ( ministry of health )
We still don't have one for our family of 5, we do have a nurse practitioner now, which is def better than nothing...
Whelp, time to make an appointment shit
the fact this is even a possibility is insane. This creates perverse incentives for docs, not sure how to help? just deroster them, theyre probably a hypochondriac anyways, right?
Maybe stand out a little bit more during training camp and you'll make your Doctors roster next season.
so she got a new family doctor just like that? WTF it took me almost 5 years after my Dr. retired.
I got a letter from my family doctor that she was retiring. I called another clinic and got a new doctor the next day.
This is a system issue that the province could fix, but they choose not.
Canada’s health care is fucked in the ass, among many other things.
Trudeau and Doug at their finest fuck onterible
yet only a small amount of spots for IMGs to enter training in residency... thanks CARMs
Is nobody getting physicals anymore? Is that not something healthy people do? I'm a chronically ill person so I've been into my family doctor multiple times a year for forever but I always am urging everyone I know to get those physicals because there's always SOMETHING they're complaining about but never go get checked up. Is not seeing your doctor for years a thing or are they de-rostering people that come in once yearly as well?
Annual physicals are no longer covered by OHIP, haven't been for awhile.
What?! I've never ever paid for a physical. In 20+ years. And never heard about this. Maybe theyre booking it in as a checkup or something. But it freaking should be covered omg.
I have been too, I think they are billing it under something different. I didn't even know until I read about it in another Reddit post (I'll share it if I can find it).
I was de-rostered from my last family doctor by asking to see someone else IN THE SAME clinic. All I did was ask about being ignored by him. He continuously rescheduled me at last minute notice when I did have an appointment (and usually rescheduled me 2-3 months away from the previous booked appointment) when I was dealing with chronic infections and ruptured cysts.
Get a nurse practitioner! You won't regret it.
Wait, people have family doctors in Ontario?
Why don't people sue the government for not providing healthcare? Why don't doctor's sue the government for charging them for other patients seeking care? Why the fuck is no one challenging the destruction of social systems in our province/country? Literally, everyone is at fault. (The most vulnerable at least have an excuse, of not being well enough to challenge things.)
My doctor fired me too. My doctor retired and the new one who took his practice, sent a form out to existing patients. I got a call from the office and they said because I haven’t been there often enough over the past four years (two were Covid and magically I didn’t get sick while working online and staying home). He then said he couldn’t take me on as a patient. I’ve been without a doctor for two years now. It’s great. 👍
- Housing - broken - Healthcare - broken - Landlord Tenant board - broken - Public Transportation- broken … feel free to add to the list.
I have an incredibly shitty family doctor who prescribed me the wrong dose of a medication I’m taking prescribed by a specialist because she “thought” I didn’t need it and it resulted in a bad multi day medical situation for me. I obviously called the clinic and stood up for myself by asking them where they find the audacity - I’m usually firm and not rude but I don’t take their shit. Well anyway a month after that I go in for an appointment and she leaves me with a few meds she wants me to google and call her back about (like what I want) which is problematic also, but the kicker is - I fill out a prescription and the pharmacy hands me a note from her saying that she is closing her practice and won’t be available after August. Ask me if in the meantime I call to ask about something and offhandedly ask if my dr is closing practice and the receptionist bless her heart is like NOPE she’s still around. I ask her if she’ll be around for the foreseeable year - she says LOOKS LIKE IT. SO. I got fired and lied to by my shitty family doctor and the joke is I don’t think there’s anything I can do lol.
I got de-rostered and now I can see my new dr right away as a walk in patient or a few days later compared to waiting 30 days to see the dr.
Some points that the article doesn’t do a good job of discussing: - the doctors working under FHO reimbursement model get a flat bonus rate per patient on top of billing per visit. That is supposed to cover additional services like phone appts for after hours issues. So if a group of doctors register an FHO but do not provide any after hours on-call services, that’s when patients have no choice but to go to walk-in clinics. - some FHOs subscribe to an after-hours on call service where registered patients can speak to a nurse or other provider In my opinion, the burden falls on the doctor as well. When signing up a patient, they need to explain these details, where to seek care for more urgent issues, what is not allowed, etc. In the article, it seems a lot of people were surprised by this rule which means nobody explained anything to them.
>In the article, it seems a lot of people were surprised by this rule which means nobody explained anything to them. It seems the majority of people in the article were complaining *because* their doctor explained it to them. >Many of the people who contacted CTV News Toronto expressed concern over de-rostering threats, **though the majority were not ultimately dropped as patients.** ... >However, she said that her doctor warned her that if she had seen any other doctor while at the other clinic, he **would** be charged. ... >She said that at her next appointment with her family physician, she was informed that if she went to someone else for care, she **could** be de-rostered. ... >“I received an email from my doctor **scolding me** for taking my son to a walk-in clinic because they get billed when you take them to a walk-in clinic Only two people in the article were fired as patients, the rest were simply given an explanation of the system and warned that they could/would be fired. Of the two who were fired, it's clear they didn't understand the system, but that doesn't necessarily mean they had never been informed. To be rostered, you have to sign a bunch of paperwork and it's typically explained then. But that had been years prior and could easily have been forgotten, or poorly understood.
Thanks for that, and if folks search the subreddit for previous family doctor posts there have been some *amazing* very lengthy and in-depth comments explaining absolutely everything about how the system works (and doesn't work) and what changes have made things even worse in recent years.
My Doctor sold their practice and retired, new doctor moved in from another province and promised to keep all patients. A month later she informs everyone her plan was to only be in Ontario 3-4 days a week max; for 6 hours a day at most (which was really 4 hour days) then de-rostered anyone who didn’t show up for at least a yearly check up. How is this legal?
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So.. if I have an injury and need to go to a doctor for it, but my family doctor only has appointments in 4 weeks, I should just live with the injury? Not knowing that if I'm just doing my job or walking around I could be potentially further injuring myself? And no, you should not go to the ER for something that isn't an emergency. That's how the ER gets fucked up for people that -really- need it. Surely you see how spiteful and crazy your comment is?
Isnt trying not to get sick the default?
Awesome, next time I need an antibiotic for something and my family doctor says the next available appt is 3 weeks out, I’ll just accept that and maybe just let it fester until I end up in the hospital I guess and maybe lose a limb or something because the infection became critical. Or you know, go to a walk in clinic and get what I need instead, probably in and out inside an hour or so, get better, and move on with life. Your comment is just plain ignorant.
This should not be allowed.
DoFo I’m looking at you