A walk-in visit could kick you off a family doctor wait-list

An Ottawa woman says she was kicked off an Ontario waiting list for a family doctor after visiting an Appletree clinic where she says she was rostered with a family doctor without her knowledge.

Charlotte Coates, 30, joined the Health Care Connect wait-list — a government-run matching program — in 2020 after her previous family physician retired.

In June, a month after visiting the Appletree clinic on Preston Street in Ottawa, which accepts walk-ins, she said she discovered she was suddenly punted off the list.

"At first I thought there must be a mistake," said Coates.

Coates said she had gone to Appletree to get a requisition for blood work.

After not receiving any new update from Health Care Connect, she said she logged on its portal to check her queue status only to discover she had been assigned to a family doctor who works with Appletree.

"I haven't been told that I had a family doctor," she said. "Nobody contacted me from either side of this situation and I don't know who the family doctor is. I've never met the doctor."

Appletree Medical Group has a team of more than 200 family doctors and specialists who provide care across Ontario in a group-based model.

The model reduces the administrative burden on the doctors who operate their practices within the chain, which sometimes allows them to see non-attached patients in a walk-in environment.

Appletree's website says, as of 2019, it operated 38 medical centres across the province and was the "nation's largest provider of telemedicine services."

Appletree says 'miscommunications' can occur

In a written statement Mahila Kanesananthakuru, vice-president of operations and virtual care at Appletree, said Coates signed up for the family practice by submitting a Family Health Group Registration form on the website.

Coates said she does not recall registering online and only filled out the form at the self-check-in kiosk during her visit.

"I put in my details there and it specifically asked if I had a family doctor. I said no, and that was really all of the information that was asked," Coates said.

I don't know who the family doctor is. I've never met the doctor.

– Charlotte Coates

After verifying who her new family doctor was with the province, Coates said she phoned Appletree to try and make an appointment but was informed the doctor only accepted virtual appointments, except for one afternoon each week on a walk-in basis.

"I'm kind of stuck between a rock and a hard place because it's either … accept what I'm given or I have to go in the back of the line and wait another however many years," Coates said.

"It's kind of a helpless feeling."

Kanesananthakuru said Appletree is open to feedback on improving its process to be more clear and transparent. She said its forms are provided by the province and the company's website clearly states those who roster will be removed from Health Care Connect.

"The confusion about where she filled out her roster form highlights that miscommunications can and in fact do occur, and that the use of patient portals, websites, self-check-in kiosks, wait-time tools and even the concept of team-based care itself, are all still relatively new to the community," Kanesananthakuru wrote.

In a written statement, the Ontario Ministry of Health said it's uncommon for patients to be unaware they're being rostered by a doctor, though it would not be a first for Appletree.

"The ministry of health is aware of two instances over the past two years where Appletree rostered patients without the patient being made aware," it said in a written statement.

More patients, more money

Dr. Tara Kiran, a family doctor and researcher at St. Michael's Hospital in Toronto with no connection to Appletree, said Coates's story isn't surprising. She recalls cases in her own practice where her patients de-rostered themselves by accident when visiting other walk-in clinics.

Kiran said all doctors, just like any business person, should act in good faith to ensure patients are clear what they're signing.

"It sounds like in this case that didn't occur clearly," she said.

Appletree said most of its doctors' income is earned primarily through the provision of services to patients.

The province does provide bonuses to physicians based on a number of factors such as the ages and number of rostered patients, but Appletree said those bonuses only account for approximately 10 per cent of its physicians' income.

Kiran, who recently co-authored a study about walk-in clinics, said pay is tied to the number of rostered patients, regardless of pay model.

"The more people who are rostered to you, the more money you get," she said.

Definition of a family doctor

Coates said she feels confused and manipulated by a system she said is designed to help everyone but patients.

"Appletree is benefiting because they're getting all these extra patients … Health Care Connect is benefiting because they're getting lesser wait times and then I feel like they know that we are so desperate for family doctors that we'll take whatever that we can get," she said.

The more people who are rostered to you, the more money you get.

– Dr. Tara Kiran

New data highlighted by the Ontario College of Family Physicians shows, as of March 2022, more than 165,000 people are without a family doctor in Ottawa.

The college predicts that number could nearly double to 318,000 in just three years.

Appletree said its networked system allows patients without family doctors to access care, but family physicians are now signalling they no longer want to see unrostered patients because it's taking too much time away from their rostered patients.

Coates said she was told she could de-roster with Appletree and go back on the Health Care Connect list, but she isn't sure what to do. She also said a family doctor should always be able to offer in-person appointments.

"It kind of feels like we've been duped into believing a system cares about us when it doesn't seem to be the case," she said.

Appletree said it works to educate patients about changes happening in health care, but "there is always going to be some complexity in interacting with what has become a complex health system."