Updates from the Physician Practice Enhancement Program

Transient care is not a scope of practice

Walk-in clinics provide a valuable service to patients in providing care to those who are unable to see their own family physicians and whose medical care concerns do not need to be addressed in an emergency department. The provision of transient care is appropriate as long as there is effective continuity of care and follow-up. However, concerns arise when patients who do not have a family physician are told to find a family physician for their follow-up care. Despite the work by divisions of family medicine and others in improving patient access to family physicians, the reality is that a large number of patients are still unable to find a family physician and therefore have chosen a walk-in clinic as their “medical home.”

Physicians working in walk-in clinics sometimes define their medical practice as confined to the provision of transient care. The College does not recognize “transient care” as a scope of practice. The College does appreciate the difficulty imposed on physicians obliged to take on the role of most responsible physician for patients who have no family physician, particularly if they themselves work only episodically in a walk-in clinic. In situations such as this, a reasonable solution is for walk-in clinic physicians to provide longitudinal care to those patients who have no family physician and have chosen to use the clinic for all their health-care needs by a shared-care model.

All clinic physicians thereby assume appropriate longitudinal and proactive patient care responsibility. In order to enable such a model, clinic physicians must have a system in place that provides detailed recorded care along with a cumulative patient profile. Ideally, all physicians should use an electronic medical record that identifies a most responsible physician (MRP) for the patient.

While it is hoped that all patients will eventually have access to their own family physician, the College is pleased to note that in the interim a number of community walk-in clinic physicians have agreed to participate in the longitudinal care of patients who have adopted the walk-in clinic as their medical home.

Through its Physician Practice Enhancement Program, the College will support responsible proactive activities such as this and persuade others to do so.

The Physician Practice Enhancement Program is a collegial program that proactively assesses and educates physicians to ensure they meet high standards of practice throughout their professional lives. The goal of the program is to promote quality improvement in community-based physicians’ medical practice by highlighting areas of excellence and identifying opportunities for professional development.