Walk-in clinic woes

Truro doc­tors say im­ple­ment­ing an ap­point­ment sys­tem for walk-in clin­ics bene ts pa­tients

Truro Daily News - - FRONT PAGE - BY HARRY SUL­LI­VAN

Leona Har­vey felt ill and didn’t want to wait out the week­end to se­cure an ap­point­ment with her fam­ily doc­tor.

So she tried her luck with a med­i­cal clinic in Truro.

Turned out, she couldn’t get any farther ahead. Har­vey was told there were no avail­able ap­point­ments un­til the fol­low­ing week.

“But what’s a walk-in clinic? Isn’t that some­thing you’re just sup­posed to walk in?” she asked, dur­ing a call to the Truro News. At one time, yes.

But both Dr. Murdo Fer­gu­son, owner of the Truro Walk-in Clinic on Ro­bie Street and Dr. Manoj Vohra, owner of the Care Now Walk In Clinic on Pic­tou Road in Bible Hill say times have changed. It’s due in part to an acute short­age of fam­ily doc­tors across Nova Sco­tia that has cre­ated an in­crease of pa­tients turn­ing to the clin­ics for care. And fewer doc­tors to serve them.

ere has also been a change in per­spec­tive. e new re­al­ity is that a sys­tem with long line­ups of pa­tients on a rst-come, rst-served ba­sis, is sim­ply not e cient.

“I think walk-in clin­ics are pro­vid­ing a ser­vice to peo­ple who don’t have any­where else to go for their care,” Fer­gu­son said.

His clinic opened in 2001. While it was op­er­ated purely as a walk-in clinic for many years, that ser­vice model was deemed to be out­dated.

“Ini­tially we sim­ply opened the doors a half-hour early and pa­tients were served on a rst­come ba­sis,” Fer­gu­son said. “But we re­al­ized that was hard on the pa­tients who were of­ten un­well or had other things to do, like work or look af­ter their kids. It’s not good to have peo­ple wait­ing out­side your door for one or two hours.”

To avoid those line­ups, the clinic hired sta to an­swer the tele­phone dur­ing day­time hours to set up ap­point­ments dur­ing the clinic’s op­er­at­ing hours, evenings and week­ends.

Har­vey vis­ited the clinic at about 6:30 p.m. on a urs­day evening. She couldn’t un­der­stand why she was un­able to ac­cess a doc­tor, given there were only two other peo­ple in the wait­ing room.

But Fer­gu­son said although the wait­ing room was nearly empty, the evening’s sched­ule was en­tirely full be­cause of pre­vi­ously booked ap­point­ments.

And, that was pre­cisely how the ap­point­ment sys­tem is de­signed to work.

“What we try and do is, book the evening se­quen­tially so we don’t have 40 or 50 peo­ple sit­ting in the wait­ing room at one time,” he said. “We try to book pa­tients in a way that pa­tients can come and go, be seen quickly and get on with their day and get on with their life.”

Due to the short­age of physi­cians, many of those who work in the walk-in clin­ics also have fam­ily prac­tices or work at the hos­pi­tal. So the time they spend at the clin­ics is in ad­di­tion to an al­ready full work­load.

Given that “fi­nite re­source” Fer­gu­son said, it is sim­ply no longer “rea­son­able” to ex­pect that some­one could walk in and ex­pect to be seen right away.

“Just like any other ser­vice, the emer­gency de­part­ment, a lawyer’s o ce, an ac­coun­tant’s o ce or any other pro­fes­sional ser­vice o ce, ap­point­ments will get booked up,” he said. Vohra agreed.

As with the Truro clinic, his fa­cil­ity is also still o cially la­beled as a “walk-in,” although pa­tients there have to book ap­point­ments on­line or by tele­phone.

“My ex­pe­ri­ence was peo­ple would line up for two hours to get an ap­point­ment on a rst-come, rst-served ba­sis and there was no need to,” he said.

“I think the days are gone that you have to stand out­side hop­ing for care. It just didn’t make sense.”

A grow­ing short­age of fam­ily doc­tors is plac­ing in­creased pres­sure on the abil­ity of two “walkin” clin­ics to re­main in op­er­a­tion, their own­ers say.

“The fact that close to one in 10 Nova Sco­tians don’t even have a fam­ily doc­tor is just as­tound­ing,” said Dr. Murdo Fer­gu­son, owner of the Truro Walk-in Clinic on Ro­bie Street.

“Based on what we see com­ing into the walk-in clinic and the hos­pi­tal, there are more and more peo­ple in the dis­tress­ing sit­u­a­tion of not hav­ing a fam­ily doc­tor. And that’s dis­tress­ing to the doc­tors, as well,” he said. “It puts an added bur­den on pri­mary care physi­cians and spe­cial­ists, nurse prac­ti­tion­ers and health­care work­ers in gen­eral.”

His clinic opened in 2001 and is one of the long­est sur­viv­ing clin­ics in the prov­ince, Fer­gu­son said. But as more doc­tors ei­ther re­tire or leave to prac­tise else­where, it is be­com­ing in­creas­ingly dif­fi­cult to of­fer clin­i­cal ser­vices.

Of­fi­cially, there are ap­prox­i­mately 60,000 Nova Sco­tians on the wait­ing list for a fam­ily doc­tor. Fer­gu­son, how­ever, be­lieves the ac­tual fig­ure is closer to 100,000, be­cause of the num­ber of peo­ple who haven’t added their names to the list or those who have sim­ply given up try­ing.

For younger, health­ier in­di­vid­u­als, not hav­ing a fam­ily physi­cian, while up­set­ting, is of­ten more of an in­con­ve­nience.

But for the el­derly, or those with se­ri­ous con­di­tions such as can­cer, heart dis­ease, un­sta­ble di­a­betes or men­tal health is­sues, the sit­u­a­tion be­come more dire, be­cause clin­ics are not de­signed to of­fer con­tin­u­ing care.

“So, the truth of the mat­ter is, Nova Sco­tia has a se­ri­ous lack of man­power both in men­tal health and in pri­mary care and in some other ar­eas, too,” Fer­gu­son said. “And Nova Sco­tians cer­tainly de­serve bet­ter.”

Over the past few months, Dr. Manoj Vohra, owner of the Care Now Walk In Clinic on Pic­tou Road in Bible Hill, said it has be­come in­creas­ingly dif­fi­cult to main­tain proper staffing at his clinic be­cause of the on­go­ing doc- tor short­age.

“Now it’s be­come run­ning an­other fam­ily prac­tice out of a walk-in clinic. So that be­comes an is­sue and con­ti­nu­ity of care be­comes an is­sue,” he said. “So, there’s a lot of chal­lenges.”

Vohra said three doc­tors who once as­sisted at his clinic no longer do so, which cre­ates a real con­cern if that trend con­tin­ues.

“There is a real chal­lenge to get enough re­sources to clin­ics,” he said. “In terms of mine, we’re just try­ing to hold it to­gether, hon­estly, be­cause we’ve been shut down over the last cou­ple of months be­cause we just don’t have enough re­sources.”

And Vohra said he is not con­fi­dent that re­cruits the prov­ince is suc­cess­ful in ob­tain­ing will help the sit­u­a­tion.

“I would sug­gest a lot of the new physi­cians who are com­ing in, if they are on a con­tract, are un­able to work out­side that con­tract. And that makes it dif­fi­cult be­cause we sort of have dwin­dling re­sources and an in­creased need with pa­tients with­out physi­cians.”

HARRY SUL­LI­VAN/TRURO NEWS

Peo­ple at­tend­ing the Truro Walk-in Clinic now have to make ap­point­ments in ad­vance, a change that Dr. Murdo Fer­gu­son says was brought about be­cause of a short­age of fam­ily physi­cians com­bined with an e ort to re­duce the amount of time pa­tients have to spend in the wait­ing room.

HARRY SUL­LI­VAN/TRURO NEWS

Dr. Manoj Vohra, of the Care Now Walk In Clinic in Bible Hill, said he be­lieves such clin­ics are in jeop­ardy be­cause of an in­creas­ing short­age of fam­ily physi­cians.

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