A shifting terrain: Understanding the perspectives of walk-in physicians on their roles amid worsening primary care access in Ontario, Canada

PLoS One. 2024 May 15;19(5):e0303107. doi: 10.1371/journal.pone.0303107. eCollection 2024.

Abstract

Background: High-quality primary care is associated with better health outcomes and more efficient and equitable health system performance. However, the rate of primary care attachment is falling, and timely access to primary care is worsening, driving many patients to use walk-in clinics for their comprehensive primary care needs. This study sought to explore the experiences and perceived roles and responsibilities of walk-in physicians in this current climate. Methods: Qualitative interviews were conducted with nineteen physicians currently providing walk-in care in Ontario, Canada between May and December 2022.

Results: Limited capacity for continuity and comprehensiveness of care were identified as major sources of professional tension for walk-in physicians. Divergent perspectives on their roles were anchored in how physicians viewed their professional identity. Some saw providing continuous and comprehensive care as an infringement on their professional role; others saw their professional role as more flexible and responsive to population needs. Regardless of their professional identity, participants reported feeling ill-equipped to manage the swell of unattached patients, citing a lack of time, resources, connectivity to the system, and remuneration flexibility. Conclusions: As practice demands of walk-in clinics change, an evolution in the professional roles and responsibilities of walk-in physicians follows. However, the resources, structure, and incentives of walk-in care have not evolved to reflect this, leaving physicians to set their own professional boundaries with patients. This results in increasing variations in care and confusion across the primary care sector around who is responsible for what, when, and how.

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Attitude of Health Personnel
  • Female
  • Health Services Accessibility*
  • Humans
  • Male
  • Middle Aged
  • Ontario
  • Physician's Role
  • Physicians / psychology
  • Primary Health Care*

Grants and funding

Funding was received from the Canadian Institutes of Health Research (CIHR) project grant awarded to Lauren Lapointe-Shaw, Noah Ivers, and Laura Desveaux (no. 175285). This funder did not play any role in the study design, data collection and analysis, decision to public, or preparation of the manuscript.