Do I need to leave my family doctor to look for a new one?

QUESTION: I live in rural Ontario and my doctor is part of a group practice. Most of the doctors in the practice are fairly old and it only makes sense that they will start to retire soon.  I would like to begin the search now for a new doctor because I don’t want to be stuck without one. There is an Ontario Government website that helps patients find doctors. But it’s for people who don’t currently have a family physician. Do I have to quit my doctor’s practice to use the website?  And what do I do if I need to see a doctor before I find a new one?  Will my previous doctor still be able to treat me? Or, can he refuse to see me because I left his practice?

ANSWER: It sounds like you want to beat the rush by changing doctors before your family physician actually closes shop.  I guess you are assuming that everyone in his practice will be looking for a new doctor at the same time. And, in a rural area, there may not be many physicians taking on new patients.  Okay, I understand your logic.

As you correctly point out, you can’t use the Ontario government’s website Health Care Connect if you are currently enrolled with a primary-care provider.

So you will have to ask your doctor to be taken off his list – or roster – of patients. But that doesn’t necessarily mean he can’t continue to treat you, says David Jensen, a spokesperson for the Ontario Ministry of Health and Long-Term Care.

“Ending enrolment with a physician does not end the patient/physician relationship, it merely changes the payment model under which services provided by the physician are funded,” he explained in an email.

Many Ontario doctors who work in group practices are now paid a flat fee, per patient, per year. This arrangement, which is known as capitation, is relatively new. The amount is adjusted to take into account the age, gender and medical complexity of the individual patient.

Generally speaking, though, your physician is paid the same amount regardless of whether you have just one appointment or 10 appointments a year.

If you are no longer part of his regular practice, he can still treat you on a traditional fee-for-service basis in which the province pays him a set fee for each medical service he provides to you.

So you can leave his practice and have ongoing medical care. But there is a catch – the doctor is not obliged to see you unless it’s “an emergency situation,” once you’ve left, cautions Kathryn Clarke, senior communications coordinator at the College of Physicians and Surgeons of Ontario.

That means you want to make the formal split from his practice on friendly terms.  Mr. Jensen says, “Patients are encouraged to discuss their circumstance with their enrolling physician to ensure continuity of care.”

And if a congenial relationship isn’t in the cards, you have a few other ways to continue your medical care. “The ministry’s Health Care Options website has a list of primary-care providers -including walk-in and urgent-care clinics across the province – who may see and treat patients on a same-day or urgent-care basis,” notes Mr. Jensen.

But I think you really need to have a thorough discussion with your doctor before you take any action.

“I see nothing wrong in just having a conversation about it the next time you’re in the doctor’s office,” says Ms. Clarke. She suggests that you ask your doctor if he has any immediate plans to retire. If that’s the case, ask how much notice he intends to give his patients. You can then raise the idea of leaving his practice – but still see him on an as-needed basis.

Ms. Clarke also points out that your assumptions could be wrong. He may have no plans to give up his practice any time soon. “Doctors don’t necessarily retire at 65 – they don’t have to and we have many physicians who are working into their 70s,” she notes.

(Of course, having an older doctor may lead to other problems such as competency-related issues that recently made headlines in British Columbia. But let’s save that topic for another time. )

“Keep the lines of communication open,” advises Ms. Clarke. “I think that most physicians would be very responsive to your questions and it is good for the relationship to have these conversations.”