Walk-in clinic doctor limit an 'extreme' move, clinic operator says

A doctor who operates seven walk-in clinics in the Halifax area says he's worried new restrictions limiting doctors from working in such clinics will make it harder for the province to recruit new physicians.

According to documents prepared for meetings in the Halifax area, the Nova Scotia Health Authority is planning to place restrictions on who can work in walk-in clinics in favour of collaborative care where the outcomes are better.

"Requests for new physicians to work in Walk In Clinics will most likely be denied," the document says.

• Nova Scotia walk-in clinics face doctor limits

Dr. Mark Fletcher told CBC News that he's received a "bit of a mixed message."He said he was initially concerned about the ability to staff the clinics, but then spoke to the deputy minister of Health and Wellness "who didn't paint as dire a picture."

How will they fill the void?

Fletcher said he appreciates the authority doesn't want doctors doing onlywalk-in work and that a walk-in does not replace the services that a primary-care physician provides.

But, he says, "I don't know in the short term [if] restricting the staffing of these clinics that are providing all this after-hours care is going to be a positive thing."

Fletcher opened his first twowalk-in clinics in the Halifax area in 2001. He was working the emergency department and seeing patients who didn't need emergency care but had no alternative.

Part of his concern is that collaborative care centres are not in place.

"How are they going to transition to this [collaborative-care] model they have in mind, which they readily state is five,10 years away?" he asked. "In the short term,access to a primary-care physician is still difficult and the walk-in clinics are still filling that void."

He said restricting the staffing means some walk-ins will be forced to close.

"If there's no physician to work, you have to close," he said. "If that happens the emergency departments will be overwhelmed."

Is it legal?

He also questioned whether the government can tell doctors where they can work.

"What is the province's ability to restrict what [doctors] are able to do in that manner? I'm not sure if that's been vetted legally and if that was challenged how well that would stand up," he said.

"To be told that you need the Department of Health's approval to work where you might want to seems a little extreme."

Fletcher said the policy won'tencourage new graduates to work in the province because of the "unwelcoming environment."

He points out that many family doctors will be retiring over the next five to 10 years and Nova Scotia will need new graduates to provide primary care.

Fletcher said some of the family doctors who are retiring don't want to completely step away from clinical care, and could choose to work in a walk-in clinic where they don't have all the obligations of a family practice.

He said the vast majority of doctors in his clinics are primary-care physicians, some are retired and a few work in the emergency department. "Very few work just walk-in," he said.

P.E.I. does it differently

Fletcher doesn't know what, if any, discussions the health authority has had with those who work in walk-in centres prior to making its decision, but he noted Prince Edward Island is giving financial incentives to walk-in clinics to reduce their wait times.

"Their government approach is collaborating and making sure walk-ins are working well because they see them as being an extension of the emergency department and keeping people out, whereas the approach in this province has been much different," he said.

Fletcher has a meeting with health authority officials later this month in an effort to determine just what the future holds for walk-in clinics.