I received an email today from my family doctor's clinic telling patients to be less particular about whether they get to see their doctor or not when they schedule an appointment with... their doctor. The parts I take issue with are in bold. Here's the email body:
Good Morning <clinic> Patients,
A Reminder to Our Patients: <clinic> is Proud to Be a Teaching and Team-Based Facility.
Medical learners (students and residents, most of whom are training to be family physicians) are an important part of our team. Physician assistants, nurse practitioners, and locum/covering physicians are also crucial to our clinic functioning.
With the help of our team:
- We are able to offer non-urgent appointments usually within 1-2 weeks.
- We are able to offer same-day appointments for urgent issues.
- We are able to continue to provide care to our current <clinic> patients at a time when there are a record number of family physicians leaving practice.
- We play an important role in training the next generation of family physicians.
There have been an increasing number of patients requesting appointments with their provider only (and declining to see other members of the <clinic> team). This causes significant disruptions to the clinic and affects our ability to provide equitable care to all <clinic> patients.
Moving forward, when you book an appointment, you should expect that you may see a medical learner, physician assistant, nurse practitioner, or a physician covering for your primary family physician. For many appointments, your family physician will be available to see you after you have been seen by another practitioner, if requested or needed. Please be aware that learners and physician assistants are supervised directly by your physician.
This team-based model of care may not be the right one for you, and if you wish to transfer your care to another clinic, we will be happy to waive the usual fee for transfer of records.
We appreciate the important role you play in medical education and making practicing family medicine sustainable.
Sincerely,
The physicians and staff at <clinic>.
So basically, patients want to see their doctors instead of medical students and the clinic is telling the patients to fuck off with their standards and expectations. Instead of building rapport, confidence, and sharing personal vulnerabilities with your family doctor, you can now expect to do it with random, unqualified, inexperienced people who you'll never see again and who don't know your history. If you don't like it, despite paying these fuckers' wages, you can pound sand.
FYI, when this email says the students and assistants are directly supervised, it's figurative. It means the students and assistants report to the doctors, not that the doctors are in the room while the assessments and appointments are conducted. You're expected to meet with these unqualifieds one-on-one. There used to be supervised appointments where medical students would simply shadow the doctor with permission from the patient, but that hasn't been the case for years.
Also, moving to another family doctor is extremely difficult. Most doctors have a maxed-out roster and are not accepting new patients. There are 2.3 million Ontarians without consistent access to a family doctor in a province of 14.5 million.
Canadian tax dollars at work.
Edit: just read this was in Canada. So I retract statement below because as I understand it you actually don’t have any medical autonomy in that shithole.
So a couple of things I would like to offer (edit: for those based in the USA)
I get your frustration, and I too, would want to work solely with my primary care physician for myself and family.
however, if you’re working with a Clinic - usually affiliated with a university- that is part of an educational program, it’s par the course that you are going to have care administered by residents and medical students in training. That’s literally part of their charter.
just devils advocate, but where do you expect residents to learn real world experience if not in a clinical setting?
Regarding use of the word equitable - yes woke term, but it’s pretty much standard language used to disarm criticism preemptively. I wouldn’t read into it.
TLDR: if you don’t want students administering care, don’t go to an educational medical facility. I’d say it sucks but that’s the function of those clinics, to teach doctors how to be doctors.
At the clinic I see is fine, if asked for less important appointments. However, I don't want to be forced to accept a medical student or be kicked off the roster. I also don't want to be told I'm in the wrong for wanting a doctor foremost.
FYI, these forced med. student appointments are new. It may be a teaching clinic (it didn't used to be), but that's no excuse for requiring people to see med. students instead of full-fledged doctors.
Furthermore, the teaching angle is an incomplete excuse. Notice how "physician assistants" was also on that list, right beside medical students? What's the justification for that?
In the states a physician assistant is an actual degreed position that requires medical education similar to an MD or DO. they are not literally an “administrative” assistant. They can prescribe medications, order lab testing, administer treatment, etc like an MD would. The largest difference is how insurance pays out for a physician va a physicians assistant.
Maybe in Canada there are differences, but for most of your general stuff at a clinic, a PA is generally qualified.
I get that you want to see your own doctor. I also get that you’re stuck in a shitty medical system. Ideally you should have the ability to opt out of that.
My point is simply that there’s a legitimate case to be made for education in a clinical setting; in fact that’s one of the foundational elements of western medicine, residency and clinical education.
the alternative is multi-generational incompetence , and a class of medical practitioners with literally zero real world experience and mentorship.