Patient Enrollment and Rostering

Rostering is the formal registration between a patient and a family physician. The goal is continuity of care. Being enrolled gives you:

• Coordinated primary care
• Better management of chronic conditions
• Access to after-hours services
• Preventive screening

Rostering is a two-way commitment. The doctor agrees to provide comprehensive primary care. You agree to come to them first. The model works best when both sides hold up their end, which is why walk-in use raises questions.

How Often Do Rostered Patients Use Walk-Ins?

A lot of Ontarians still visit walk-ins even when they have a family doctor:

• Roughly 30% of rostered patients visit a walk-in clinic at least once a year.
• Walk-in visits make up about 10% of all primary care encounters in Ontario.

The usual reasons:

1. Same-day care for acute, non-emergency issues
2. Extended hours
3. Convenient location
4. Can't get a timely appointment with their family doctor

Walk-ins have their place. They can also chip away at continuity of care if used too often, which is where the friction with family doctors comes from.

The Family Doctor's Side

Most family doctors are fine with occasional walk-in use. What concerns them is patients regularly bypassing the practice for non-urgent issues. The thing they ask for most is communication: tell your doctor about the visit so they can update your chart and arrange any follow-up.

The underlying goal is still good care. That usually means balancing access with continuity, not punishing patients for using a walk-in once or twice.

Derostering Rules in Ontario

Derostering rules sit under OHIP and the Ministry of Health. The key points:

1. No automatic derostering. Using a walk-in clinic doesn't kick off an automatic process.
2. Patients can seek care elsewhere. You have the right to do that.
3. Physician discretion. Family doctors can deroster, but only for valid reasons and following proper procedure.
4. Valid reasons for derostering:
   • A breakdown of the doctor-patient relationship
   • Moving outside the practice area
   • Persistent non-compliance with essential treatment

1. 30 days' notice. Physicians must give 30 days' notice before derostering, except in cases of threat or violence.
2. Continuity of care. Even when derostering, doctors must make sure you have access to care during the transition.

Walk-in use isn't explicitly listed as a reason to deroster. Frequent use can damage the relationship, and in extreme cases that's what leads to derostering.

What Influences a Derostering Decision

Doctors rarely deroster a patient just for walk-in use. Several factors play in:

1. Frequency. Occasional visits are fine. Repeated visits start to raise concerns.
2. Nature of the issue. Walk-in care for a minor acute problem is less concerning than walk-in care for an ongoing or chronic condition.
3. Communication. Patients who tell their family doctor about walk-in visits are far less likely to face derostering.
4. Overall compliance. Patients who attend their regular check-ups and follow advice are at lower risk.
5. Practice policy. Some practices have specific rules about walk-in use. Ask if you're not sure.
6. Impact on care quality. If walk-in use is preventing your doctor from giving you good care, that matters.
7. Financial side. Frequent walk-in use can affect physician compensation, which adds tension.

Derostering for walk-in use alone is rare. Most doctors try to address the issue through a conversation first.

How to Avoid Derostering

Some habits keep your relationship with your family doctor in good shape:

1. Try your family doctor first. Book with your regular physician for non-urgent issues.
2. Be open. Tell your family doctor about any walk-in visits and why you went.
3. Use their after-hours services. Many practices have extended hours or an on-call line.
4. Consider telehealth. Your family doctor is required to pay the walk-in physician personally for each visit you make to their clinic. That's why they discourage walk-in use. Virtual telemedicine services like TeleTest don't bill OHIP, so your family doctor isn't penalized when you use one. You can use TeleTest for lab testing or prescription renewals when your doctor isn't available, without risking your spot on their roster.
5. Plan ahead. Book routine check-ups and follow-ups in advance.
6. Be honest. If access or wait times are a problem, say so. You and your doctor can work it out.
7. Know your enrollment agreement. Understand what you signed up for.
8. Keep your contact info up to date. The practice needs your current phone and address.

Follow these and the risk of derostering goes down to almost nothing.

Alternatives to Walk-in Clinics

If you want to reduce walk-in visits, you have options:

1. After-hours care. Many practices have extended hours or partner with after-hours clinics. Ask yours.
2. Telehealth Ontario. Free, 24/7 advice from registered nurses.
3. Virtual care. Many family doctors now do video or phone consults for non-emergency issues.
4. Urgent care centres. Handle more serious issues than walk-ins, with shorter waits than ERs.
5. Family Health Teams. Some practices have nurses, dietitians, and other allied health professionals on staff.
6. Patient portals. Use them to message your doctor, request refills, or book appointments.
7. Nurse practitioner-led clinics. Good for non-complex primary care.
8. Community health centres. Often more flexible hours and a range of services.

These options usually let you get timely care without straining your relationship with your family doctor.

Bottom Line

Family doctors in Ontario rarely deroster patients just for using walk-in clinics. Frequent use can still strain the relationship and affect the quality of your care. The goal is to balance access with continuity. Telemedicine services like TeleTest don't bill OHIP, so your family doctor isn't penalized when you use them. You can use TeleTest for lab tests or prescription renewals when your doctor isn't available, without losing your spot on their roster.

Your family doctor is your main partner in your care. Open communication and judicious walk-in use will keep that partnership in good standing.