Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.
Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada.
PLoS One. 2024 May 15;19(5):e0303107. doi: 10.1371/journal.pone.0303107. eCollection 2024.
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.
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.
高质量的初级保健与更好的健康结果以及更高效和公平的卫生系统绩效相关。然而，初级保健的就诊率正在下降，及时获得初级保健的情况正在恶化，这促使许多患者前往门诊诊所满足其全面的初级保健需求。本研究旨在探讨在当前环境下，门诊医生的经验以及他们对自身角色和职责的认知。方法：2022 年 5 月至 12 月期间，对在加拿大安大略省提供门诊服务的 19 名医生进行了定性访谈。
门诊医生的主要职业压力源是连续性和全面性医疗服务能力有限。对其角色的不同看法源于医生对其职业身份的看法。一些医生认为提供连续性和全面性医疗服务侵犯了他们的职业角色；而另一些医生则认为他们的职业角色更加灵活，可以根据人口需求做出反应。无论他们的职业身份如何，参与者都表示感到无法应对不断增加的无固定医生患者，他们提到缺乏时间、资源、与系统的连接以及薪酬灵活性。
随着门诊诊所实践需求的变化，门诊医生的职业角色和职责也随之演变。然而，门诊医疗的资源、结构和激励措施并没有随之发展，这使得医生不得不与患者自行设定职业界限。这导致医疗服务的差异越来越大，初级保健领域对谁在何时、何地以及如何负责感到困惑。
