A question that occasionally arises is whether patients are able to switch - permanently instead of for certain medical concerns - between different Arbour Family Medical physicians after having had their initial intake appointment. 

In short, the answer is almost always no for the reasons that follow. There are several different reasons that relate to ensuring physicians working in a collaborative team environment can deliver the best long-term patient care possible:

• maximizing physician availability
• preventing the screening of patients
• supporting sound physician decision making.

In addition, positive side-effects of this policy include:

• reducing high-risk patient hand-overs
• promoting long-term patient-physician relationships
• enabling family-friendly staffing policies

Notably, this policy applies even in situations where a particular patient is requesting a switch based primarily on physician gender. The reasons relate to the following as also discussed in more detail here:  

• all Arbour Family Medical physicians are fully qualified to provide primary care to men, women (including expectant mothers), seniors, children, and infants
• as an organization, we believe in and promote equality and respect for all and have an obligation to not discriminate or support discrimination
• we do not assign patients to physicians taking into account factors such as physician age, ethnicity, or gender
• we offer patients the opportunity to request a special accommodation prior to their first intake appointment.
  
  

Maximizing Physician Availability

One of the modern challenges for family physicians is the amount of administrative work involved. For every hour of seeing and providing care to patients directly, there may be up to another hour of paperwork and other administrative tasks required. Generally speaking, the proportion of administrative work required has been increasing, commensurate with ever increasing legal and regulatory requirements, as well as the increasing complexity of care.

One particularly time-consuming task for physicians is the work associated with taking over responsibility for the care of a patient. On average, every new patient involves several hours of work comprising an initial half-hour meeting, a detailed review of their old medical records, and constructing and configuring an optimized patient medical record.

This investment of time and resources is entirely wasted in the event of a switch as the new physician needs to redo this entire process.  In the aggregate, restricting switches between Arbour Family Medical physicians therefore helps maximize physician availability to provide actual medical care, as opposed to spending time on administrative matters.

Preventing The Screening Of Patients

A practical reality is that different patients have different needs and expectations. In a clinical environment, these differences can sometimes manifest as an unconscious desire, on the part of physicians, to screen out (or ‘cherry-pick’) certain patients.

As an office we do not believe this is appropriate, and indeed, we strongly believe in the professional obligation of physicians to accept patients on a first-come, first-served basis.  

Allowing switches between physicians within our office unfortunately undercuts this foundational principle; it provides a loophole that incentivizes subtly suggesting to certain patients that perhaps another physician would be better suited to their needs and expectations, in the hopes that the patient requests a switch.

Restricting switches between physicians therefore supports the philosophy that physicians must take patients as they come, for better or for worse, and helps ensure Arbour Family Medical physicians continually work hard to provide the best possible care for all of their patients.
 

Supporting Sound Physician Decision Making

As a professional, it is a physician’s duty to provide appropriate and quality medical care. Fulfilling this duty means sometimes saying no to patient requests or making an unpopular treatment recommendation. In such circumstances, some patients may wish to seek out a second opinion or a different approach.

Unfortunately, in a collaborative team-based office, allowing switches between Arbour physicians undermines both this duty, as well as the patient’s ability to obtain unbiased second opinions.

First, knowing that a patient can easily request a change of physician within the office makes it much more difficult for a physician to provide objective medical care in the patient’s best interest, especially in situations in which their professional opinion conflicts with a patient's request. A common situation in which this occurs is when a patient requests a prescription for a controlled medication (such as narcotic painkillers), and the physician's professional opinion is that this is not safe or appropriate.

Second, patients deserve a fully unbiased second opinion. Within a collaborative team-based office, a patient’s new physician will be extremely hesitant to contradict their colleague - doing so is simply not conducive to a long-term working relationship. Patients deserve independent second opinions, which requires seeing a physician at a different office altogether.

Positive Side Effects

In addition to the reasons for this policy discussed above, there are several additional positive side effects worth noting.

One positive outcome is a reduction in transfers of responsibility between physicians for patient care. Such transfers are known to increase the risk of administrative and medical errors; minimizing the frequency and need for such transfers in turn reduces the risk of such errors.

Another positive outcome is the promotion of long-term patient-physician relationships which research has evidenced reduces morbidity and mortality. As with every relationship, there may be some bumps in the road; restricting intra-clinic switches promotes overcoming these challenges.

Lastly, this policy is consistent with our family-friendly staffing policies. In the specific scenario of parental leave, we actually take an even stricter approach on not ever allowing switches from the parent on leave to another Arbour Family Medical physician.