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Weekend shifts are a mind shift: Expanding access to primary care on the weekend

Dr. Robert Oliver never missed his kids’ basketball games because of work -- despite running a busy family practice out of the Woodlawn Medical Clinic in Dartmouth and offering his patients weekend appointments.  This was possible because he teamed up with other local physicians who care for each other’s patients in weekend clinics on a rotating basis. 

This model is known as an Urgent Care Centre .  Weekend appointments are available Friday evenings and on Saturdays and Sundays for patients of doctors who have joined the urgent care group. Patients will see whichever doctor is on shift that weekend, but unlike a walk-in clinic, the doctor will have full access to their charts and medical histories. 

Dr. Oliver says this is sustainable because a group of like-minded physicians who want to offer coverage outside nine to five in their office joined together to make it happen.

“I have probably four of those weekend commitments a year. So that’s not a large commitment.  I can still have a family life. Part of medicine is you work weekends.  Four weekends a year.  The reality is that medicine is not a nine to five job, but people are starting to think that’s what it is,” said Dr. Oliver.

If some of the financial obligations and workload could be shared through Urgent Care Centres, it might encourage more doctors to open a family practice.  At the same time, it would improve access to health care for patients who have doctors but might have to wait weeks for appointments.

This is why one of the recently announced initiatives under Nova Scotia’s Action for Health plan is to open five more[TD1]  Urgent Care Centres in Halifax Regional Municipality this year, according to Graeme Kohler, director of primary health care in the Central Zone. 

“It will increase the total number of appointments available across the zone [TD2] on any given weekend.  You are adding capacity to the system because there are just straight up more appointments that can be booked,” said Kohler. “This expands access to primary care.  It makes our system stronger and more able to adapt to the needs of the community. That’s the real win.” 

Nova Scotia Health will be paying all the extra overhead costs associated with opening a practice on the weekend. 

The secret sauce for the success of Urgent Care Centres is to sign up 25 to 40 doctors so the work is spread around, says Kohler. “Amidst the group, if you want to work more or less, you have the flexibility to do that, so you earn a good living and your rotation as part of that is quite minimal. There are always people looking to reduce medical school debt or pick up some extra shifts because they want to earn a little bit more money, so the ability to trade your shift away seems to be there very consistently.” 

Individual physicians can always offer weekend appointments to expand access and earn more money, but it doesn’t always work out.  “A doctor trying to do weekend work on their own may find they are not busy enough to make it worthwhile giving up the time off.  But when you’re seeing patients from a number of practices it pays off,” said Kohler.  With Urgent Care Centres, “ means that when they work on the weekends, they are busy enough that they earn a good living. It’s not like you’re going in to only see three patients on a Saturday.  You go in, you work half a day.  You are busy.” 

Dr. Oliver says his experience practicing in this model proves it can work.  “The society thought is that doctors work 80 hours a week and they don’t have a life.  I’ve practiced for 40 years, and I went to all my kids’ basketball games because I was in a group.  By practicing that way, you can have a life. Not a lot of people see that as they go through their training.  They say, ‘I’ve got to see so many patients.  How am I going to do that?’  The whole idea of a larger community of physicians is the answer to that. So, they can have a lifestyle.”

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