Family doctors’ offices prefer new patients to be well off, new study finds

If you're a lower-income Canadian looking for a family doctor, a new study suggests you'll have better luck by pretending to be a banker.

Research published Monday by the Canadian Medical Association Journal found fake patients who phoned for appointments and let slip that they were newly-transferred bank executives had much better luck getting a family doctor's appointment than those who said they were on welfare.

The study, conducted in 2011, found researchers posing as bank employees were significantly more likely to be offered an appointment by the doctor's administrator (about 23 per cent) than those who said they were welfare recipients (14 per cent), Postmedia News reported.

Overall, 69 of the 375 calls to family-practice doctors resulted in appointments, 33 of which were offered screening visits — essentially an audition to determine if the patient would be enrolled in the doctor's practice — and 12 went onto waiting lists, CTV News said.

When it came to being offered a screening visit or a waiting-list slot, the difference was also significant — 37 per cent for the faux welfare recipients compared with 24 per cent for the fictional bank employees.

The discrimination was evident despite the fact doctors get paid the same medicare fee per patient visit regardless of their socioeconomic status.

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“In my personal experience as a physician caring for people who are marginalized, I’ve been struck by the fact that many of them say they feel that they’ve been treated poorly by health-care providers in the past, and that it’s in large part because they’re either poor or homeless,” Dr. Stephen Hwang the study's senior author, told Postmedia News.

“The tendency to favour people of higher status in society is probably universal," said Hwang, an internal-medicine specialist and researcher at St. Michael's Hospital. "It’s something I’m conscious of in myself — I have to guard against that tendency."

Postmedia noted the College of Physicians and Surgeon of Ontario’s policy on accepting new patients states that doctors who are able to take new patients should do so on a “first-come, first-served” basis. The policy also frowns on screening of new patients as potentially discriminatory and “because it can compromise public trust in the profession, especially at a time when access to care is a concern.”

In a statement, Hwang criticized the apparent discrimination against poorer patients.

"Even in a system where doctors receive the same payment for every patient, regardless of the patient's income or occupation, we see evidence of discrimination against people of low socioeconomic status," Hwang said, according to CTV News.

"This impairs access to primary care, and we don't think this is acceptable."

One piece of good news did come out of the study: Patients with a chronic health problem were not discriminated against. Quite the opposite.

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Hwang said researchers had expected doctors to prefer healthy patients because they take up less time and effort. But it turned out would-be patients who said they had diabetes or back pain were nearly twice as likely to get an appointment than those who had no pre-existing problem.

Hwang speculated doctors may like chronically ill patients because there's a higher revenue potential. However, the higher-income patient with a chronic health issue was still more likely to get an appointment, the study found.

Hwang cautioned that the results don't necessarily reflect the prejudices of the doctors themselves but those of the office staff who act as gatekeepers, though the doctors could have set the criteria.