Offices of family physicians appear to give preference to people with chronic health conditions

Some family physicians' offices discriminate against people of low socio-economic status, even when there is no economic incentive to do so under Canada's system of publicly funded universal health insurance, new research has shown.

At the same time, offices appear to give preference to people with chronic health conditions, according to the research led by Dr. Stephen Hwang of St. Michael's Hospital.

In his study, published today in the Canadian Medical Association Journal, researchers telephoned the offices of family physicians and general practitioners offices in Toronto playing the role of an individual seeking a primary care physician. They followed a script that indicated they had high socio-economic status (a bank employee transferred to the city) or low socio-economic status (welfare recipient) and the presence or absence of chronic health conditions (diabetes and low back pain).

The proportion of calls resulting in an offer of an appointment was significantly higher for people with high socio-economic status (22.6 per cent) than people with low socio-economic status (14.3 per cent). If an offer of a screening visit with the physician or a spot on a waiting list is also counted, the difference is 37 per cent for people with high status with 24 per cent for those with low status.

An individual with chronic health issues was significantly more likely to get an appointments than someone without - 23.5 per cent compared to 12.8 per cent.

"Even in a system where doctors receive the same payment for every patient, regardless of the patient's income or occupation, we see evidence that some offices discriminate against people of low socio-economic status," said Dr. Hwang, a general internal medicine physician at the hospital and a researcher in its Centre for Research on Inner City Health. "This impairs access to primary care, and we don't think this is acceptable."

Dr. Hwang noted that the Ontario College of Physicians and Surgeons has a policy prohibiting "cherry picking" or screening of patients. Family physicians are expected to take patients on a first-come, first-served basis or, if they are not accepting new patients, offer to put them on a waiting list.

"Screening visits, or 'patient auditions,' are unacceptable," Dr. Hwang said, yet that is what nine per cent of the doctors surveyed offered. "Obviously that presents even more opportunities to discriminate."

Dr. Hwang said stricter enforcement of the college's rules would help prevent discrimination in access to primary health care.

Dr. Hwang stressed he was not trying to single out family physicians or suggest they discriminate more than other physicians or professions. He also noted that most of the telephone calls made by the researchers were answered by secretaries or administrative assistants, and their actions do not necessarily reflect the views of the physicians for whom they work.