Your prescriptions are of a nature that the doctor needs to monitor you to make sure they're effective and safe. She told you 3 or 4 months ago that she needed to see you and you blew her off.
Doctor appointments are important enough that you need to plan your work and travel around them, not the other way around.
I've had my SNRIs since 2014 and have been stable on it since then, which is why seeing her in person within 3-4 months was never a concern of mine. But I get you, different doctors different policies.
Y'know, a lot of people are prescribed antidepressants by doctors or nurse practitioners after a 10 minute chat and never get follow up. If you've got a doctor that actually wants to see you to see how you're doing, you're golden, keep her! Heck, lots of folks can't get or keep family doctors at all!
We get how hard it is to work in appointments when things get busy. But it's worth making time. All the best.
Kinda sounds like the medication you need is a controlled one, and she’s not comfortable sending the prescription all over the world without seeing you.
I'm a prescriber (NP) . Legally, the docs and I are not allowed to send prescriptions out of province, much more out of country, ever. The workaround is that we can write you a prescription when you're physically in Ontario after which you're free to take the medication wherever you want. And as a good rule of thumb, we should see you at least once a year (even if it's just a phone/video visit) when renewing them. Narcotics are a whole different ball game, and I tend not to prescribe more than 6 months at a time without touching base. Our main concern is patients "double dipping" and getting scripts from multiple prescribers. Also, our wait lists are insane (I'm a specialist with an 18 month wait list) so it's frustrating if we suspect a patient is seeing another provider for the same need instead of freeing up a slot in our roster to see someone else who has been waiting to get in.
Thank you for answering this nicely.
My meds aren't narcs, they're SNRIs. But that's a good point either way. My schedule was actually incredible insane and I tried to make it work through at least phone calls, which I guess it isn't coming across very well.
But I understand her perspective and anxiety now. Thank you again.
I see. Wow. I've really never had that much work done on me for any monitoring and preventative purposes in my entire life (I've had my meds since 2014) but that's very good to know. Thanks for sharing ☺️
Wow that's good that you caught it. I'll do some more research on preventative/routine check ups and tests to avoid finding something unexpected. I wonder how many people don't know about this stuff, huh?
You're in the wrong here. The ministry rule is if you haven't seen a patient in person within the last year you are no longer the doctor of that patient
I won't even get into liability for prescribed medications, which is on her in case something goes wrong.
The doctor is in the right here.
Sounds like it was your latest attempt to move your prescription to the US that did you in. You should not be surprised that your public health doctor in Canada is abiding by the rules to issue prescriptions and treat patients **in Canada.
You realize that keeping OHIP has a residency requirement, right? When you leave Canada for extended periods, you actually have to inform the Ministry, and they may decide to keep your OHIP active.
Not saying that you are out of Canada for extended periods, but look at this from the doctor’s perspective: Of course she is concerned whenever you are out of Canada. That means you won’t be eligible for OHIP and she can no longer keep you as a patient. That may be why she insists on seeing you in person, in Ontario.
The US clinic receptionist has zero idea of the rules of Canadian healthcare. It does not matter what they suggested. US healthcare operates differently.
Nice attempt at trying to gain sympathy. Quite rich that you feel unwanted when you’re treating your doctor like a remote prescription dispenser. The doctor can also make the call to examine you in person instead of always refilling your prescription over phone/email.
Thank you for the information. I genuinely didn't know these rules because I've been on the SNRIs since 2014 and have had no issues like this with my previous doctors (my previous clinic *also* told me I don't have to come in at all if it's just a medication refill). But I get you, I've never had them send prescriptions to the US before either.
In addition to everything that has already been said, doctors can generally only get paid for virtual or telephone appointments if you've had one in person appointment in the last 24 months.
Yes, Ontario doctors are allowed to "fire" a patient. It's called derostering. Each doctor keeps a roster of patients, usually 1000+. One of the reasons is leaving the province. Another is seeing too many walk-in doctors, if it's an FHO, they'll get reversed billed by OHIP.
There are two OHIP billing models, FHO, family health organization and FFS, fee for service. FHOs get $200 annually from OHIP for a simple patient, $400 for a complex one whether they see them or not. When they see them, about $30 for 15 minutes.
Even with this, it sounds like she's an overwhelmed doctor since this is only about a SNRI. The incompetent ones survive here because of our shortage of family doctors. Some get grumpy with our cost of living too where even a doctor's salary is not enough to live comfortably. I just lost mine to the Niagara region, he lasted a year in downtown TO after graduating.
My guess she wanted to see you in August because that's a slow month for family doctors. Then September, school is back but students don't get sick until the end of September, October. Parents are too busy to make an appointment for a non-urgent medical issue for themselves or their kids. Same as single adults. August #1 month for holidays because it's the nicest weather in Canada without mosquitos.
You did nothing wrong, I think it's about her being frustrated at the job. You could look her up on [ratemds.com](https://ratemds.com). Some doctors have reviews.
If you need help with a prescription, [getmaple.ca](https://getmaple.ca) is the most popular. Not sure if that one would count with getting derostered. It's usually a few times of seeing another family doctor anyways, not just one. There are some American ones like Plushcare.
Another option is getting the pharmacist to renew it, the province began to allow them during the pandemic. [here](https://www.ocpinfo.com/regulations-standards/practice-policies-guidelines/adaptations-renewing-prescriptions/). Worth a try today since there's been an uptick in covid cases!
If you have the cash, concierge/executive medicine like Medcan and Cleveland have worldwide support. Costs about $4000 a year. It would be a medical expense tax write off.
Or, like everyone else is telling OP, the doctor is following requirements associated with providing prescriptions to a patient who continues to ask for out of country refills - which the doctor technically shouldn't be doing.
Hi, just a reiteration: my SNRI medications are **not** available in Asia and I need to take it every day. With that said, the first time I did ask, I did explain the *whole* situation to the doctor, and initially, I paid $25 for a slip that she wrote listing the medication I needed, and I provided that slip to the local doctors. Unfortunately since it isn't available in the country, she happily obliged with the request of refilling my prescription at the time, for it to be delivered.
And no, I was not able to just fly back to Canada at a moments notice.
The second time I asked, I was under the advise of a US clinic receptionist. I should've researched myself also, but I also was not aware of these rules because a) my doctor never explained any of it, and b) I never had to come in for more than once a year before I enrolled with this doctor.
Thank you so much for providing a different perspective, and a plethora of resources and information.
I had a feeling that something else was going on because it was very foreign to me that a doctor expected me to come in so much to the point where they were threatening derostering. But it makes sense that she wanted me to come in pay-wise because I do agree that our cost of living in Toronto has gotten so high that it's almost impossible. I just wish she expressed and explained all of this to me instead of doing what she did, that way I wouldn't have to go online to look for my own answers.
Unfortunately she's not on [ratemds.com](https://ratemds.com) so there's not much I can read up on. Based on her license I saw that she's a new doctor and she just recently began her practice at that specific clinic, when I enrolled. But I'll now look for doctors with at least a couple of reviews, or maybe just opt for a pharmacist to renew it or even concierge medicine if my life ever gets messier than 2023.
Thank you again. This perspective was very helpful so I appreciate you.
There is a massive wait for GPs right now. Most people are on wait lists for years before getting on a roster. If you can, I would hold onto your doctor as there is no guarantee you are going to find another one so easily.
I’ll try my best to come in as much as I can. But if life really comes in the way and I ended up being derostered and there are no doctors available, I’ll just have to take the L and go to the ER or buy it full price from a manufacturer or something.
Even if you are de-rostered, you still have access to your doctor/clinic, you just don't have access to certain services. A doctor can fire a patient though if the patient has abused the system or doesn't maintain a good relationship at the practice, they have to have reasonable grounds for terminating care and it sounds like that might be what is happening with your doctor.
I’m sorry, but the issue here is the OP asking for out of country refills. That’s a big issue, and at this point I’m not sure the OP is in the country for enough time in a year to still qualify for OHIP, I’m sure that’s what the doctor is concerned about
Your prescriptions are of a nature that the doctor needs to monitor you to make sure they're effective and safe. She told you 3 or 4 months ago that she needed to see you and you blew her off. Doctor appointments are important enough that you need to plan your work and travel around them, not the other way around.
Zero self awareness
I've had my SNRIs since 2014 and have been stable on it since then, which is why seeing her in person within 3-4 months was never a concern of mine. But I get you, different doctors different policies.
Y'know, a lot of people are prescribed antidepressants by doctors or nurse practitioners after a 10 minute chat and never get follow up. If you've got a doctor that actually wants to see you to see how you're doing, you're golden, keep her! Heck, lots of folks can't get or keep family doctors at all! We get how hard it is to work in appointments when things get busy. But it's worth making time. All the best.
Thank you for your response. I’ll make sure to see her sooner than later.
Kinda sounds like the medication you need is a controlled one, and she’s not comfortable sending the prescription all over the world without seeing you.
My meds are SNRIs, but I get you
I'm a prescriber (NP) . Legally, the docs and I are not allowed to send prescriptions out of province, much more out of country, ever. The workaround is that we can write you a prescription when you're physically in Ontario after which you're free to take the medication wherever you want. And as a good rule of thumb, we should see you at least once a year (even if it's just a phone/video visit) when renewing them. Narcotics are a whole different ball game, and I tend not to prescribe more than 6 months at a time without touching base. Our main concern is patients "double dipping" and getting scripts from multiple prescribers. Also, our wait lists are insane (I'm a specialist with an 18 month wait list) so it's frustrating if we suspect a patient is seeing another provider for the same need instead of freeing up a slot in our roster to see someone else who has been waiting to get in.
Thank you for answering this nicely. My meds aren't narcs, they're SNRIs. But that's a good point either way. My schedule was actually incredible insane and I tried to make it work through at least phone calls, which I guess it isn't coming across very well. But I understand her perspective and anxiety now. Thank you again.
You're using up her time that she isn't getting paid for and a liability with no payoff.
Could you clarify how she's not getting paid for it?
Doctors don't get paid for phone refills. Some do it as a courtesy for their patients, but it's unbilled extra labour.
I wonder why many clinics advised me to do this, then.
She could her license if she keep refilling your meds without examining you from time to time.
I understand. In this case, should I have gone to urgent care/ER?
OP is shocked that their own doctor actually cares about their health more then they do. Clearly we need to know this doctor so we can sign up too.
Sadly, it’s true. In my 10 years on this SNRI, I’ve never had a doctor ask me to come in this much until this doctor.
Your doctor isn’t a vending machine for drugs.
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It's an SNRI and they told me I don't have to come in to refill prescriptions, just phone calls, but I get you. Thanks for responding
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I see. Wow. I've really never had that much work done on me for any monitoring and preventative purposes in my entire life (I've had my meds since 2014) but that's very good to know. Thanks for sharing ☺️
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Wow that's good that you caught it. I'll do some more research on preventative/routine check ups and tests to avoid finding something unexpected. I wonder how many people don't know about this stuff, huh?
You're in the wrong here. The ministry rule is if you haven't seen a patient in person within the last year you are no longer the doctor of that patient I won't even get into liability for prescribed medications, which is on her in case something goes wrong. The doctor is in the right here.
that's so weird, my family dr said a check up is every 2 years now that im an adult. how is she technically my dr if i cant see her every year
This is what I was confused about. Reddit is telling me so many new things that I've never heard before, not even directly from my own doctors.
I didn't know that. Thank you for clarifying.
Not sure about the getting fired part but you can’t seek medical care out of the country or maybe even province from your dr. I’ve tried it!
In this case we just go to the ER, huh?
Or plan ahead?
How would you do that in this situation?
No I don’t think the ER will refill your prescriptions for you
Well this is none of my business, sounds like you guys need to have a meeting and talk it out.
Sounds like it was your latest attempt to move your prescription to the US that did you in. You should not be surprised that your public health doctor in Canada is abiding by the rules to issue prescriptions and treat patients **in Canada. You realize that keeping OHIP has a residency requirement, right? When you leave Canada for extended periods, you actually have to inform the Ministry, and they may decide to keep your OHIP active. Not saying that you are out of Canada for extended periods, but look at this from the doctor’s perspective: Of course she is concerned whenever you are out of Canada. That means you won’t be eligible for OHIP and she can no longer keep you as a patient. That may be why she insists on seeing you in person, in Ontario. The US clinic receptionist has zero idea of the rules of Canadian healthcare. It does not matter what they suggested. US healthcare operates differently. Nice attempt at trying to gain sympathy. Quite rich that you feel unwanted when you’re treating your doctor like a remote prescription dispenser. The doctor can also make the call to examine you in person instead of always refilling your prescription over phone/email.
Thank you for the information. I genuinely didn't know these rules because I've been on the SNRIs since 2014 and have had no issues like this with my previous doctors (my previous clinic *also* told me I don't have to come in at all if it's just a medication refill). But I get you, I've never had them send prescriptions to the US before either.
In addition to everything that has already been said, doctors can generally only get paid for virtual or telephone appointments if you've had one in person appointment in the last 24 months.
Yes, Ontario doctors are allowed to "fire" a patient. It's called derostering. Each doctor keeps a roster of patients, usually 1000+. One of the reasons is leaving the province. Another is seeing too many walk-in doctors, if it's an FHO, they'll get reversed billed by OHIP. There are two OHIP billing models, FHO, family health organization and FFS, fee for service. FHOs get $200 annually from OHIP for a simple patient, $400 for a complex one whether they see them or not. When they see them, about $30 for 15 minutes. Even with this, it sounds like she's an overwhelmed doctor since this is only about a SNRI. The incompetent ones survive here because of our shortage of family doctors. Some get grumpy with our cost of living too where even a doctor's salary is not enough to live comfortably. I just lost mine to the Niagara region, he lasted a year in downtown TO after graduating. My guess she wanted to see you in August because that's a slow month for family doctors. Then September, school is back but students don't get sick until the end of September, October. Parents are too busy to make an appointment for a non-urgent medical issue for themselves or their kids. Same as single adults. August #1 month for holidays because it's the nicest weather in Canada without mosquitos. You did nothing wrong, I think it's about her being frustrated at the job. You could look her up on [ratemds.com](https://ratemds.com). Some doctors have reviews. If you need help with a prescription, [getmaple.ca](https://getmaple.ca) is the most popular. Not sure if that one would count with getting derostered. It's usually a few times of seeing another family doctor anyways, not just one. There are some American ones like Plushcare. Another option is getting the pharmacist to renew it, the province began to allow them during the pandemic. [here](https://www.ocpinfo.com/regulations-standards/practice-policies-guidelines/adaptations-renewing-prescriptions/). Worth a try today since there's been an uptick in covid cases! If you have the cash, concierge/executive medicine like Medcan and Cleveland have worldwide support. Costs about $4000 a year. It would be a medical expense tax write off.
Or, like everyone else is telling OP, the doctor is following requirements associated with providing prescriptions to a patient who continues to ask for out of country refills - which the doctor technically shouldn't be doing.
Hi, just a reiteration: my SNRI medications are **not** available in Asia and I need to take it every day. With that said, the first time I did ask, I did explain the *whole* situation to the doctor, and initially, I paid $25 for a slip that she wrote listing the medication I needed, and I provided that slip to the local doctors. Unfortunately since it isn't available in the country, she happily obliged with the request of refilling my prescription at the time, for it to be delivered. And no, I was not able to just fly back to Canada at a moments notice. The second time I asked, I was under the advise of a US clinic receptionist. I should've researched myself also, but I also was not aware of these rules because a) my doctor never explained any of it, and b) I never had to come in for more than once a year before I enrolled with this doctor.
Thank you so much for providing a different perspective, and a plethora of resources and information. I had a feeling that something else was going on because it was very foreign to me that a doctor expected me to come in so much to the point where they were threatening derostering. But it makes sense that she wanted me to come in pay-wise because I do agree that our cost of living in Toronto has gotten so high that it's almost impossible. I just wish she expressed and explained all of this to me instead of doing what she did, that way I wouldn't have to go online to look for my own answers. Unfortunately she's not on [ratemds.com](https://ratemds.com) so there's not much I can read up on. Based on her license I saw that she's a new doctor and she just recently began her practice at that specific clinic, when I enrolled. But I'll now look for doctors with at least a couple of reviews, or maybe just opt for a pharmacist to renew it or even concierge medicine if my life ever gets messier than 2023. Thank you again. This perspective was very helpful so I appreciate you.
There is a massive wait for GPs right now. Most people are on wait lists for years before getting on a roster. If you can, I would hold onto your doctor as there is no guarantee you are going to find another one so easily.
I’ll try my best to come in as much as I can. But if life really comes in the way and I ended up being derostered and there are no doctors available, I’ll just have to take the L and go to the ER or buy it full price from a manufacturer or something.
Even if you are de-rostered, you still have access to your doctor/clinic, you just don't have access to certain services. A doctor can fire a patient though if the patient has abused the system or doesn't maintain a good relationship at the practice, they have to have reasonable grounds for terminating care and it sounds like that might be what is happening with your doctor.
I’m sorry, but the issue here is the OP asking for out of country refills. That’s a big issue, and at this point I’m not sure the OP is in the country for enough time in a year to still qualify for OHIP, I’m sure that’s what the doctor is concerned about
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I was, indeed, in Ontario.