Unattached patients do not have a regular primary care provider and are often left to seek basic and preventative health care through walk-in clinics and emergency rooms [1, 2]. It has been well established that there is a significant number of unattached patients in Canada , with some media reports estimating that up to five million Canadians do not have a regular family doctor [3, 4]. A recent estimate suggests that there are 3200 fewer family doctors practicing in Canada than what is needed to meet demand . A 2008 survey reported that approximately 25% of Canadians experience some form of barrier to accessing regular medical care  and a 2009 survey found that 13% experience barriers to routine or ongoing primary care specifically . Given the structure of Canada’s public health care system, the existence of unattached patients is problematic. This is because Canadian family doctors serve as ‘gatekeepers’ to secondary and tertiary care, whereby referral from a family doctor is required for a patient to see a specialist or obtain surgery [8–10]. This aspect of the organization of the public health care system heightens the need for Canadian patients to have a regular family doctor above and beyond the preventative care and treatment they offer to patients .
It is thought that there are a number of reasons as to why Canadian patients become and/or remain unattached to a family doctor, including the: closure of rural practices, steady stream of new immigrants, and health care planning mandates that have not accurately anticipated physician demand [12–14]. In response, a number of regional and provincial/territorial health administration bodies have created initiatives in the form of policies and programs designed to increase the numbers of practicing family doctors . These initiatives exist typically at regional and provincial/territorial levels because while the Canadian public health care system is partially funded federally, it is administered on a provincial or territorial basis . For example, in the province of British Columbia (BC), the BC Ministry of Health has developed the Attachment Initiative, which is designed to ensure that all residents of the province who want a family doctor have access to one [17, 18]. Among other features, the program encourages family doctors to take new high-needs patients into their practice, including chronically ill individuals and seniors [17, 19]. Initiatives such as this one have been implemented across the country [20–22].
Existing studies have identified the health risks that patients face as a result of being unattached to a family doctor. For example, such patients are less likely to receive preventative care, such as routine blood pressure checks [23–25]. Conversely, studies have also demonstrated the benefits of attachment. Among these is that having a regular family doctor increases the likelihood of having an annual medical visit [25, 26]. Attached patients have also stressed the importance of being able to have a continuous medical record and the benefits of seeing a family doctor who is familiar with their family health history [27–29].
Patients can have a regular place of care without having attachment to a regular provider [30, 31]. This is true for those who are reliant on walk-in clinics. In Canada, walk-in clinics prioritize offering care without an appointment . The medical care provided in these clinics is funded by the public system, and thus does not require out-of-pocket payment. While some walk-in clinics allow patients to request a particular physician, this varies by site and is often not allowed because the walk-in clinic model is built around interpersonal discontinuity . These clinics are commonly visited by patients who have a regular family physician but need care for a non-emergency health issue for which they do not want to wait to see their regular doctor . There are some patients, however, for whom the walk-in clinic is their regular place of care . Although there are benefits to be had from having a regular place of care, such as having a continuous medical record being kept , in a health care system predicated on gatekeeping at the primary care tier in order to access specialized care like Canada’s, having a regular care site alone poses as a barrier to obtaining referrals due to a lack of continuous and ongoing monitoring by a single knowledgeable physician .
In order to inform initiatives aiming to address the problem of unattached patients in Canada, it is imperative that consideration be given to the experiential accounts of unattached patients. This is because knowledge end-users place increasing value on the role that personal accounts and qualitative evidence more broadly can play in decision-making processes [35–37]. Meanwhile, most existing attention paid to unattachment has focused on quantifying the problem and health system costs [1, 12, 25, 38, 39]. To address this knowledge gap, in the present article we examine the experiences of unattached patients in a low socio-economic status neighbourhood of a mid-sized BC city who are managing chronic illnesses in order to provide policy-relevant qualitative insights. By virtue of their low socio-economic status and lack of attachment they are marginalized in Canada’s health care system. We focus on chronic illnesses because people managing chronic illnesses require timely access to care  and yet are more likely to be unattached than those without chronic health conditions . This may be due, in part, to the fact that Canadian family doctors can choose who to accept into their practices, and so it is thought that difficult or challenging patients are screened out .