Is virtual care a cure for Canada’s battered health-care system?

Lesley Campbell leaves the emergency room at Michael Garron Hospital in east Toronto, hugging her right arm.

“I fell off the bike,” he said, looking at his white cast. “Sorry It was a mistake.”

He said you should go to the hospital for some ailments like a broken bone, but for other less serious things there should be an alternative.

“For a minor dent or whatever, or a lot of other things like a sprain, it would be nice to ask what I’m going to do next.” said Campbell. For example, for a child with a fever, “I could easily call there for a referral. The doctors can see them on video and it would be great not to have to come downtown.”

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“It saves your time, energy and definitely gas,” said Zahir Mohammed, who also leaves Michael Garron Hospital. But while it’s convenient, he said he’s not a fan of virtual care. Instead, Mohammed said he prefers to see his doctor in person so he can better explain his symptoms and ask questions.

“Sometimes through the virtual, those kinds of things just can’t be expressed, so they’re more likely to be misdiagnosed.”

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Virtual care is generally defined as the delivery of health services by electronic means such as telemedicine, online video consultations and remote monitoring. During the COVID-19 pandemic, consulting a doctor via video conference or phone has proven to be a convenient way to access care.

Pandemic sparks growth in virtual care

Many provinces in Canada have turned to virtual care to take the pressure off their strained healthcare systems. Hospitals have succeeded in removing patients from crowded emergency rooms and have been used to deal with problems caused by a nationwide shortage of healthcare workers and long waiting lists for family doctors.

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But despite the increased use of virtual care during the pandemic, there is now some backlash from the nation’s most populous province, Ontario, and the medical association.

Even before the pandemic, a number of platforms were offering virtual medical appointments, including Telus Health, Maple, Babylon, Tia Health, and Rocket Doctor. Some platforms bill provincial healthcare plans, while others charge a user fee.

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Dr. William Cherniak is an emergency room physician in Markham, Ont., and the founder of Rocket Doctor, one of a series of platforms that provide virtual medical appointments. He says such services offer greater accessibility for rural patients as well as those who cannot find a family doctor. (Philip Lee Shanok/CBC)

In Markham, Ont., north of Toronto, emergency room physician and founder of Rocket Doctor, Dr. William Cherniak said that with the COVID-19 restrictions and crowded hospitals and clinics, this is an opportunity.

“Virtual care was not something we tolerated during the pandemic as it filled the void where doctors couldn’t see patients in person, but something Canada has missed for years because it’s not in our public funding. And we’re just beginning to understand its potential,” he said.

Cherniak’s virtual care company has partnered with Georgian Bay General Hospital in Midland, Ont., in a new service trial that gives patients an alternative option to the emergency room.

He said most people who go to the emergency room have minor illnesses or injuries that can be virtually treated, and leave the emergency room for those with more serious illnesses or trauma.

“We have a huge healthcare system crisis where physicians who don’t want to practice medicine are exhausted, patients are losing their family doctors, and we have physicians who want and are willing to see patients virtually.”

But in Ontario, Cherniak said a change in policy has resulted in fewer doctors interested in signing up to provide such services.

Virtual care stays in the background in Ontario

On December 1, a new physician services contract with a new virtual care financing framework between the province’s Department of Health and the Ontario Medical Association (OMA) went into effect. The new assistance program for physician services makes temporary virtual care billing codes permanent, while the new Ontario Virtual Care Program pricing structure, rates, and payment parameters have new limits to what OHIP – the province’s public health insurance plan – will cover.

Ontario health minister Sylvia Jones said the need for virtual care is not as urgent as it used to be, with the worst of the pandemic over.

“We need to bring patients in front of their doctors on a more regular basis,” Jones told reporters last month. “We need family physicians to see patients in person. For this parent, when that caregiver has questions, primary care physicians are the first place they can go and reach.”

The president of the Ontario Medical Association, Dr. Rose Zacharias acknowledges that virtual care is not intended to replace in-person care.

Dr.  Rose Zacharias is president of the Ontario Medical Association.  She says the fact that nearly 1 million Ontario residents don't have a family doctor makes it difficult for them to navigate the system, especially at these times.
The president of the Ontario Medical Association, Dr. Rose Zacharias says the state urgently needs to license more doctors instead of prioritizing virtual therapy so that more people can receive in-person care. (Jennifer La Grassa/CBC)

“We’ve now stepped back, looking at how we can get the most out of virtual care and also prioritize the patient-doctor relationship,” he said. “We don’t have enough doctors for everyone to have this relationship, and so there is an urgency to license more doctors, to get more doctors into this system to catch patients in this care relationship.”

But Cherniak said the new agreement between the Ontario Department of Health and OMA will threaten many virtual care business models because – where there is no existing doctor-patient relationship – doctors who make virtual visits will only receive a flat fee of $20. Doctors who have seen a patient in person in the previous 24 months will be paid the same fee for virtual care as in-person care, but doctors who provide “one-time” visits will not be paid.

“So they’re saying, ‘Hey, we’re going to really cut your pay rates in half despite all the hardships you’re going through in tackling this epidemic,’ and that’s really unfortunate because a lot of patients will lose access to care,” Cherniak said.

But some doctors see the bill change as an incentive for follow-up care in the community.

Kyle Vojdani is chief of emergency services at Michael Garron Hospital, which offers virtual care for minor ailments and assists nearly a dozen patients a day.

“Getting a virtual visit from a doctor in another province or perhaps … hundreds of kilometers away, trying to coordinate follow-up management for you is difficult, if not impossible,” he said.

Studies differ on benefits of virtual care

The OMA recently cited a report linking virtual care to the added pressure on the overwhelmed healthcare system. The report said that the lack of continuity of care after virtual visits has resulted in patients staying in the emergency room.

But Rocket Doctor’s Cherniak cites another study that found that 94 percent of patients who used virtual care instead of going to the emergency room rated their overall virtual care experience as 8 out of 10 or higher. More than 80 percent said they received answers to all of their questions about health concerns and believed they could manage the problem.

People sit on chairs in a hospital waiting room.
People wait for treatment in the emergency room of Sainte-Justine Hospital in Montreal in January 2020. Virtual care has allowed hospitals to move patients away from crowded emergency rooms and has been used to tackle the problems stemming from a nationwide lack of healthcare. long waiting lists for care workers and family doctors. (Ryan Remiorz/Canadian Press)

Another study by the Angus Reid Institute found that half of Canadians were either unable to find a doctor or were unable to make a timely appointment with the doctor they had. It also reported that one-third (32 percent) of Canadians communicated with their family doctor, mostly by phone or video call. And 65 percent of Canadians who see their family doctor primarily over the phone or online say they’re happy with the arrangement.

Unlike Ontario, Canada’s western provinces welcome virtual care providers more, Cherniak said, because they realize that people in isolated rural areas need access to timely care when they can’t get to a doctor’s office.

“So BC and Alberta really doubled down on virtual care, you know, like the Alberta government is giving in-person and virtual services a parity,” said Cherniak, who saw the potential to help those who are having trouble finding a family doctor in particular. those with mobility problems in remote areas or that make it difficult to travel to a healthcare facility.

Newfoundland and Labrador recently requested requests for proposals to provide virtual health services in the face of the state’s emergency services shutdown. It also plans to explore options to expand virtual care for people who are not GPs.

WATCH | Manitoba will receive new virtual emergency care in 2023:

New virtual emergency care service coming to Manitoba in spring 2023

The service was originally announced as part of the state government’s $200 million plan to retain, train and recruit more than 2,000 health care workers. VECTRS is a centralized emergency care service that will provide clinical guidance and patient transport to healthcare professionals.

“In an ideal world, yes, everyone will have a family doctor that they can use in a mix of virtual and in-person practice. And you can access that family doctor within a few days or within the same day, but it’s not just the world we live in,” Cherniak said.

He estimates that between 20 and 25 doctors signing up to provide services through his platform pay as much as 600 per day, but now there is only one doctor left who cares for 20 patients per day or less.

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