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

Lesley Campbell, cradling her right hand, leaves the Michael Garron Hospital emergency department in east Toronto.

She said, “I fell off my bicycle,” and looked down at her white cast. “Accidents happen.”

She stated that while you should go to the hospital for certain ailments (e.g. a broken bone), there should be another option for less serious conditions.

“For many other things, such as a minor contusion, whatever, or a strain, it would have been nice if you just asked what I should do next.” Campbell stated. Campbell stated that for a child who has a fever, it was easy to call and get immediate advice. They can be seen by doctors on video, which would make it much easier to not have to travel downtown.

“It saves your time, saves your energy and definitely saves on gas,” said Zahir Mohammed, who was also leaving Michael Garron Hospital. Although it is convenient, he stated that he does not like virtual care. Instead, Mohammed said, he’d rather see his physician in person, so he can better explain his symptoms and ask questions.

“Sometimes through virtual, it’s not just expressible those kind of things, so … there’s more likelihood to be misdiagnosed.”

Virtual care is broadly defined as the delivery of health-care services through electronic means, such as telemedicine, online video consultations and remote monitoring. During the COVID-19 pandemic, consulting with a doctor by videoconference or phone proved to be a convenient way to access care.

Pandemic lead to virtual care growth

Many provinces in Canada have turned to virtual care to lift pressure from their strained health-care systems. Hospitals have been able to divert patients from crowded emergency rooms, and it’s been used to deal with problems caused by a nation-wide shortage of health-care workers and long waiting lists for family doctors.

But despite the growing use of virtual care during the pandemic, there’s now pushback from Ontario, the country’s most populous province, and its physicians’ association.

Numerous platforms offered virtual medical appointments even before the pandemic. While some platforms allow you to bill your provincial health-care plan, others charge a monthly fee.

With COVID-19 restrictions and crowded hospitals and clinics, Dr. William Cherniak — an emergency room physician in Markham, Ont., north of Toronto, and the founder of Rocket Doctor — said it was an opportunity.

He stated that virtual care was more than something we could tolerate during the pandemic, as it filled the gap between doctors and patients. Instead, it was something Canada has been lacking for many years due to a lack of public funding. We are only now beginning to see the potential.

Cherniak’s Virtual Care Company has partnered up with Georgian Bay General Hospital, Midland, Ont. to test a new service that offers patients an alternative to the emergency room.

The majority of people who go to the ER have minor illnesses or injuries that could be cared for virtually, he said, leaving the emergency department for those with more serious illnesses or trauma.

“We have a massive health-care system crisis. Doctors are not willing to practice medicine anymore, patients are losing their family doctors. And we have physicians who want patients to see them virtually.

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

Virtual care takes back seat in Ontario

On Dec. 1, a new physician services agreement between the province’s Ministry of Health and the Ontario Medical Association (OMA) came into effect, with a new virtual care funding framework. While the new schedule of benefits for physician services made temporary virtual care billing codes permanent, the new Ontario Virtual Care Program pricing structure, rates and payment parameters have new limits on what OHIP — the province’s public health insurance plan — will cover.

Sylvia Jones, Ontario’s health minister, said with the worst of the pandemic over, the need for virtual care is not as urgent.

Jones said last month to reporters that “we need to get patients before their physicians more frequently.” We need family doctors to see patients in person. The primary care physician is the place that parents should go to if they have any concerns.

President of the Ontario Medical Association Dr. Rose Zacharias agrees that virtual healthcare is not meant to replace in-person care.

She said that she had reexamined the options and prioritized the patient-doctor relationship. “We don’t have enough physicians to ensure that everyone has that relationship. This is why it is so urgent to license more doctors and to get more doctors into the system in order to capture those patients.

But Cherniak said the new agreement between Ontario’s Health Ministry and the OMA will threaten many virtual care business models because doctors conducting virtual visits — where there is no existing relationship between the physician and patient — will receive only a flat $20 fee. Physicians who have previously seen a patient in person once in the prior 24 months will be paid the same fee for virtual care as in-person care, but not those providing “one-off” visits.

“So they’re saying, ‘Hey, we’re going to actually cut your fee rates in half, in spite of all the challenges you experience fighting this pandemic,’ and it’s really unfortunate because a lot of patients are going to lose access to care,” Cherniak said.

Some doctors view the billing change as an incentive to provide community follow-up care.

Dr. Kyle Vojdani is chief of the emergency department at Michael Garron Hospital, which offers virtual care for minor ailments, assisting about a dozen patients a day.

“Receiving a virtual appointment from a doctor in another province, or maybe… hundreds of kms away from you, trying coordinate the followup management is difficult if it’s impossible,” he stated.

Virtual care has many benefits, but studies vary.

The OMA recently cited a report linking virtual care to additional pressure on the overwhelmed health-care system. The report said a lack of continuity of care after virtual visits was leading to patients ending up in the ER.

But Cherniak of Rocket Doctor cites another study that found 94 per cent of patients who used virtual care instead of going to an ER rated their overall virtual care experience as an 8 out of 10 or greater. More than 80 per cent said they received answers to all of their questions related to their health concerns and believed they were able to manage the issue.

Another survey by the Angus Reid Institute found that half of Canadians either can’t find a doctor or can’t get a timely appointment with the one they have. The survey also revealed that 32% of Canadians report having a mostly phone- or video-based interaction with their family doctors. And of those Canadians who see their family doctor primarily over the phone or the internet, 65 per cent say they’re fine with the arrangement.

Cherniak said that unlike Ontario, Canada’s western provinces have been more welcoming to virtual care providers because they realize that people in isolated rural areas need access to timely care when they can’t get into a physician’s office.

“I mean, B.C. “I mean, B.C. and Alberta have really stepped up on virtual care. You know, like Alberta gave in-person parity.” Cherniak said that she sees the potential for helping those who are having difficulty finding a family physician, particularly in remote areas or with mobility issues that make it difficult for them to travel to a medical facility.

Newfoundland and Labrador asked for proposals to offer virtual health-care services, in light of the closures of the emergency room in the province. It will also explore ways to provide virtual health care to people who do not have a family physician.

Manitoba will have a virtual emergency care service by 2023| Manitoba to get new virtual emergency care service in 2023:

Manitoba to get new virtual emergency service in spring 2023

This service was originally announced by the provincial government as part of its $200 million plan to train, retain and recruit more than 2000 health-care workers. VECTRS, a centralized emergency service that provides clinical guidance and patient transportation to health-care workers, is called a VECTRS.

“In an ideal world everyone would have access to a family physician who is available in both virtual and in-person practice. Cherniak explained that it is possible to access a family doctor in just a few days, or even the same day. However, this is not the reality of our world.

He estimates that between 20 and 25 doctors signed up to his platform to offer services to pay up to 600 people per day. But, there is only one remaining doctor, who sees 20 or fewer patients each day.