Excluding virtual healthcare will do more harm

When the pandemic hit, we were forced to change the way we work, live and socialize. It also forced us to rethink how technology could improve things we assumed were working well. As we look to a post-pandemic future, we’re at risk of unraveling progress, as provinces begin to pull back funding in a manner that will disincentivize physicians from using virtual care, harming access to care for the Canadians most in need.

The past two years have exposed deficiencies in healthcare systems across Canada. Nearly five million Canadians don’t have access to a family doctor, and one in five Canadians wait more than seven days for an appointment if they do. As an ER physician, thousands of my patients have been those without primary care providers, or whose family doctors had no availability for weeks, using the hospital as their only way to access treatment and advice for things like prescription renewals, UTIs and rashes, waiting hours to be seen for a concern that often requires me only minutes to solve.

At the onset of the pandemic, provinces moved quickly to give Canadians greater access to healthcare, by developing frameworks for physicians to provide virtual care through new public funding. This enabled physicians to safely assess patient needs using online care platforms, without having to bring a patient out of the comfort and safety of their home, and while being fairly compensated for their service.

This was a lifeline for many Canadians, who could cut down on long waiting room times, minimize potential exposure to disease, or avoid travel for those in more rural areas. Since then, we’ve seen a surge of innovation connecting patients to doctors, for example, the virtual emergency room servicing the community of Grey and Bruce Counties in Southwestern Ontario, and the virtual urgent care clinic at SickKids.

Despite how far we’ve come, access and delivery of healthcare through digital tools is now under threat.

In Ontario, the recently proposed Physician Services Agreement between the Ontario Medical Association and Ministry of Health will dissuade physicians from providing virtual care and including it as a part of their ongoing practices. By drastically cutting physician fees for virtual care provided to patients seeing a new doctor, this agreement radically disadvantages millions of Ontario patients who don’t have an established family doctor relationship. Vulnerable populations and those in rural and remote communities are often underserved, without primary care provider relationships, and whose care journeys result in avoidable emergency department consultations, hospitalizations and worse health outcomes. It’s a cruel irony that this proposed agreement would punish this population because of their vulnerability—their lack of access to in person care—by curtailing their access to virtual care.

The proposed agreement will eliminate the opportunity for physicians to add extra virtual capacity to the healthcare system by helping patients outside of their own clinics. 18% of Canada’s population is rural, but is only served by 8% of Canadian doctors. The ability for underutilized urban physicians to provide virtual care to patients in non-urban areas over the last two years has fundamentally improved access to care for rural and remote areas and added much needed capacity to Ontario’s healthcare system. Taking this access away will return these patients to a world where they again have to wait days or weeks or travel hundreds of kilometers for essential care.

Moving on from the pandemic doesn’t mean we’ve fixed the glaring shortages of access to healthcare, or that we should reverse the wins that we’ve worked hard to achieve. We have to continue to invest in ways that help the most vulnerable Ontarians, the rural, the underserved—not just those fortunate enough to have good access to care already. As physicians, it’s our responsibility to advocate for care models that support all Canadians, not just those of us that are lucky enough to have a family doctor who is readily available.