Tyler Griffin, The Canadian Press
Posted Thursday, December 15, 2022 4:33 pm EST
Virtual care clinics may be adding pressure to an overwhelmed health care system, the Ontario Medical Association said Thursday, even as some patients and doctors say they are a vital alternative to a necessary emergency room visit.
The WCO’s comments come as children’s hospitals, emergency departments and the broader health care system struggle to meet the demands of a triple threat of respiratory syncytial virus, seasonal flu and COVID-19.
“Virtual-only walk-in clinics can actually result in more turnover, more costs for our system,” said Dr. Tara Kiran, a family physician at St. Michael’s Hospital in Toronto and lead author of a preliminary study comparing patients who visited their own family doctors virtually with people visiting a virtual-only clinic.
The preprint study, which has not been peer-reviewed, found that virtual walk-in patients are twice as likely to visit an emergency department within 30 days due to lack of continuity of care.
However, some patients and doctors lament a reduction in virtual care options as doctors leave the platforms after the province and the OMA reached an agreement to reduce the fees paid to doctors for virtual visits, effective of December 1.
While one-time visit fees were previously set at $37 for minor evaluations and up to $60 for longer sessions, the changes brought them down to $15 for phone calls and $20 for video sessions.
Advocates say virtual walk-in clinics provide greater access to care and keep them from visiting emergency rooms and children’s hospitals with less urgent matters.
Dr. Aviva Lowe, a Toronto pediatrician who has seen children across Ontario through the KixCare virtual clinic, said she was able to provide the same level of one-appointment care as first-time patients referred to her by another doctor.
KixCare is no longer offering virtual urgent care services due to fee changes, which it said has made its funding model unfeasible.
Before Dec. 1, its list of pediatricians saw about 2,000 children a month and about 20,000 children in Ontario during the course of the pandemic, Lowe said.
The study and the OMA do not address that the majority of patients who access virtual care platforms use them due to a lack of options, and the majority do not have timely access to a family doctor or cannot get one due to the lack of options. lack of availability, Lowe said.
“We can’t make policy decisions based on studies that aren’t peer-reviewed.”
“It is not surprising that the patient may re-present to the ER for lack of other options, but there is certainly no evidence to suggest that the virtual visit … caused or contributed to their going to the ER.”
More than 90 percent of parents surveyed by the platform said they would otherwise have gone to an emergency room for lack of other options, which equates to an estimated 18,400 visits diverted from the in-person system, he said.
To maintain a certain level of access for children, the platform has launched a paid monthly subscription service for appointments with a nurse instead of a doctor.
“Virtual care should be seen as part of the comprehensive child health solution for our province. It should not be seen as the enemy, as something mediocre,” she said.
“Children and families in a publicly funded health care system deserve timely access to a doctor and we have the technology, we have the experience to be able to do a lot of that through virtual visits.”
Fee reductions for doctors on platforms like KixCare have caused many virtual walk-in clinics to scale back or reduce services, making it difficult for parents like Martin John to easily access care for their children.
For months, John, who said his daughters’ pediatrician is too overwhelmed to see them in a timely manner, was able to get same-day appointments through Rocket Doctor, a virtual care platform that connects patients in Ontario with doctors.
“The amount of relief to know there was something that’s not stressful to find and we know it’s there, we can call them if we have one of those issues that aren’t super urgent,” John said. “It was so accessible and it just made sense.”
Rocket Doctors founder Dr. William Cherniak said the platform has seen a mass exodus of doctors from Ontario since the fee changes were implemented. He said his company went from having 20 family or emergency physicians available a day to between three and four. Where he used to see 500 patients a day, he added, that number is now closer to 50 a day.
“Unfortunately, millions of people in the province have lost access to care,” Cherniak said. “Which is better: forcing those patients to go to a walk-in clinic in person or directly to the emergency department, or giving them the opportunity to receive virtual care?”
Ottawa father Eli Kassis, who has been using Rocket Doctor since early 2021 to get quick medical advice or treatment for his son, said he has been turning to the service instead of a family doctor, which he has given up on getting.
“I’m very busy and it’s really hard when your child has some kind of flu or cold. They can’t go to daycare and we’re fighting to sort it out,” he said. “I don’t think virtual doctors can fully take over, but they’re a great avenue for this kind of thing.”
Rocket Doctor said on its website that it had to suspend appointments for family and emergency physicians, as well as pediatricians under OHIP through its platform. Cherniak said he continues to help patients access specialty care, which was spared similar fee cuts through an agreement with the province in October, as well as services in Western Canada and the US.
Under the new agreement, specialists and family doctors with a special designation approved by the ministry can continue to offer virtual care to patients without an in-person visit as long as a consultation, which can be done remotely, takes place every 24 months. .
The Ontario Ministry of Health has said that it learned of the benefits of virtual care during the COVID-19 pandemic and the new agreement it reached with the OMA ensures that virtual care will be permanently integrated within the OHIP-insured framework.
“Virtual care is meant to complement in-person care, not replace it,” the ministry said in an earlier written statement.
The OMA noted that more than a million patients in the province do not have a family doctor and said it was advocating for measures such as faster licensing for internationally educated doctors to help address the doctor shortage.
This report by The Canadian Press was first published on December 15, 2022.
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This story was produced with the financial assistance of Meta and the Canadian Press News Fellowship.