‘what’s the appropriate amount of virtual care? it’s not zero, and it’s not 100’

in response to the covid-19 pandemic, provincial and territorial governments and medical associations moved quickly to  fund  virtual care,  defined  as any remote, technology-based interaction between a health-care provider and a patient or patient representative. it can be a phone call, videoconference, email exchange or a text.

while this tool has been  essential  in reducing the risk of viral transmission, providing care for patients who need ongoing medical attention and conserving personal protective equipment, it is also having unintended consequences, according to provincial ministry officials who say the trend is now increasing pressure on hospital emergency rooms and may be leading to poorer health outcomes.

“while these tools have advantages for certain patient care needs, including providing necessary virtual pathways to care in remote and indigenous communities, the pandemic experience has also reinforced the vital importance of hands-on in-person care … with appropriate measures in place, we expect all practitioners to resume routine in-person visits,” the b.c. ministry of health wrote in a sept. 3  statement .

ontario followed with a similar  statement  on oct. 13: “there are limits to what can be done virtually and the standard of care is often difficult to meet in a virtual care environment…. it is the joint position of the chief medical officer of health, ministry of health and the college of physicians and surgeons of ontario that in-person care can be provided safely and appropriately and it is expected that all physicians are providing in-person care based on clinical needs and patient preference.”

but doctors are pushing back, saying virtual care needs to be more fully developed and standardized. during the september federal election campaign, the college of family physicians of canada (cfpc)  said  that virtual care tools “enhance access,” and called for “drafting and adopting national standards for virtual care.” the cfpc’s  position  is that “virtual care is the new reality for most family physicians and their patients.”

in a february  health policy document , the cfpc outlined advantages to virtual care, including improving access to care, especially for patients who cannot easily travel to a clinic; simplifying the coordination of care for those with chronic or complex conditions who often require several care providers; and  saving  patients travel time and the cost of missing work or making caregiving arrangements.

however, there is concern over virtual care’s ability to diagnose illness. a u.s.  article  in may called virtual health a “double-edged sword” in that it presents the opportunity to improve care, but also makes the potential for mistakes “exponentially greater.” ontario pediatric neurosurgeon sheila singh recently  wrote  about the limited ability of virtual care to diagnose serious illnesses, stating, “seeing a patient on a screen is nothing like examining a child in person.”

the canadian medical association has  committed  $2.5 million to study the impacts of virtual care, equity of access to care and its outcomes, its evolution during the pandemic and its future in a post-pandemic world.

pre-pandemic, family physicians were not paid for phone calls, with few exceptions. for example, according to a b.c.  billing guide  from 2018, they could earn $20 to manage a limited number of patients, or $6.77 to give advice about blood thinners over the phone, compared to over $30 for an in-person visit.

after march 2020, many provinces, including  b.c.  and  ontario , allowed family doctors to  earn  the same amounts for phone calls as they would for in-person visits. this enabled the public to continue “seeing” their physicians without exposing them to the risk of catching or spreading disease in clinics.

since the virtual care shift, its uptake has exploded. a  study  of ontario data revealed that pandemic usage of virtual care was up 56-fold in early 2020. figures from the b.c. ministry of health showed that from 2019-20 to 2020-21, virtual care delivered by family physicians increased from less than 6 per cent of all visits to nearly 52 per cent.