Save Virtual Care in Ontario
Save Virtual Care in Ontario
On December 1st an agreement by the Ontario Medical Association (OMA) and the Ontario Ministry of Health will come into effect. It includes changes that will greatly reduce the availability of virtual care provided by Pediatricians, Family and Emergency Doctors in the Province of Ontario.
Currently, 1.8 million Ontarians live without a family doctor. By 2025, this figure is expected to reach 3 million. Some have been on a waiting list for up to 10 years.
Virtual care promotes equitable access to care by providing a solution to those who can't see a doctor in person. Virtual care levels the playing field for patients without family physicians, limited access to family physicians, or mobility issues.
I am an emergency physician with training in family medicine and global public health. I am the founder and CEO of Rocket Doctor, a virtual health platform designed to power MDs to provide equitable access to care for all people using their provincial health insurance.
Nearly 250 MDs who practice a mix of care, including emergency medicine, urgent care and family practice have been providing virtual care during their spare hours on Rocket Doctor the last two years in Ontario. They have been able to provide care to >200,000 patients in the Province, almost 50% of whom have no family doctor.
85% of these MDs have indicated that they would be unable to provide care after December 1st given the proposed fee cuts.
What are the changes?
Physicians will now need to have seen a patient in-person at least once before being able to access reasonable remuneration for virtual care.
Seeing a patient in-person first becomes impossible when you look at the size of our province and the vast distances people have to travel to see a doctor, as well as the number of people who do not have a family doctor. If a patient is not first seen in person, MD fees will be cut by 50% or 60% for a video or telephone visit, respectively.
We can expect these changes to impact the care that you receive virtually, particularly for patients who do not have a family doctor.
These changes make it so that patients requiring an urgent visit will find it much more difficult to be seen virtually and may be more likely to need to go to a physical Emergency Department or walk in clinic, waiting hours in line for a visit they may not need.
By cutting physician fees by 50%+ for those who currently offer these services, these changes essentially eliminate a patient’s option to access virtual care, and will force them into an already overwhelmed Emergency care system.
As a result, the vast majority of family and emergency doctors that currently practice virtual care on OHIP will no longer be able to provide the same level of service.
Why are the changes happening?
In an ideal world, every patient would have a family doctor who could urgently see them at any moment when needed, both in-person and virtually. However, there is a lack of understanding that this is not the reality in Ontario, and that if done correctly hundreds if not thousands of physicians can be allowed to work together to provide comprehensive longitudinal care entirely virtually.
There is clear evidence on the positive impact of virtual care, but this has not been made clear to policy makers.
In March 2022, Christine Elliott, Deputy Premier and Minister of Health stated:
“This agreement is another step our government is taking to build a stronger, more resilient health care system for Ontario by making it easier and faster for Ontarians to see a doctor, ensure virtual care remains an option for patients and ultimately improve patient experience and outcomes, all while respecting Ontario taxpayers.”
Let’s break that down
Intention: The changes will make it easier for Ontarians to see a doctor
Reality: The changes will make it significantly more difficult for Ontarians to access a doctor
Currently 1.8 million Ontarians live without a family doctor. By 2025, this figure is expected to reach 3 million.
This is according to new research, where looming MD retirements, dwindling interest in family medicine and physician burnout are factors which are exacerbating the challenges faced by Canada’s COVID-19-battered health system. In a recent post-appointment survey at Rocket Doctor, 50% of patients indicated that they don’t have a family doctor and are using virtual care as an alternative means to access care.
The changes to the PSA will make it dramatically more difficult for Ontarians to access healthcare, likely forcing many into an already overwhelmed Emergency care system.
Intention: The changes will ensure virtual care remains an option
Reality: Doctors are unable to continue seeing patients at the same quality of care with 50%-60% fee cuts.
The changes will make it nearly impossible to practice primary care virtually in Ontario without an in-person visit. Yet, 36% of patients being seen on Rocket Doctor are cared for entirely virtually on a longitudinal basis, as if the patient had a Family MD.
In a recent study at Rocket Doctor asking physicians that practiced virtual care before the changes took effect, 85% stated that they would stop practicing virtual care altogether.
Intention: The changes will make it faster for Ontarians to see a doctor
Reality: There is a capacity crisis in Ontario. Removing virtual care will only take away an existing option that patients have had to see a doctor, making it more difficult to access care.
According to recent reports, a capacity crisis in primary care has resulted in some Ontario residents being waitlisted, in some cases as long as 10 years, for access to a family doctor. With reduced access to virtual care, the time to see a doctor will only take longer.
And for those without a family doctor, or in underserved communities (including for people with disabilities, and people in rural and remote areas, where patients experience difficulty attending in-person visits), seeing a doctor altogether will become significantly more challenging with many having no choice but to visit an emergency room.
Intention: The changes will improve patient experiences
Reality: The changes will result in options being taken away from patients who do not have a family doctor, or need to be seen before their family doctor has availability.
Virtual care was never designed to replace in-person care, it was designed to support an overburdened healthcare system where technology allows us to treat certain conditions virtually.
Less travel time, less time off work, less childcare, less time in the waiting room all offer practical benefits for those that don’t need to see a doctor in-person. And for those that don’t want to see a doctor in-person, for stigmatized or embarrassing conditions, virtual care is an ideal alternative.
Of course, it isn’t perfect, and there are cases where patients will have to be seen in-person. If you have crushing chest pain, a broken arm, a laceration etc. - these are things that you absolutely should be attended to in the ER. However, there is an enormous number of conditions that can be safely and effectively managed virtually.
A recent study examining the experiences of 22,278 patients at virtual emergency departments in Ontario found that:
94% rated their overall experience as highly positive (8/10 or greater)
Intention: The changes will improve patient outcomes
Reality: In most cases, a positive patient outcome can be achieved virtually without the need for in-person care.
As mentioned above, the system isn’t perfect. But virtual care can significantly improve patient outcomes by offering a quicker means to care.
In the same study, over 80% of patients said they had answers to all the questions they had related to their health concern, believed they were able to manage the issue, had a plan they could follow, and knew what to do if the issue got worse or came back.
Intention: The changes respect Ontario taxpayers
Reality: Based on 33% of patients stating that they would have gone to ER had Rocket Doctor not been available, we estimate we have saved the system $40M in two years from unnecessary ER visits alone.
MDs on Rocket Doctor have seen 200,000+ virtual appointments in Ontario. Our data from thousands of patients surveyed shows that 33% of these appointments prevented an ER visit. 50% more avoided patients going to a walk-in clinic. This represents a cost saving of over $40M based on $750 average ER visit and $37 average virtual care visit. This does not take into consideration downstream effects of earlier access, provider and patient satisfaction, and a variety of other factors.
We have not been shown any medical evidence that virtual care is “limited” compared to in-person care. Virtual care offers an alternative means of care for those who can’t or those that don’t want to see the doctor in person.
These changes are a major step backwards, and our healthcare system will feel the full impact when it is already in great difficulty.
We must continue to embrace technology and available resources to ensure that all Ontarians have access to affordable, quality care, not take options away.
Please sign this petition if you agree that the changes to the Physicians Service Agreement must be delayed over this winter season, such that virtual healthcare can continue to support our system and be examined more carefully before being removed all at once.
After signing the petition, please find your MPP here and call and write their office expressing your concern with these changes.
Please also copy the Minister of Health, Sylvia Jones: firstname.lastname@example.org, the Premier: email@example.com, and the President of the Ontario Medical Association, Dr. Rose Zacharias: firstname.lastname@example.org