Virtual walk-in clinics may contribute more strain to health-care system: OMA

Virtual health care appointments are more popular than ever since the beginning of the COVID-19 pandemic, but are they here to stay?

Virtual-care clinics may be adding pressure to the overwhelmed health-care system, the Ontario Medical Association said Thursday, even as some patients and doctors say they are vital alternative to an otherwise necessary visit to an emergency room.

The OMA comments come as pediatric hospitals, emergency departments and the overall health-care system are struggling to meet the demands of a triple-threat of respiratory syncytial virus, the seasonal flu and COVID-19.

"Virtual-only walk-in clinics may actually be resulting in more churn, more cost to our system," said Dr. Tara Kiran, a family physician at Toronto's St. Michael Hospital and senior author of a preliminary study that compared patients who visited their own family doctors virtually with people who visited 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The preprint study, which has not been peer reviewed, found that virtual walk-in patients are twice as likely to visit an emergency department within 30 days due to a lack of continuity of care.

However, some patients and doctors are lamenting a reduction in virtual care options as doctors leave the platforms after the province and the OMA reached an agreement to reduce fees paid to doctors for virtual visits, effective Dec. 1.

While fees for one-off visits were previously set at $37 for minor assessments and up to $60 for longer sessions, the changes cut those to $15 for phone calls and $20 for video sessions.

Advocates say virtual walk-in clinics provide greater access to care and prevent them from visiting emergency rooms and pediatric hospitals with less urgent matters.

Dr. Aviva Lowe, a Toronto pediatrician who has seen children from across Ontario through virtual clinic KixCare, said she was able to provide the same level of care for one-off appointments as with first-time patients referred to her by another doctor.

KixCare is no longer offering urgent virtual care services due to the fee changes, which it said has made its funding model unviable.

Prior to Dec. 1, its roster of pediatricians saw approximately 2,000 children per month and around 20,000 children in Ontario over the course of the pandemic, Lowe said.

The study and the OMA are failing to address that the majority of patients accessing virtual care platforms utilize them because of a lack of options, and most don't have timely access to a family doctor or are unable to secure one at all due to lack of availability, Lowe said.

"We can't make policy decisions based on studies that are not peer reviewed."

"It's not surprising that the patient may again present to the ER for lack of other options, but there's certainly no evidence to suggest that the virtual visit caused them or contributed to going to the ER."

More than 90 per cent of parents surveyed by the platform said they would have otherwise gone to an ER for lack of other options, which amounts to an estimated 18,400 visits diverted from the in-person system, she said.

In order to maintain some level of access for children, the platform has launched a paid monthly subscription service for appointments with a nurse instead of a physician.

"Virtual care should be seen as part of the comprehensive children's health care solution for our province. It shouldn't be seen as the enemy, as something that's subpar," 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 expertise to be able to do much of that through virtual visits."

Fee reductions for doctors on platforms like KixCare have caused many virtual walk-in clinics to reduce or cut back on services, making it harder 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 connecting patients in Ontario with physicians.

"The amount of relief knowing there was something that is not stressful to find and we know it's there, we can just call them up if we've got one of those issues that's not super urgent," John said. "It was so accessible and just made sense."

Rocket Doctors' founder Dr. William Cherniak said the platform has seen a mass exodus of Ontario doctors since the fee changes kicked in. He said his company has gone from having 20 family or emergency physicians available per day to between three and four. Where it used to see 500 patients per day, he added, that number is now closer to 50 daily.

"Unfortunately, millions of people in the province have lost access to care," said Cherniak. "What's better: forcing those patients to go to an in-person walk-in clinic or directly to the emergency department, or giving them the opportunity to have virtual care?"

Ottawa dad 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 in lieu of a family doctor, which he's given up on securing.

"I'm so busy and it's really hard when your child has any kind of flu or cold. They can't go to daycare and we're scrambling to get that together," he said. "I don't think virtual doctors can take over completely but they're such a great avenue for this type of thing."

Rocket Doctor said on its website that it had to cease appointments for family and emergency doctors as well as pediatricians under OHIP through its platform. Cherniak said it continues to help patients access specialist care, which was spared from similar fee cuts through an agreement with the province in October, as well as services in Western Canada and the U.S.

Under the new agreement, specialists and family physicians with a special ministry-approved designation can continue to offer virtual care to patients without an in-person visit so long as a consultation, which can be done remotely, is conducted every 24 months.

Ontario's Ministry of Health has said it learned of the benefits of virtual care throughout the COVID-19 pandemic and the new agreement it reached with the OMA ensures virtual care will become permanently integrated within the OHIP-insured framework.

"Virtual care is intended to complement in-person care, not replace it," the ministry said in a previous written statement.

The OMA noted that more than one million patients in the province don't have a family doctor and said it was advocating for measures like faster licensing of internationally educated physicians to help address the doctor shortage.

This report by The Canadian Press was first publishedDec. 15, 2022.