The pandemic has revolutionized virtual care in family medicine and may help ease the impact of a doctor shortage, says the head of Doctors of BC.
Just as online services forever changed banking, the pandemic has sharply increased the use of telemedicine to the point that there’s no going back, said president Matthew Chow, whose group represents 14,000 physicians, residents and medical students in the province.
“Our health policy, our remunerative models, our team models are catching up with the fact that virtual care is here to stay,” Chow said.
“I feel very optimistic about virtual care. I think there’s a lot potential here.”
Telemedicine has long been touted as a way to transform the delivery of health care, but it has emerged as the “new normal” during the pandemic.
On June 1, 2020, the province temporarily adjusted telemedicine fee codes that family doctors use to bill the Medical Services Plan for visits, counselling and consultations conducted by phone or video so that they have the same value as the in-person fee codes for similar patient encounters.
The Doctors of BC wants those telemedicine fee codes to become permanent.
A recent survey by Insights West on behalf of London Drugs found 65 per cent of respondents — polled Feb. 3 to 7 — said they were more likely to choose virtual care rather than in-person visits for simple or routine health advice.
People without doctors — 18.2 per cent in B.C., according to the latest Statistics Canada report, from 2017 — can turn to the 811 provincial health line, which is now answered by both nurses and doctors. Previously, it was just operated by nurses.
While it doesn’t replace a family doctor, Chow said someone in an urgent situation can call the line, and if it requires a physician’s attention, a doctor can speak to the patient and assess the problem, offering advice about where to turn next.
As well, both walk-in clinics and family practices now offer telephone or online video visits, where they may have offered limited or no access to such services in the past.
“I think it’s definitely going to be one of those tools to help, because we need more efficient ways to utilize our existing workforce to look after more people,” said Chow. “Quite frankly, there are some significant inefficiencies.”
One of the complaints from doctors is the time they spend on paperwork, phone calls and negotiating and navigating on behalf of patients.
“So we have to take that burden and either take it away from them or transform it in such a way so that it isn’t such a burden — and an electronics system and virtual care has the potential to do that,” said Chow.
Using phone calls for simple follow-up consultations, including prescription refills, frees up appointment time for more complex or time-consuming cases, he said.
Virtual appointments also increase access for patients with disabilities or mobility challenges, while reducing risk of exposure to other illnesses, or commuting challenges for those in rural and remote communities, Chow said.
Family doctor Vanessa Young in View Royal said she’s seen a significant increase in mental-health complaints since the pandemic began, noting patients needing mental-health support already absorbed 25 to 30 per cent of her day prior to the pandemic.
She is also concerned for those without a family doctor.
“It’s hard enough for us to support our patients, and try to get resources for them in this situation,” said Young. “I can’t even imagine how difficult that must be for folks trying to navigate this on their own.”
Young said telemedicine has definitely improved and increased access to care for patients, but the trick to making gains for the entire health-care system is knowing when and how to use virtual care.
Virtual visits are ideal, she said, for care where there is an established therapeutic relationship with the patient and knowledge of the patient’s file.
“It just saves time for everyone — patients like it, physicians like it,” Young said.
Young said in her practice, which includes husband Dr. Steve Keeler, “we estimate that we can help 10 to 20 per cent more of our patients daily due to time savings of virtual care.”
When it comes to episodic virtual care, which is also on the rise for patients without family doctors, Young has concerns, calling it “fraught with increased risk for both patient and provider due to lack of medical history and due to lack of a therapeutic relationship.”
Episodic virtual care can end up being more costly to the system, said Young, if tests are repeated unnecessarily and referrals are made to specialists when they are not needed.
Referrals are also made to a hospital emergency department if a health provider cannot physically examine the patient.