As the prevalence of virtual health care exploded across Canada, so too did the implementation across the three featured provinces of Alberta, Ontario, and Nova Scotia. The feasibility of evaluating a recent qualitative study with 25 health professionals from these areas is examined. It unveiled the fact that while virtual care has undeniably increased access for many patients, it still hasn’t lived up to its true potential. As this new study illuminates, long-standing barriers in the system remain. It particularly zeros in on considerations impacting physician burden and healthcare billing ethics.
Christine Leulo, MD, is a family physician with more than 25 years of clinical practice experience. She’s seen the mood around her climate shift dramatically since the start of the COVID-19 pandemic. Before the pandemic, she was only able to bill for seven virtual care calls per week. As a result, she now sees an average of 25-30 patients a day with virtual consults. While this figure showcases a truly unprecedented jump in the adoption of virtual care, other hurdles continue to exist.
Billing and Access Issues
One of the major barriers is the existing fee-for-service billing codes that require in-person interactions for physicians and patients. Dr. Leulo stated, “The current fee-for-service billing codes require what’s called ‘whites of the eyes.’” This uniform consent requirement creates an obstacle to enabling broader virtual care access as part of normal practice. With Alberta clinics now moving away from a fee-for-service model, they’re leaving a little bit of that traditional “eyeball-to-eyeball” touch to make things a little bit easier.
Even after making these adaptations, the overwhelming majority of providers in the healthcare system remain under acute financial pressure. Dr. Leulo noted, “You still have to pay for the nurse … and you have to pay for the room.” This reality makes it hard to deploy virtual care in an equitable way. Without this, clinics cannot afford to guarantee permanent staffing and facilities while absorbing the unpredictable patient flow.
Effectiveness and Patient Feedback
This qualitative study indicates that virtual care works well for follow-ups, check-ins, and sharing lab results. It hasn’t done much to improve access to primary care for Canadians of all stripes. Today, about 17% of Canadians lack a regular family doctor and virtual care hasn’t made a dent in those numbers.
Dr. Myles Leslie, a researcher with the University of Calgary’s School of Public Policy, pointed out an even bigger issue. While virtual care met an important need during the early days of the pandemic, healthcare providers remain overwhelmed. He remarked, “It isn’t providing more access to care. The doctor is still the bottleneck.”
On a positive note, Dr. Leulo shared that patients have positively embraced virtual care from the start. This is reflected in high patient satisfaction survey results seen over the past year. The unified feedback provides an opportunity to remedy systemic issues. What’s been fascinating is that, rest assured, patients love this in real life—that convenience, simplicity, efficiency.
Cultural Shifts Needed for Improvement
To make sure virtual care is as effective as it could be, experts say a cultural shift is needed within the healthcare system. Dr. Leslie emphasized that the virtual care model should include greater involvement of other members of the healthcare team. This has deprived students of mentors like nurses, specialists, and pharmacists. By expanding the roles of these professionals, the system could better manage patient needs and reduce the pressure on physicians.
This research points to an important call for sustained conversation about how to best integrate virtual care into current structures. One thing is clear — healthcare is always changing. To ensure all Canadians can access the best medical care, we need more than just new money—we need smart, disruptive ideas.
