Despite the proliferation of virtual care during and following the pandemic, the practice is not freeing up doctors as some might have hoped, according to new research published in the journal BMC Primary Care. 

“It isn’t providing more access to care. The doctor is still the bottleneck,” said Myles Leslie, one of the study’s co-authors.

That’s because virtual care tends to just be physicians speaking to patients by phone, said Leslie, a researcher at the University of Calgary’s School of Public Policy. 

And phone calls still take up time in the doctor’s day, just as an in-person appointment would. Without expanding the pool of doctors, the study says little changes for the roughly 17 per cent of Canadians with no primary care physician. 

Researchers conducted a qualitative study interviewing 25 health care professionals from three Canadian provinces — Alberta, Ontario and Nova Scotia — on their experiences with virtual care.  

It became increasingly used during the pandemic, as a way to ease pressure on an overburdened health care system, and provide remote options during a time of physical distancing.

Leslie says there have been some benefits. For patients whose primary desire is convenience, virtual care can provide that. And for patients in more rural settings, it can be an easier way to connect. 

In-person still incentivized

The study also suggests virtual care is not as effective as it could be thanks to payment models that incentivize doctors to see patients face-to-face.   

“The current fee-for-service billing codes require what’s called ‘whites of the eyes,’” said family physician Dr. Christine Leulo. 

Prior to the pandemic, Leulo could only bill for seven calls a week — nowhere near the 25 to 30 patients she sees daily.

Now she says there’s no cap on how many calls she can bill for, and a call is priced the same as an in-person visit.

But if that call is complex and ends up taking more time, it is still priced the same. With in-person appointments, on the other hand, doctors have ways to charge more for longer visits. 

Doctors are also financially encouraged to see a patient themselves. Leulo gives the example of a nurse who specializes in diabetes handling all of the diabetic patients who come in. The doctor can not bill for those patients.

“But you still have to pay for the nurse … and you have to pay for the room,” said Leulo. 

That dilemma is echoed by some of the professionals quoted in the study. One, whose name was not provided, says the virtual care team can “almost be too efficient,” because they are “starting to rob” the doctors of some billing opportunities. 

What could change

Leslie says there are a few clinics in Alberta that have shifted their funding models away from the “eyeball-to-eyeball” requirement. 

The province also brought in a new compensation model last year that incentivizes physicians to take on more patients outside of typical working hours. Leslie says he has seen more doctors gravitating toward it. 

To encourage more use of virtual care, Leslie says it will require a cultural shift to integrate more members of the health care team, like nurses, specialists and pharmacists.

He says expanding its use beyond phone calls to use secure messaging systems or video calls more often could also help.

A majority of respondents to the qualitative study said they’ve seen improved efficiency thanks to the expansion of virtual care.

Leulo says her practice’s patients have given a thumbs up to virtual care in recent satisfaction surveys, and that it has been helpful for follow-ups, check-ins, and to relay lab results.