B.C. doctors pressured to reduce virtual appointments

Family physicians, specialists and surgeons in British Columbia have received a stern letter pressuring them to resume in-person appointments as provincial officials hint they may reassess how they compensate doctors for virtual visits.

In a joint statement sent to doctors on Friday, provincial health officer Dr. Bonnie Henry, assistant deputy health minister Ted Patterson and College of Physicians and Surgeons of B.C registrar and CEO Heidi Oetter urged doctors to resume seeing patients in person rather than virtually, claiming telehealth may lead to pressures on other parts of the healthcare system.

“Potential drawbacks of providing only virtual care could result in unnecessary emergency room visits when patients are unable to access necessary face-to-face visits, specialist referrals that lack sufficient or pertinent clinical information for accurate triaging and care, and lack of access to important preventive and screening health services,” wrote the signatories. “With appropriate measures in place, we expect all practitioners to resume routine in-person visits based on clinical needs and patient preferences.”

The bolded passage was emphasized by the letter writers, who end the document with a hint they may decide to reduce or eliminate the ability for doctors to bill the medical system for virtual appointments.

“You may recall that a series of adjustments to the payment schedule were approved by the Medical Services Commission on the basis that they were temporary and could be cancelled on the advice of the provincial health officer,” reads the second page of the document. “The ministry is actively reviewing the current temporary fee codes and considering the appropriate path forward for virtual care compensation.”

The Doctors of B.C. points out most doctors and surgeons have long-since resumed seeing patients in person, in addition to continuing virtual appointments, and believes the letter was targeting certain doctors.

“We’ve become aware of a small number of physicians who’ve only been seeing people virtually and have not provided any in-person care over the course of the pandemic and this has raised concerns from patients as well as other doctors,” said organization president Dr. Matthew Chow. “I want to emphasize that virtual care is here to stay, we’ve seen how important it is in the past 18 months and how it saved the medical system from collapse in the first wave.”

CHANGES IN PHYSICIAN RISK THROUGHOUT PANDEMIC

Chow says when doctors were ordered to avoid seeing patients face-to-face in March of 2020 it made sense for the protection of patients and practitioners, but now with effective vaccines (and 97 per cent of doctors vaccinated) and a better understanding of protective measures against COVID-19, doctors have an obligation to resume in-person appointments where appropriate.

CTV News has heard directly from a number of frontline doctors who’ve raised a number of issues and concerns stemming from the letter; several spoke on condition of anonymity only. Most emphasized how vital virtual care has been for elderly patients, those with disabilities, and others living far from medical services who’ve been able to access care much easier than before -- and don't want to lose the ability to provide that kind of healthcare support. Others pointed out there’s been growing resentment among doctors who’ve continued the more difficult and riskier work of face-to-face care, while some of their peers have opted to deal with patients only at a distance.

"The pandemic has exposed a lot of the inequities in the system and it's really accelerated the adoption we've had of providing better ways of reaching out patients and sometimes that's in the office, sometimes that's by phone and sometimes that's by video," said Vancouver physician, Dr. Eric Cadesky. “We always want to provide the right care at the right time at the right place.”

His comments echoed those of Dr. Manya Sadouski, a family doctor on Salt Spring Island, who urged the province and college to have faith doctors would choose the appropriate method of assessing and treating their patients.

“It was quite a coercive tone – ‘though shalt return to routine in-person care’ – and lacked some of the subtlety that I was hoping for and so the letter landed to me as if those telehealth appointments are no longer appropriate and the comment about defunding them left me a lot of concerns,” she said. “There needs to be an element of trust in our professionalism and our good faith towards our patients.”

THE FUTURE OF TELEHEALTH IN B.C.

“Telehealth is here to stay, the key is to have the right balance between in person face-to-face care and virtual care and that is something we’re exploring,” said Chow, insisting he doesn’t see a sudden removal of funding for virtual care, which has been compensated at the same rate as in-person visits since last spring.

Telehealth, whether via phone or video chat have proven extremely popular with patients, many of whom have responded to news of the letter with pleas to continue providing alternatives to in-person visits.

"For people with chronic illness there are often multiple specialists involved and many appointments are for routine things like referrals, prescription refills, forms, even things like special authority renewals for certain medications -- It can feel like a full-time job frankly," pointed out disabled writer and policy analyst, Gabrielle Peters.

"Virtual appointments fill a gap and address some of the accessibility barriers in healthcare."

While it’s likely that virtual health care will continue in some form into the future, the memo was clear that the provincial government and college will have little tolerance for doctors who keep their doors closed to patients as the province hints it’s operating under the idea we are now in the endemic phase of the virus.

“We are now at a different stage in the COVID-19 pandemic in BC,” reads the memo. “COVID-19 is now a vaccine preventable virus that we will be living with into the future.”

But Sadouski doesn’t believe that’s the case yet and pointed out each doctor needs to assess their own risk in an indoor work environment where no one is denied care based on vaccination status or any other factors; she emphasized all doctors she knows have been seeing patients in person and virtually throughout the pandemic.