COVID-19 has affected much of our public and private lives – the way we eat, work, communicate and even see our family doctor has changed. Some of these changes may reverberate once the COVID-19 pandemic stops being a daily reality and becomes a collective memory. One trend in the healthcare field has been a shift toward more privatized medicine.
The COVID-19 pandemic has resulted in a significant increase in consultations through telephone/video calls rather than in-person visits. Until recently, any phone call a doctor made was not compensated. However, to decrease physical interactions between doctors and patients, the Ontario government has temporarily provided compensation for doctors to provide care remotely, meaning vast majority of patient “visits” now occur remotely.
Interestingly, for the past few years a few companies have offered phone consultations as their business model. However, since the service was not covered by OHIP, patients had to privately pay as much as $100 per call. With calls now covered and with infrastructure and funding already in place, these companies have been able to increase their capacity rapidly.
What this means is that they have hired more doctors. For example, a company called Maple saw an immediate increase in demand for their service by 600 per cent. Maple has even partnered with Shoppers Drug Mart to gain still wider exposure. To accommodate the surge in demand, the company is aggressively on-boarding doctors.
Essentially, what is happening is that seeing a doctor is no longer tied to location. Small local doctors’ offices are competing against national pharmacy-private company partnerships for patient visits. The result is predictable. In a time when businesses everywhere are being decimated by the pandemic, community doctors’ offices have not been spared. Responsibly, people have stopped physically seeing their physician to “help flatten the curve” and many community clinics’ main source of income is now through phone visits. However, they simply cannot compete against Shoppers Drug Mart and Rexall partners (which has teamed up with Tia Health) for exposure.
At my own family medicine practice, our volume from patients we typically serve has dropped by more than 50 per cent. Some clinics have been hit so hard that they have had to lay off staff. Working for a private company like Maple or Tia Health offers family doctors an opportunity to maintain cash flow during this downturn and continue to treat patients who have shifted to companies like Maple.
The problem is that these phone visits are only temporarily covered by the Ontario government. When COVID-19 is finally under control, many of those visits likely will disappear overnight. What will be left is a big shift in doctors who used to work in a public medical clinic but now work at a private enterprise.
Now is the time for patients as consumers to form habits if they want to avert this shift while still accessing timely, high-quality care. The first doctor people should call is their family doctor. Not only do these doctors know their patients best but it is also the safest way to get care while supporting local clinics. Although many doctors would not address patients’ needs over the phone prior to the pandemic, the compensation for phone visits combined with safety protocols have shifted practice guidelines to allow for addressing concerns remotely.
If someone does not have or cannot reach the primary provider, another option is to use a service that supports the public healthcare system. If a website has a tab for “pricing,” it is a pretty good clue that it will go back to charging for visits as soon as the pandemic is over. There are other websites like Telehealth Ontario or dialadoc.ca (that a few colleagues and I have created) that can address medical needs by phone and will never start charging patients for visits.
COVID-19 will cause shifts in the way business is conducted in many industries. When choosing how to seek healthcare during this time, I implore patients to choose it in a way that will strengthen the public healthcare system rather than giving more power to private companies that until now have operated on the peripheries of our strong public system. After COVID-19, there will be a flood of patients who will need to catch up on health screening, diabetes monitoring and many other health concerns.
Losing family doctors at this time to pay-for-visit websites would be devastating to a lot of communities. It is impossible to say if over time these doctors who deflected to the private system will ever return to the public one. If the working conditions are better, the appeal to stay may be too much. Even if they do return, it will take months to set up their clinics again and hire the appropriate staff at a time when demand for healthcare services will be unparalleled.
It is already hard enough to find a family doctor. Let’s not shift more of them into the private sector. Free healthcare is a fundamental Canadian value and needs to stay that way.
*Dial-a-doc was started by a group of Ontario family doctors in response to COVID-19.