Billed as remedy for doctor shortage, virtual medicine in N.S. hits bottleneck

Early in the COVID-19 pandemic, virtual medicine offered a novel way for patients to see doctors during a lockdown and hope that technology could alleviate chronic pressure on a strained health system.

For many in Nova Scotia, though, the early promise has proven illusory.

Tim Neufeld, 28, from Dartmouth, N.S., has been on the province's wait-list for a family doctor for five years. He said in a recent interview that he was left frustrated after several unsuccessful attempts at securing a virtual appointment.

"The biggest hurdle is just accessing the system, having to log on between 8:59 a.m. and 9:09 a.m.," he said, noting that when he tried to sign up for virtual care after 9:10 a.m., all the day's appointments were already booked.

"Obviously the demand far exceeds the supply, so there's some pain around that and whether or not you're able to even get the care you need."

Sara Wallace, 48, from Dartmouth, compared the experience to "trying to buy concert tickets." She said she tried unsuccessfully to schedule a medical appointment four times over two weeks before finally succeeding.

Nova Scotia launched its virtual health platform in May 2021, and it now has 67 health professionals — physicians and nurse practitioners — who provide virtual consultations on top of existing general practice commitments.

Brendan Elliot, a spokesman for Nova Scotia Health, said in an email that there are between 150 and 200 virtual visits available on a typical weekday, available to the 120,400 people in the province without a family doctor.

Elliot acknowledged that demand is high and said the province is trying to recruit more doctors and nurses to take part.

Zen Tharani, founder and CEO of Vancouver-based digital consulting firm Xenex Consulting Inc., said in an interview that challenges are expected in the early stages of virtual care implementation, but a bottleneck at the booking stage is a problem.

"It really defeats the purpose" of virtual care, which should be increasing access to medical care and improving the patient experience, he said.

Tharani, who has worked in digital health for 22 years, said a process like Nova Scotia's that requires logging in quickly during a short time frame is likely going to be a barrier to those who have poor internet connection or are less comfortable using digital tools.

"We don't want people to feel left behind," he said.

Because provinces are implementing different methods of virtual care, access looks a bit different in New Brunswick, where virtual appointments are funded for everyone — not just those without a family doctor.

We don't want people to feel left behind.- Zen Tharani, CEO of Xenex Consulting Inc.

Kelly Stokes of Saint John, N.B., uses virtual health care for herself and her young daughter through the province's eVisitNB application.

The 27-year-old said in an interview the experience was "hit or miss" when she first tried it a year ago — but she said it has improved as some referrals were outsourced to nurse practitioners and doctors in other provinces. She said a nurse practitioner based out of Ontario provided care for her daughter last month.

New Brunswick's eVisitNB, which is operated by virtual health company Maple, is staffed mostly by nurse practitioners and a few physicians who may be working remotely from other parts of the country.

Like Nova Scotia, Prince Edward Island reserves provincially funded virtual appointments for residents without a family doctor or primary care provider. In Nova Scotia that represents about 12 per cent of the population, and in P.E.I. it's more than 15 per cent.

In Newfoundland and Labrador, where the medical association reported in June that about 24 per cent of residents were without primary care, virtual appointments are covered for everyone. The appointments are provided by Springdale, N.L.-based telemedicine company Medicuro, which employs 16 local physicians.

Last month, the medical director of a Medicuro virtual clinic called on the province to raise the cap on the number of daily appointments funded by the province. Dr. Todd Young said in a statement that the province's limit of 40 virtual appointments a day is far too low given the number of  residents without a family doctor and the circulation of influenza, COVID-19 and respiratory syncytial virus.

"The time is now to remove any restrictions to available reliable and professional health care," Young said. The province's health department has not said if it is considering funding more appointments.

Tharani said it's very positive to see that provinces are using virtual care to fill in some of the gaps caused by a shortage of primary care providers, and agrees that limits should be removed from virtual care whenever possible.

"Why would you want to put limitations on innovation and accessibility in that way?" he asked.

Tharani said that while virtual care does not work for everything, there's potential to use it strategically to increase efficiency in pre- and post-operative care, emergency medicine and mental health care.

Part of the challenge, Tharani said, is that advances in telehealth have happened in a rush as the pandemic dramatically increased the need for virtual medical care.

"It's difficult because a lot of this is happening in panic, it's reactive," he said, adding that there is a need to step back and look critically at the system.

Neufeld and Wallace both said that once their appointments were booked, they enjoyed the experience of using virtual care.

Wallace, who lost her longtime family doctor when he closed the practice in June, said that the virtual appointment she secured on her fifth attempt led to an in-person followup six weeks later.

She said that appointment, in a Halifax clinic reserved for virtual patients, was "the most thorough medical appointment of my adult life."

It was a complete change from the "packed and overcrowded walk-ins" in the Halifax area she's had to visit since losing her doctor.

"I think there's real potential here for this to positively change the way things are done," Wallace said.