Doctors worried about 'splintering' of health system as virtual care comes online

Doctors in Newfoundland and Labrador are questioninga government plan to usea private company to provide virtual physician coverage and are warning of the potential for damage to primary care and the patients who rely on family doctors.

The Newfoundland and Labrador Medical Association wants to know how physicians working with a company calledTeladocHealth will be paid, how much they'll earn, and how the new services they provide will be integrated with the current system.

President Dr. Gerard Farrell said he also hasconcerns about the increasing use of private companies to provide health-care services.

"We're seeing more and more privatization in health care because we are seeing more and more gaps in the delivery of health care and that opens opportunities for private companies," Farrell said in an interview.

"When that happens we have to worry: is that thebeginningof a splintering of our health-care system into public and private?What does that mean in terms of how much it is going to cost to deliver care?" he said.

Farrell expectsvirtual care will continue to be one of the ways community-based doctors connect with patientsbut said he doesn't believe private companies should be used indefinitely.

"One of the things we learned fromCOVIDis that virtual care is a valuable entity, but one of the questions is, in what context? If [using private companies]is a short-term measure to overcome the significant backlog we have, then Ithink it's an option, but I don't think it's something that should be considered in thelong term," he said.

New service will not 'poach' doctors: Osborne

Health Minister Tom Osborne says virtual physician care will be available for patientsby the end of November who don't have a family doctorand to cover emergency care in New-Wes-Valley.

In September 2022, the provincial government issued a request for proposalsfor virtual emergency care services at ruralemergency departments and urgent-care centres to reduce the number of ER closures in the province, as well as a virtual primary-care service for residents who don't have family doctors.

Those patients will have to register with Patient Connect N.L. to access the virtual primary care service.

WATCH | NLMA president Gerard Farrell says financial details are key for virtual care:

New virtual care good for short term, but payment questions are unresolved, doctors say

11 months ago

Duration 1:11

The president of the Newfoundland and Labrador Medical Association says hes OK with the provincial governments plan to use a U.S.-based company to provide virtual doctor access to anyone without one for now. But Gerard Farrell says its crucial that existing family doctors not be out-earned by these virtual physicians, drawing parallels whats been happening with travel nurses.

The medical associationwants assurances the new services will not attract physicians who already serve attached patients away from their community-based practices.

"We certainly don't want to see another situation like we've got with the travelling nurses and the 811 system, where 811 is getting significantly more to take a phone call than arephysicians sometimes to see that patient as a result of that phone call. We don't need any more incentives for physicians to leave primary care practices to deliver virtual care," said Farrell.

Speaking outside the House of Assembly on Monday, Osbornesaid the new service won't drain resources fromcommunity-based practices.

"We have put into the request for proposalsthat the proponent is not able to poach doctors from this province. That is part of the contract. That is part of theRFP," he said.

The medical association also wants to know how patients referred to in-person care at a virtual visit will be connected with a community-based physician.

In a letter to members, the association says it was told by Health Department officials thatN.L. Health Services is working with the vendorto establish patient navigators to link virtual services to in-person care.

Osborne said doctors working virtually in Newfoundland and Labrador will have to be members of the NLMA and licensed by the province's College of Physicians and Surgeons.

He hasn't said how much the contract for virtual care will cost but has said the provincial government will release more details about thenew services in the weeks to come.

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