Fee-for-service gender-affirming virtual healthcare clinic launches in Ontario

A new virtual clinic offering gender-affirming healthcare for transgender, non-binary and other gender diverse people launched in Ontario on Wednesday, rising from the remainsof Toronto's Connect Clinic to offer services for people who can't access them anywhere else.

But this time, patients will have to pay for thoseservices.

Connect Clinic and its founder,Dr. Kate Greenaway, havelaunched Foria Clinic in partnership with PurposeMed, a company that operates specialized telehealth services for underserved communities.

The clinic employs nurse practitioners, whose services are not covered by OHIP.

Fees for a simple follow-up appointment to check blood work, renew prescriptions and perform health screenings will run around $99, said Greenaway, who is the medical director of the new clinic.

New patients could pay $199 or $299 for initial appointments.

Only viable option available

"I had a choice to not serve them at all or to do this," Greenaway said.

"It's just kind of a false choice, right? In the sense that I didn't have a way to fully fund a clinic through the Ministry of Health they've chosen to not value virtual care in this way, which has a particular effect on trans, non-binaryand gender diverse populations in Ontario."

Greenaway said she hopes to create a fund to help people access the clinic's services even if they're unable to pay.

Data from Statistics Canada found that more than 12 per cent of trans people and 20 per cent of non-binary people lived in poverty in 2020, compared with around eight per cent of cis gender people.

Trans advocate Jemma Keigher credited Greenaway with doing everything possible to help the community access care given the rules the province has set up. But she asked why Ontario is failing trans, non-binary and gender diverse people.

"By moving to a user-pay model, it effectively creates a two-tier privatized system in Ontario," she said in an email. "How does Ontario get away with removing access to care without repercussions, both legally and medically?"

Trans/non-binary Thunder Bay resident Colin Redston said the costs would serve as a barrier to some members of the community, while others in remote locationsor stuck at the bottom of long waitlists for in-person care might pay them out of desperation.

"It stinks that the province's funding situation put [the clinic] in that situation," they said."Because, as I think anyone who deals with trans people knows, we are statistically more poor and more likely to be unemployed."

Connect Clinic launched in 2019 with funding through the Ontario Telemedicine Network (OTN), Greenaway explained.

When the COVID-19 pandemic hit, Ontario shifted funding for virtual careto OHIP.

Then, on Dec. 1 of last year, it reduced fees for virtual care to $20 per visit, regardless of the length or purpose, if the clinic was seeing the patient for virtual care only. Previously the clinic might bill $60 or $70 for a longer appointment.

The changes rendered Connect'sbusiness model unsustainable, and it ceased providing services at the end of April, leaving approximately 1,500 patients and another 2,000 people on its waitlist without gender-affirming health care.

A spokesperson for the Ministry of Health told CBC in March that virtual care should compliment, rather than replace, in-person care and that the billing changes were intended to foster positive physician-patient relationships.

Virtual care safer and more accessible for some people

He also said thatprovincial funding for team-based health care models, such as community health centres, was intended to improve access to in-person care, including for trans people.

Greenaway, however, said she believes virtual care is preferable for some trans people because it can be safer, and it's accessible to people who can't find providers in their home communities.

The ministry did not directly respond when CBCNews asked if it would restore funding to provide gender-affirming care virtually.

Connect negotiated with the ministry through the Ontario Medical Association for six months prior to the Dec. 1 funding change, andattempts were made to find an exception to allow the clinic to continue, Greenaway said.

Staff believed they would be restricted from taking new patients, but they didn't learn until a week before the changes that they would no longer be able to serve their existing clients.

"We didn't have any recourse, right?" she said."We can tell the Ministry this is going to ruin everybody's, you know, physician-patient relationship, but we have no other recourse there."

She described the ensuring conversations with patients as some of the most heartbreaking weeks of her practice.

"Patients were very scared and very sad about losing a reliable service that was safe for them," she said.

"The most heartbreaking responses were maybe just the resignation, like the people who sort of said, 'Well, like, of course this is gone. This was so helpful for my life. And like obviously that would be removed.'"

In the wake of Connect's ceasing operations, PurposeMedwas among several organizations that reached out and asked if they could help, Greenaway said.

The new Foria Clinic can be accessed online at ForiaClinic.com.