Opinion: The future of telemedicine is at risk in Quebec

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In a world that sometimes feels like everything is falling apart, doctors somehow remain resilient and resourceful. No matter what is thrown our way, we always look for novel ways to ensure adequate access and care for our patients.

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During the pandemic we saw the rise of telemedicine, which rapidly became one of the staples of patient care — a quick and efficient way to manage a variety of health conditions without obliging a person to physically come into the office.

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On Nov. 22, the Fédération des médecins omnipraticiens du Québec, representing general practitioners, issued a statement informing physicians that if an agreement with the government cannot be reached, family doctors will be unable to bill for teleconsultation appointments as of Dec. 31.

The existing agreement for teleconsultations has been up for renewal since April 2023. The government has made an offer to continue compensation for these virtual doctor appointments, but with a drastic decrease in payment: as low as $6.22 for a five-minute phone consultation.

Family doctors pay about 30 per cent of their earnings in overhead costs such as rent and clinic supplies. A decrease in salary of that magnitude not only fails to reflect the work that family doctors do during teleconsultations, but it also renders telemedicine financially unfeasible.

What does this mean for patients? It could mean decreased access to your family doctor, especially for those who are the most vulnerable and sick.

Many patients in my practice are no longer able to drive, or are otherwise mobility impaired, or have had to move further away from the clinic to be closer to family. Teleconsultation appointments have been a wonderful way to continue to provide care to these individuals.

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Instead of a family member having to take a day off from work to drive them to the clinic or for them to struggle to arrange adapted transport, I can simply call them and manage their issues by phone. High blood pressure can be managed remotely by discussing their log of home readings. Diabetes medication can be adjusted based on the most recent blood work.

In today’s modern world I would argue there is just as big a place for telemedicine as in-person medicine. Prompt outpatient care is essential to keeping people healthy and out of the ER. How that care is delivered depends on the needs and context of each specific patient.

Something as simple as being able to call my patient to ensure their pneumonia is improving on antibiotics can make a huge difference. This can allow them to recover at home, whereas without prompt medical follow-up, they could decompensate and end up having a one-week hospital stay.

Instead of allowing my cancer patient to rest, an end of this agreement could force her to come to the clinic for a reassessment of her cancer-related anxiety and risk catching something in the waiting room.

What does this mean for doctors? It could mean more unpaid work for those who continue to provide teleconsultation services. It could mean more hours spent at the clinic and away from our families. It could mean more burnout and more exodus from the public system and the province altogether.

I took an oath to do no harm, but decreasing access to care — regardless of how it is administered — is harmful. I strongly urge the government to remain flexible in its negotiations to ensure that telemedicine remains a part of our standard practice.

Laura Sang is a family physician practising in the southern Laurentians.

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