Doctors worried about 'splintering' of health system as virtual care comes online
NLMA wants to know how much Teladoc physicians will be paid
Doctors in Newfoundland and Labrador are questioning a government plan to use a 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 called Teladoc Health 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 has concerns 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 the beginning of 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 expects virtual care will continue to be one of the ways community-based doctors connect with patients but said he doesn't believe private companies should be used indefinitely.
"One of the things we learned from COVID is 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 I think it's an option, but I don't think it's something that should be considered in the long term," he said.
New service will not 'poach' doctors: Osborne
Health Minister Tom Osborne says virtual physician care will be available for patients by the end of November who don't have a family doctor and to cover emergency care in New-Wes-Valley.
In September 2022, the provincial government issued a request for proposals for virtual emergency care services at rural emergency 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.
The medical association wants 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 are physicians 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, Osborne said the new service won't drain resources from community-based practices.
"We have put into the request for proposals that the proponent is not able to poach doctors from this province. That is part of the contract. That is part of the RFP," 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 that N.L. Health Services is working with the vendor to 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 the new services in the weeks to come.
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