In-person and virtual care patient visits

Dear colleagues:

Doctors received a letter on Friday September 3 from the College of Physicians and Surgeons, Provincial Health Officer, and Ministry of Health describing expectations with respect to providing in-person clinical care. This capped off a week of disturbing protests, rising numbers of COVID-19 hospitalizations, and our collective fatigue and burnout as a profession. I understand that many of us are hurting, and want to acknowledge that as a profession we have been giving it our all for 18 months. I have received many messages of support and concern for doctors’ wellbeing from the public. I stand with you, Doctors of BC stands with you, and the vast majority of our province stands with us.

I want to clarify some important points arising from the letter from the College, PHO, and Ministry.

Who is the letter aimed at?

In March 2020, at the start of the pandemic, the PHO and College advised doctors to suspend all but essential in-person care. In the ensuing months, most doctors have resumed providing in-person care in accordance with our increased understanding of COVID-19 and the clinical needs of our patients. Last week's letter advises doctors who have been providing very little or no-in person care that they must consider the clinical needs and preferences of their patients and provide in-person care as required. It is aimed at: 

• Physicians who stopped seeing patients in-person in March 2020, and have not resumed in-person care or have been doing little in-person care. Numerous complaints have been received from patients who have not been able to see their physicians in the last 18 months. 
• Physicians who are directing all or nearly all patients who require in-person care to other sites without mutual agreement. This is leading to notable strain in emergency rooms, urgent and primary care clinics, and other community physician groups. Physicians have expressed concerns about patients directed to them by colleagues who are not making themselves available to see patients in-person.

Why were telehealth fee codes mentioned?

It is the position of Doctors of BC that virtual care is here to stay. Virtual care is an indispensable tool with a number of benefits for our patients. It is accurate to say that a number of telehealth fee codes were put in place on an emergency basis at the beginning of the pandemic to supplement pre-existing telehealth fee codes. These fee codes prevented the collapse of community care at the beginning of the pandemic. We believe that these fee codes continue to be an important part of supporting the care of patients.

Doctors of BC is engaged with the Ministry in active discussions about the future of virtual care, including transitioning from emergency fee codes to more permanent fees that reflect the realities of providing care in a post-pandemic environment. The Ministry and College agree with Doctors of BC on a number of principles for virtual care, including the protection of longitudinal primary care, appropriate use-cases for virtual care, and the importance of providing options for patients and physicians. 

What about safety of staff and patients?

The Ministry and BC Centre for Disease Control have updated infection and prevention control protocols that support continued safety measures, including the continuation of a mandatory mask policy in health care settings. A  reminder that during the pandemic family doctors and specialists working in community clinics are eligible to order free PPE and critical supplies through the Health PPE Portal. Doctors of BC will continue to advocate for measures to protect you, your patients, and your staff, as the pandemic situation and our understanding of COVID-19 evolves over time. 
 
What about ‘hybrid’ care?

Many physicians are providing a hybrid of virtual care and in-person care. This is appropriate and should continue. There are a number of benefits of virtual care including improved access, convenience, and reducing unnecessary travel. Bear in mind the following:

• Pre-screening patients to determine their vaccination status and whether they have respiratory symptoms is an appropriate practice.
• You cannot refuse to see a patient who declines to provide their vaccination status or tells you that they are unvaccinated. However, you may take appropriate precautions to protect yourself, your staff, and vulnerable patients, for example by seeing the patient in a separate area or at a different time of day when there are fewer people present.

Virtual care is an important part of our work and is here to stay. Doctors of BC will continue to advocate for appropriate recognition of virtual care, protection of longitudinal primary care, and measures that protect your safety and that of your patients.

Thank you for everything you are doing for your patients, including adapting your practice in constantly changing conditions. I am very proud to be a member and leader of this profession.

Sincerely, 

Dr Matthew Chow
President, Doctors of BC 
View Email Addresspresident@doctorsofbc.ca