An answer to persistent doctor shortages facing the North might be online, according to Canadian Medical Association president Sandy Buchman.
Virtual care would allow doctors from across the country to offer treatment over the internet, skipping over provincial and territorial boundaries and access barriers like wait times and low patient mobility, the physician said during a visit to Yellowknife, Jan. 30.
Vitally, it can also potentially assist the roughly 45 per cent of NWT residents without access to a regular doctor, and communities such as Hay River facing intermittent doctor shortages, or smaller communities with even less.
“You can get a pretty quick doctor’s consultation, get it from your living room, and it’s just as effective for certain visits,” Buchman said.
There are a few barriers to this approach. Under current rules, a doctor such as Buchman is clear to practice in Ontario, where he practices, but not in NWT. Even clearing this regulatory hurdle would entail asking who pays him for that virtual care visit: the NWT, where the patient is, or Ontario, where Buchman is?
“Right now, the territory wouldn’t license me unless I went right back to my medical school days, until I got all the documentation in order,” he said, which would stretch back to his time in medical school, on top of a hefty amount on application costs.
“It would make sense that if I’m safe in Ontario, I should be safe up here,” he said. “But you have to go through that for each province and territory.”
There are other limitations from the patients' end.
Limited context of a virtual visit can be a challenge treating conditions such as diabetes, high-blood pressure, chronic pain or addiction.
“If I’m your virtual walk-in doctor, I may not know enough about these other aspects of your care to really get a good sense of, ‘Is your diabetes under control; are you dealing with your addiction and want pain killers?’" he said.
“That’s where there’s danger. We don’t want to turn virtual care into just walk-in care because we know that trusting relationship of really good quality care has to be in that context.”
He pointed to PEI, which faces a shortage of hospital doctors, as a potential model for jurisdictions facing similar issues.
Nurses push a computer on wheels with a doctor on screen to meet with patients on a daily basis. The nurse and sometimes the patient can provide data like blood pressure and oxygen levels electronically.
A virtual stethoscope similarly can listen for signs of infection, which are then related to the doctor.
“You can make a lot of good decisions without necessarily physically examining the patient at that time," Buchman said.
He gave an example of an elderly person with diabetes and a heart condition in Fort Smith. If that person reports shortness of breath, it could be heart failure and the virtual care doctor could give a referral for further in-person care.
“But then you know it’s really needed,” he said. “It’s not just somebody coming back from several hundred or thousand kilometres away just to check in for 10 minutes on how you’re doing.”
But then there are other concerns: access to technology and internet infrastructure that can support virtual care, and whether or not these lines are private — a consistent issue in NWT’s own health sector.
Ideally, for Buchman, this sort of care can be as trustworthy as banking on your phone. But there are higher security requirements for health that can lead to pressing questions.
“Can somebody hack in? Can somebody get into your records? Can somebody follow in on the conversation?” he said.
For all the challenges, however, the CMA president says virtual care could be an alternate route for overworked doctors facing burnout and jurisdictions facing a shortage of physicians.
This would all be while limiting the expenses — and CO2 emissions, according to Buchman — of medical travel to other cities embedded in the NWT's health-care system. Meanwhile, the territory has already begun experimenting more with distance mental health services.
“We don’t have to get a patient coming down from Fort Simpson to Yellowknife because they may be able to get their care there,” Buchman said.