the rise in virtual care gives clinicians more options to close treatment gaps

dr. brett belchetz started his medical career in toronto, first studying at the university of toronto and then doing a residency in the city. but before his residency, he stepped away from healthcare to work as a management consultant at mckinsey & company, where he learned everything there is to know about starting and running a successful business.

once he stepped back into healthcare, his career led him to become an emergency room physician, but his business acumen never quite faded. in 2015, he co-founded maple, an early leader in virtual and telehealth care offerings in canada.

“it was really inspired by all of my experiences working on the front lines of the healthcare system,” he said. “after 10 years of working many, many, many shifts in canadian emergency rooms, both urban and rural, what i was really struck by was just how difficult it was for canadians to access healthcare and how uncomfortable and inconvenient and sometimes unsafe the experience was for patients.”

in his experience, and for many others, he saw patients wait eight or more hours to see him for only four to five minutes at a time. this made it clear that many of the people he saw didn’t actually need emergency care; they just “had nowhere else to go.”

his inspiration to start maple came from his business and healthcare background and his desire to address these issues and create a viable alternative that could truly benefit canadians.

for many young professionals entering healthcare today, the surge of virtual care has become another career pathway that gives providers more freedom. they can now choose how they want to operate, what their goals are with their patients, and how they can be the best medical providers they can be while still allowing themselves to experience life outside of their jobs.

the gaps that led to the rise in telehealth

while technology certainly made it easier for telehealth to pick up speed as a more commonplace offering of medical care, it wasn’t just that—it was a system full of gaps. for example, people need to see doctors for a variety of ailments, but in that time, many have to take at least a half day off work and lose wages. for many canadian families, those lost wages can mean the difference between seeing a doctor and getting food on the table.

another issue is access. almost six million canadians do not have a family physician, or even if they do, the wait time to see them is exponentially longer than it should be. for routine care, people can wait up to two weeks for an appointment, while those without family doctors may have to wait months or even years to find onethat’s taking on new patients.

“that’s not good enough for anything that is urgent or semi-urgent,” said dr. belchetz. “if you have a urinary tract infection or almost any other condition, or even if you’ve just run out of your prescriptions, waiting two or three weeks can result in a very bad outcome for patients.”

add specialist appointments for more serious diagnoses or management, and the wait averages about 28.6 weeks after a physician referral. because of these wait times, people have no choice but to seek faster care, and that often means going to the emergency room.

dr. belchetz noticed his friends and family didn’t follow the same song and dance when seeking healthcare.

“when my friends and family members got sick, and we’re going back in time to 2012, 2013, they would always just text message me,” he said. “for my friends and family members, they didn’t have to go to the emergency room.”

instead of spending eight hours waiting to see a doctor, they could virtually call the one they already knew for instant care. dr. belchetz offered free care, got the diagnosis right according to his friends and family who saw their doctors weeks later, and realized it was an easy alternative that could be scaled much more widely.

remote care is highly beneficial for patients

when looking at the patient side of things, “remote care certainly has really made a big difference in terms of getting access to care when you need it versus weeks later or versus having to wait a very long time in a waiting room at the emergency room or a walk-in clinic to get care.”

people can also get in touch with a medical professional without having to interrupt their life to the point where they need a babysitter or have to take time off work, for example. because even without the wait times, getting an appointment requires the time to go in, see the doctor, and can be “highly disruptive to most professional obligations or it’s disruptive to your social obligations, to your social schedule.”

“[there are] many things that we all struggle to take care of in our regular schedules in our lives, so when you have to take many hours out of the day, which is always the case for an in-person health-care appointment, it is highly disruptive,” said dr. belchetz.

the experience itself is also “more pleasant,” notes dr. belchetz, because sitting in a waiting room isn’t fun for anyone. having to go up to a counter and tell the medical secretary about a very personal health problem in front of a full waiting room is unpleasant. putting yourself in a room full of potentially sick people with contagious diseases is dangerous. the entire experience lacks the comfort, ease and care that telehealth can provide.

why opting for a career in telehealth helps everybody

when looking at it from the physician’s perspective, it also opens a lot of doors career-wise, which is a great benefit. in dr. belchetz’s experience, providers don’t necessarily choose one over the other when it comes to in-person versus virtual care, but the beauty is that they don’t have to.

“what we’re seeing more and more is that even in very, very traditional family practices, there is a healthy blend of virtual and in-person care. where i think there is a bit of a choice is clinicians to decide, are you the kind of clinician who is just going to do your core practice or you’re just going to do your family practice and when you’re out of the hours of your practice you’re kind of done, or are you the kind of clinician who does your eight-hour shift or your six-hour shift in your family practice in your emergency room and then in your off hours you say, ‘i’m also going to add on some virtual to supplement.”

it all comes down to a few factors that help clinicians lean one way or the other, such as their personal financial situation, other obligations they may have outside of work, or their preferences regarding time off and being fully scheduled. and that may change throughout one’s career, so the option to shift and change from more virtual to less virtual or vice versa is always there and always available to clinicians.

after all, virtual care isn’t a replacement. it’s an extra line of care that helps provide more care for more people while also allowing physicians to stay balanced in their own lives.

“what we typically see now is that most healthcare providers are doing both,” he said. “from a system perspective, that’s very beneficial because we’re expanding the number of hours that healthcare providers are working. we’re adding more capacity to the system.”

for example, when dr. belchetz worked full-time as an emergency room physician, he would have 15 to 16 “extraordinarily gruelling” shifts per month. now, it may seem like that’s not a lot of work for a full-time job, but because of the nature of these shifts and the fact that they were spread around between overnights, evenings, weekends and days, “it’s really hard to do more than that.”

but he had 15 days off a month. he could have picked up extra in-person shifts, but “when i was sitting at home, tired the day after an overnight shift, the last thing anybody could ever persuade me to do is pick up another in-person shift.” the job is tough, and you can burn out incredibly quickly.

but with two weeks off every month, providing a level of care that’s easier for the physician is something many physicians would be happy with.

“it’s this idea that there are going to be many, many times throughout the day, throughout the week, throughout the month, where you might have a few minutes, and you would never pick up a shift during those few minutes, but it’s enough minutes to help one patient,” said dr. belchetz. “and the way our system works [at maple] is you can see just one patient, just like an uber driver would take on a ride and then turn it off.”

so, when there’s downtime and physicians want to work a little more without committing to another overnight shift, they can do that without changing their current in-person work status or giving up their personal lives in the process.

“we have clinicians who are on parental leave who couldn’t work before, and now they can work during a parental leave. a lot of clinicians have summer cottages or summer homes where it used to be that you had to make a choice of, ‘i’m going to give up all of my income to enjoy my summer home and the healthcare system will lose all of my capacity, but at least i get to have my holiday, and so there was that trade-off they had to make,” said dr. belchetz.

with virtual care options in the current system, that trade-off has all but disappeared, granting both work-life balance and patient benefits in one shot.

“the flexibility and the additional income and the additional capacity that it provides the health-care system are all tremendous benefits to both the clinicians and to the system as a whole.”

these types of virtual health-care careers also apply to most specialties, so if people believe they cannot offer virtual care because of their job title, they may be surprised.

for example, specialist surgeons cannot do surgery virtually, but they can look at all the tests needed to determine if someone is a candidate, go over their medical history and learn more about their condition all from their and the patient’s comfort of home.

“that is true of almost every specialty now; it’s very much investigation-driven,” said dr. belchetz. “when we think about surgeons, we’re often very constrained by physical premises and how many people they can fit in their office, and we know there are very, very long wait times for surgeons. if we could actually allow them to do consultations with far more patients because of having a virtual element to their practice, it would be extraordinarily helpful for them and their patients.”

the level of care remains the same—mostly

clinicians do not have to pass a certain test or complete specific training for a job in telehealth care because the clinical guidelines and technical requirements are “very similar” to traditional, in-person medicine.

“you’re going to ask the right questions. you’re going to take a good history. a lot of the actual examinations that you can do in an in-person setting, you can do virtually,” said dr. belchetz. “if you’re able to upload pictures of things, i can see a picture of the back of your throat. i can see a picture of the rash that you have. i can look at a video of how your joint’s moving. i can walk you through an examination of your sore elbow or your sore shoulder.”

even areas where telehealth might fall short, such as listening to a person’s lungs or looking inside their ear, are being addressed through technological advancements. for example, sites like amazon now offer digital devices such as digital ear scopes and digital stethoscopes that can help with that.

that said, just because telehealth can do most things doesn’t mean that there aren’t limitations physicians need to be aware of.

“as a physician practicing virtually, what are the things that you absolutely can do, and what are the types of things that you might need to do some form of in-person examination that you can’t perform remotely? and so, you have to be able to triage those and direct people to the appropriate place,” said dr. belchetz.

for physicians, a one-stop-shop application that keeps everything in one tidy place can make a virtual care practice much easier to manage. having one application for video, another for chatting, and others for tasks like ordering labs or prescribing medication can get “really messy.”

“[it’s] really difficult to keep good records, really difficult to make sure that it’s a seamless experience where the patients can get access to all these things that they need to access,” said dr. belchetz.

it also helps if this program can share the information back with family providers, specialists, or anyone else on the patient’s care team so everyone involved in care is in the know. of course, modern technology has made much of this easier.

“every phone, every computer now has a webcam built in, so you should be able to do the video part without difficulty. i think in another era, you might’ve had to have a separate webcam and other stuff pulled together, not really the case anymore,” said dr. belchetz.

the availability of internet bandwidth has also made it easier for virtual care to thrive, especially now in rural areas where people lacked access. but that’s changed “in the era of starlink being almost omnipresent.”

“there’s almost no place on earth where you cannot do a virtual care practice or virtual care visit very effectively.”

and in the future, all the technology that continues to be created is going to make virtual care that much easier. for example, wearables continue to improve and can provide useful health data that a person can share with their physician, while integrated health systems will make medical record sharing seamless. artificial intelligence (ai), in particular, will also handle certain administrative tasks, taking a load off physicians and freeing them to provide better care.

because certain tasks will free up physicians’ time, they’ll be able to get back to the “big job,” which is the most “human part of the job.”

“it’s going to make healthcare much more available. it’s going to make it much more human because you’re not going to have that experience anymore where you’re talking to the doctor and they’re just looking down at the computer screen typing notes. they’re actually going to be speaking to you because they don’t have to focus on those administrative tasks. and i think it’s going to make it more accurate and less error-prone,” said dr. belchetz.

at the end of the day, the beauty of virtual care is “having those choices” to make as a clinician in how you want to practice, when you want to practice and how you want to balance life with your goal of helping as many patients as possible.

“i think we’re moving more and more and more to a future where there’s lots of choice, lots of places to get care,” said dr. belchetz. “so, i think we’re on a really bright trend line, and i think virtual care is obviously a big part of that.”