Ontario doctors are worried about the future of primary-care services as financial uncertainty and private telehealth providers threaten to disrupt the entire health system.  

At the start of the outbreak doctors switched to phone and virtual consultations and OHIP allowed doctors to bill for these appointments, something which previously wasn't available. 

While primary-care facilities made the switch, OHIP also funded some previously established virtual health companies, like Maple and Tia Health, to help with the transition and increase in demand. 

"This [was] a smart thing to do for the pandemic but it’s repercussions could have extremely negative effects," Dr. Mark Auspitz, a family physician at Watson Clinic in Toronto, told Freshdaily. 

These private companies partnered with Rexall and Shoppers Drug Mart and they saw a huge surge in customers. For example, Maple saw an overnight jump of 600% in daily volume and as a result started hiring up doctors from the public health system to meet demand. 

"The problem is that Ontario is only temporarily covering these phone visits and will likely get rid of them after COVID-19. After the pandemic is over Maple and Tia Health will start charging for visits again," Auspitz said. 

Now the small doctor clinics have to compete with these big companies for patients, which is an issue because many doctors don't get a salary but operate as independent small businesses. They bill OHIP every time a patient comes in for a test, consult or exam and then OHIP pays them.

And while doctors have been allowed to temporarily bill for virtual and phone consultations, a hitch in the OHIP billing system resulted in payments for the new virtual care being delayed until mid-June.

This causes a lot of problems as, according to the Ontario Medical Association (OMA), between 30% and 50% of OHIP payments go toward Ontario's health system infrastructure. That's stuff like salaries for nurses and administrative staff, rent, utilities, equipment etc. 

On top of that clinics haven't had their usual number of patients and they're not billing for other things they normally would so clinics have already had to make cuts. 

Auspitz says the clinic he works at has cut hours and personnel by 50%. And according to the OMA about 49% of members have laid off some staff and 53% are planning to lay off more staff if the billing issue is not rectified.

Additionally, the delayed payments means that nearly half of Ontario's primary care clinics face financial uncertainty, of which 50% would need to shut their clinics for three months or permanently, according to a survey by the OMA.  

And unlike many small businesses many doctors do not qualify for COVID-19 relief programs, according to an independent third-party analysis. 

So if a quarter of Ontario clinics close, the OMA says hundreds of thousands of patients wouldn't have access to a doctor. That's on top of the nearly 800,000 people who already don't have a doctor. 

Last week, the Ford government responded and approved advance payments for doctors. 

The government proposed averaging out billings for a doctor for 12 months and would give them up to 70% of that average up front. Doctors would still continue to bill OHIP and be paid normally but would start to pay back the advance payment in November. 

But on Tuesday, OMA rejected the advance payments stating they were “totally deficient in meeting the needs of the healthcare system for future sustainability, including income stabilization and infrastructure support.”

"Advance payments will not maintain a sustainable and accessible publicly funded health care system," the OMA added in a letter to the Ministry of Health. 

 “We are worried about our patients. We are worried about increasing wait times and worsening hallway medicine. We are worried about the sustainability of Ontario’s community healthcare infrastructure. Advance payments will not meet these needs. That is why we continue to advocate for the relief necessary to protect Ontario’s health care infrastructure,” said Dr. Sohail Gandhi, President of the OMA, in a statement.  

“For the sake of our patients, we are eager to find a solution that provides Ontario’s doctors with the support needed to keep our practices open now, and after COVID.”

In the meantime, family doctors and primary-care clinics are having to come up with stop gap solutions to keep them afloat. 

Auspitz and his colleague Dr. Thomas Debbsou started a website dialadoc.ca to help out his clinic and others. 

"The purpose of our website is to gather a list of patients who need to speak to a doctor and distribute the list among brick and mortar doctors clinics to help them stay in business during this time and keep their staff employed," Auspitz explained. 

So far they've seen 60% to 80% of patients come through their website. 

"It's still keeping us afloat," he said. 

Although, it's unclear if it will be enough as more and more publicly-funded virtual health clinics crop up. 

"They do not have to pay mortgages or many staff, as a result they can put more money into advertising and are taking patients away from brick and mortar doctor’s offices which cannot compete," Auspitz said. 

And while private companies and virtual health clinics are helping fill a void now, Auspitz and many other doctors worry that when the temporary funding stops and people need to go back to visiting their family health doctor in a clinic there will be nowhere to go.  

"I worry about what will happen when this first wave of COVID-19 is over and a big chunk of our health-care system just won’t be there,” said Gandhi. 

"We want to be there when this over. People should know how they choose health care effects the future of it," added Auspitz.