Sask. introduces controversial ‘virtual physicians’ to staff rural hospitals

Allison Bamford reports on Saskatchewan's implementation of a controversial technology to assist the province's rural communities facing doctor shortages.

A Canada-wide doctor shortage continues to fuel service disruptions and temporary closures in rural and remote emergency departments.

As a result, more patients in rural Saskatchewan are being treated by virtual doctors when they step inside an emergency room.

“Our goal is always to try and have in-person physician coverage,” said Dr. Johann Roodt, deputy chief medical officer for Integrated Rural Health with the Saskatchewan Health Authority (SHA).

When that isn’t possible, Roodt said virtual physicians are the health authority’s last line of defence against temporarily closing emergency departments and forcing patients to drive elsewhere for immediate care.

The SHA launched the virtual physicians pilot program in five communities in July 2023. Two-and-a-half years later, the program has expanded to 28 rural health centres that have been flagged for doctor shortages, or being at risk of service disruptions due to staffing vacancies.

“Not only in Saskatchewan, but across Canada, we are facing significant physician pressures with significant vacancies,” Roodt told CTV News.

Visiting a virtual physician in the emergency department is a similar process to when a doctor is on site, according to Roodt.

Patients are first triaged and assessed by a nurse, who then consults with an off-site physician through the SHA’s Healthline 811. From there, the doctor will speak with the patient over the phone or video call to provide a diagnosis, treatment, prescription or order imaging.

Outlook and District Health Centre was an early adopter of the virtual physician program. The town, an hour southwest of Saskatoon, is one of several rural communities that struggles with doctor shortages and temporary closures.

Emily Trew, who has lived in Outlook for the last four years, rang in the new year with a trip to the town’s emergency department.

She says she was suffering from a severe migraine, and the centre was staffed with a virtual doctor that night.

“There are people that are frustrated with it, but at the same time, a virtual physician is better than not being able to see anyone at all,” Trew said, adding it can be less comforting to talk to a doctor over the phone than face-to-face.

While Trew was able to get medication for her migraine, she says there have been times when the off-site doctor has had trouble assessing patients.

“We had one experience last year when my little girl had pneumonia, and because a doctor couldn’t physically see her, and see her breathing, they debated sending her to the city,” Trew said.

Virtual health care comes with some limitations. There are certain conditions that doctors can’t treat if they are not there in person.

For example, doctors can’t give stitches to patients over the phone or on a video call, Roodt said, but they can treat a heart attack.

“It certainly is not something that will replace in-person physician services, but certainly, we live in a technology age where I believe, if we use the tools in our toolbox to deliver services and be innovative with the way we deliver services, I think that’s important,” he said.

The health authority is planning to trial new technology to improve video calls between remote doctors and on-site nurses, according to Roodt.

“I certainly want health care to be safe. I also do not want people to have to be worried if they have a heart attack and their emergency department is closed. I personally think that’s more unsafe,” he said.

Expanding virtual care to the north

In other parts of the province, primary care, physiotherapy and diagnostic imaging, including ultrasounds, are being performed virtually through the Virtual Health Hub.

The health-care organization uses leading edge technology, robotics and AI to deliver the services in northern and remote communities, according to hub director Dr. Ivar Mendez.

“This is the only program in the country that has this advanced technology where we can provide diagnostic imaging to the people that need it in real time, without them needing to be traveling to the cities,” he said.

About 15 per cent of Saskatchewan’s population doesn’t have access to a family doctor, Mendez said. It’s especially hard for those in remote northern communities to access specialists or primary care.

Technology is not meant to replace the health-care workers in these remote locations, according to Mendez, but instead support them.

“It’s hard to retain health-care workers in rural and remote locations, because they feel they really are not supported by the system,” he said.

“I don’t think we have any option but to innovate.”

The Virtual Health Hub is set to open a new facility on Whitecap First Nation in 2027, which Mendez said will eventually help expand virtual services to about 90 communities. Currently, the Virtual Health Hub serves six communities.

“The future is a hybrid system, where virtual care supplements and supports human care,” Mendez said. “We really feel that the human touch is absolutely crucial, and it is something that should not be lost.”