AVÐÇÇò

In 2019, between 35% and 80% of physicians provided 1 or more virtual services per month, depending on the province. A year later, between 79% and 90% of physicians provided care virtually. In all provinces where data was available, the number of physicians providing virtual care increased significantly in March 2020, coinciding with the onset of the pandemic.

Not only did more physicians work virtually in 2020, but the volume of virtual services they provided was also higher. Between April 2020 and March 2021, physicians provided an average of 152 virtual services per month, compared with 39 virtual services per month the year before. Virtual care volumes — shown below by bubble size — jumped significantly in March 2020 and remained relatively stable for the rest of the year.

Number of physicians providing virtual care and average number of virtual services per physician, by province, April 2019 to March 2021

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Month	Ontario physician count	Ontario average virtual services per physician	Manitoba physician count	Manitoba average virtual services per physician	Saskatchewan physician count	Saskatchewan average virtual services per physician	Alberta physician count	Alberta average virtual services per physician	British Columbia physician count	British Columbia average virtual services per physician
Apr-19	8,875	10	1,753	64	1,339	42	7,133	30	6,177	28
May-19	8,927	10	1,751	61	1,347	41	7,147	32	6,192	29
Jun-19	8,769	10	1,724	59	1,309	39	7,127	30	6,110	27
Jul-19	9,016	10	1,751	63	1,332	42	7,267	31	6,233	28
Aug-19	8,882	10	1,774	60	1,320	39	7,182	30	6,201	26
Sep-19	8,825	10	1,782	61	1,355	39	7,298	30	6,278	26
Oct-19	9,021	10	1,816	64	1,352	42	7,359	32	6,377	29
Nov-19	8,948	10	1,814	59	1,350	39	7,394	30	6,339	27
Dec-19	8,924	9	1,821	60	1,347	39	7,328	30	6,279	26
Jan-20	9,039	10	1,811	66	1,349	42	7,385	33	6,387	30
Feb-20	8,749	10	1,790	57	1,340	36	7,320	30	6,293	28
Mar-20	22,309	72	2,049	131	1,566	123	7,950	61	8,028	106
Apr-20	23,907	146	2,082	206	Not available	Not available	8,173	123	8,272	195
May-20	24,164	141	2,099	189	Not available	Not available	8,152	112	8,275	189
Jun-20	24,275	150	2,100	175	Not available	Not available	8,140	102	8,346	196
Jul-20	24,434	136	2,106	148	1,605	165	8,187	88	8,476	183
Aug-20	24,366	123	2,101	147	1,620	149	8,153	78	8,472	168
Sep-20	24,575	134	2,134	158	1,634	157	8,185	84	8,540	185
Oct-20	24,758	138	2,153	159	1,650	163	8,198	85	8,696	183
Nov-20	24,762	137	2,157	191	1,656	170	8,214	90	8,729	184
Dec-20	24,814	132	2,157	190	1,633	176	8,160	104	8,683	184
Jan-21	25,060	147	2,137	183	1,642	172	8,151	104	8,673	191
Feb-21	25,044	135	2,118	171	1,630	155	8,086	92	8,725	178
Mar-21	25,214	158	2,114	196	1,630	183	8,152	104	8,850	206

Notes
Data for Saskatchewan from April 1 to June 30, 2020, is not shown; this data is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
The sudden rise in each graph coincides with the time in mid-March 2020 when public health measures were introduced and billing rules for virtual services came into effect in many provinces.

Source
National Physician Database, 2019 to 2021 (open-year data), Canadian Institute for Health Information. Data reported to AVÐÇÇò as of October 15, 2021.

Though the trends above show increases in physicians’ uptake of virtual care, they do not necessarily reflect physicians’ preferences regarding virtual care. Virtual care billing codes and billing rules that were in place prior to the pandemic differed across provinces, and each jurisdiction took a different approach to expanding virtual services early in the pandemic.Reference2 

During the first year of the pandemic, physicians overall provided 32% of their services virtually, but this varied by physician specialty. Family doctors provided the highest proportion of their services virtually, at 42%. This was nearly double the proportion of virtual services provided by medical specialists (23%) and more than triple the proportion of virtual services provided by surgical specialists (12%).

Percentage of services provided virtually, by physician specialty and province, April 2020 to March 2021

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Specialty	Ontario	Manitoba	Saskatchewan	Alberta	British Columbia
Family medicine	38%	41%	47%	30%	53%
Medical specialists	23%	25%	22%	19%	27%
Surgical specialists	13%	16%	9%	10%	14%
Total physicians	29%	33%	34%	24%	42%

Notes
12-month average.
Data for Saskatchewan from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
The average for Saskatchewan is based on the months of July to March.

Source
National Physician Database, 2019 to 2021 (open-year data), Canadian Institute for Health Information. Data reported to AVÐÇÇò as of October 15, 2021.

The variation in virtual care delivery by physician specialty can be, in part, due to variations in practice patterns. For example, family physicians provide higher proportions of consultations and visits (approximately 82% of their services), while medical and surgical specialists provide higher proportions of procedures (approximately 37% and 44%, respectively).Reference3 

In all provinces, family physicians provided the highest proportion of services virtually, compared with other physician specialties. Among family physicians, female physicians provided a higher proportion of virtual care than their male counterparts. Between April 2020 and March 2021, female family physicians provided an average of 46% of their services virtually. Males, on the other hand, provided an average of 39% of their services virtually.

Percentage of services provided virtually, family medicine, by physician sex and province, April 2020 to March 2021

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Sex	Ontario	Manitoba	Saskatchewan	Alberta	British Columbia
Female	42%	45%	52%	34%	54%
Male	35%	39%	44%	27%	53%

Notes
12-month average.
Data for Saskatchewan from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
The average for Saskatchewan for 2020–2021 is based on the months of July to March.

Source
National Physician Database, 2019 to 2021 (open-year data), Canadian Institute for Health Information. Data reported to AVÐÇÇò as of October 15, 2021.

Differences in the provision of virtual care may be partially due to variations in practice patterns between the sexes. A study by Cohen et al. demonstrated that female family physicians are more likely to provide psychotherapy and counselling,Reference4 services that shifted to virtual modes during the pandemic. Male family physicians, on the other hand, are more likely to deliver procedural services,Reference4 many of which remained in person during the pandemic.

For information on how virtual care impacted patients receiving physician services, please see our companion release Virtual care: A major shift for Canadians receiving physician services.

With the rapid emergence of virtual care in Canada, it is difficult to address all the questions that are out there. It is great to see different organizations like AVÐÇÇò and the Centre for Digital Health Evaluation connecting and working together. It’s a win for the Canadian health care system when like-minded organizations with common goals can build and grow off of each other.— Dr. Onil Bhattacharyya, Scientific Director, WCH Institute for Health System Solutions and Virtual Care, Women’s College Hospital

AVÐÇÇò partnered with the Canadian Agency for Drugs and Technologies in Health (CADTH), Canada Health Infoway, the Centre for Digital Health Evaluation (CDHE) and the Centre for Wise Practices in Indigenous Health in our collaboration with the Canadian Network for Digital Health Evaluation (CNDHE). We and the partner organizations at CNDHE are combining our expertise to support a comprehensive approach to digital health evaluations for the country that includes measurement and analysis of virtual care.

AVÐÇÇò would like to acknowledge its collaboration with the CDHE and the learnings shared between organizations that helped shape this work on virtual care.

• What were the barriers to providing care virtually for physicians?
• What are physician preferences regarding virtual care? 
• What obstacles does virtual care create for optimal patient–physician interactions? 
• What are the advantages to physicians of delivering care virtually?

• Physician billing codes in response to COVID-19
• COVID-19 Intervention Timeline in Canada
•  
• Health Indicators e-Publication

• Virtual care in Canada
• Virtual care: Impact of COVID-19 on patients receiving physician services
• Health workforce in Canada: Highlights of the impact of COVID-19
• Impact of COVID-19 on Canada’s health care systems
• COVID-19 resources

  Back to Virtual care: Impact of COVID-19 on physician practice patterns