ST. JOHN'S, N.L. — Doctors in Newfoundland and Labrador say they’re looking for guidance on how they should reopen their offices and clinics in the age of COVID-19.
So far, they haven’t gotten much.
Since pandemic health orders were first imposed in March, most non-hospital consultations in the province have come in the form of virtual care. However, phone calls and video links are not always the solution, especially as time drags on and patients require more face-to-face diagnoses.
“Everyone’s getting twitchy now because when it starts to open, there’s going to be a long waiting list,” family doctor Patrick O’Shea told The Telegram Wednesday.
O’Shea shares a St. John’s clinic with seven other doctors. His views reflect many of the same concerns of other doctors who have approached The Telegram.
“We’ve just talked among ourselves about spacing people in the waiting room, having to reduce capacity, cleaning the rooms in between the patients … but we haven’t got any ideas as to how we’re really going to do it,” O’Shea said.
The province and the Newfoundland and Labrador Medical Association (NLMA) came to an agreement in March on a fee for virtual care. The agreed upon flat rate of $42 per consult, which compares to the average in-office fee, is set to expire at the end of June. But both the NLMA and Health Minister Dr/ John Haggie have signalled they want virtual care to play a key role in the future.
Virtual visits are fine, O’Shea said, but they can’t cover every situation.
“It’s looking in the ears or looking in orifices … you can’t do that over the phone or even virtually with Facetime or things like that. It’s hard to make a diagnosis,” he said, adding that it’s impossible to catch the nuances of a person’s condition without seeing them in person.
“The longer the virtual stuff goes on, the more anxious you get about certain symptoms and patients downplaying symptoms or not paying attention to symptoms that they have.”
One St. John’s specialist who contacted The Telegram said virtual care is not at all conducive to patients he normally sees in a private clinic. He didn’t want to be named because he also works within a regional health authority as a surgeon.
“I can tell you from our point of view it simply is not possible to re-hire all our staff and be able to afford to pay our significant overhead,” he said last week.
We do small procedures, all things that we can ‘bill for’ at small rates, but they add up.”
He said with the limit on what he can still do in the operating room, as well as uncertainly about clinical consults, he estimates he’s earning less than 10 per cent of his typical income.
“I can't speak for all outside offices, but it is simply not possible for our … group to open our clinic, unfortunately, under the current situation.”
O’Shea said his colleagues also have a lot of considerations to take into account.
“We have to decide about our staff, we have to decide about how many people we can fit into our waiting room, the schedule. We have seven doctors in our office, so we can’t have all seven doctors there and 30 people in the waiting room. We’re going to have to restrict the numbers of people that we see through the clinic right now with the social distancing.”
Protective equipment
The NLMA has been updating its members about the availability of personal protective equipment (PPE) throughout the pandemic.
On May 15, president Charlene Fitzgerald update doctors on provincial needs.
There is a weekly requirement of 6,522 face masks, 1,633 face shields, 2,567 gowns, 6,305 nitrile gloves and 11,956 non-sterile gloves.
“The NLMA will continue discussions with the department to determine whether or to what extent these needs can be met from the current inventory of (health authorities), as well as whether they can be included in a separate procurement package,” Fitzgerald said. “We will continue to update members on progress of these discussions.”
However, the health minister conceded Monday that PPE supplies continue to be sketchy.
“Our backstop has to be the maintenance of emergency services and our backstop has to be the protection of health care workers who are on the front lines,” he said.
Peter Jackson is a Local Journalism Initiative reporter covering health for The Telegram.