Dr. Wilhelm Hofmeyr is the medical director of Equinoxe, a B.C.-based medical firm that runs EQ Virtual.
A trip to the doctor's office often means an experience rife with inconvenience. There's the time off work, the commute, the parking. In the waiting room, you can't help but study the people around you – their hacking coughs, dripping noses.
Even if your appointment is for something benign, such as a prescription renewal, you risk walking out with someone else's flu bug along with your script.
How much money would you be willing to pay to avoid all of this and video chat with a doctor on your mobile phone while in your living room or at your desk over lunch?
An increasing number of upstart companies are racing to test the theory, giving rise to a niche in the health technology sector that allows Canadians in several provinces to buy time with licensed doctors online. Patients with a smartphone or computer can substitute a trip to the doctors' office for most illnesses with what one service, Akira, calls "a doctor in your pocket."
Co-founded by tech entrepreneur Dustin Walper in 2015, Akira has logged more than 15,000 virtual consults and has 12,000 registered users. The company was born out of Mr. Walper's own frustration at wasted time in doctors' offices while he waited for routine test results and prescription renewals for a common thyroid condition. In a frustrating, flawed and slow-to-change health-care system, he saw an opportunity for entrepreneurialism. Seizing it could also solve problems many people have with simply accessing a family doctor, he thought.
At the same time, Brett Belchetz, a Toronto emergency room doctor who co-founded the online service Maple, had a similar vision. "So many of the patients I see know they don't have an emergency, but they don't have anywhere else to go," he said. "They end up waiting four of five hours in the ER for really basic problems like a sore throat or a prescription renewal. And it is just craziness," he said.
Each service follows a relatively similar model. Users create an account, including credit card information that is securely stored. Before "seeing" a doctor, the user completes forms for symptoms and medical history. They can upload files, including photos and other medical records. Within minutes, they are connected with a doctor who has been custom-selected – either via an algorithm or a triage nurse – to treat their symptoms.
Akira is operating in Ontario with plans to expand throughout Canada this year. The service charges users $49 plus tax for an online consultation, via video chat or text, with a doctor who can write prescriptions, sick notes or make referrals. The company sells annual memberships for unlimited individual consultations ($120 per year) or a family package ($240).
Maple launched last fall and also charges $49 for a weekday virtual "visit." Unlike Akira, Maple offers 24-hour, seven-days-a-week service. Fees increase for overnight calls ($99 plus tax) or weekend appointments ($79) and memberships range from $359 to $579.
Maple operates in seven provinces and has served 6,000 patients so far. Akira is in the mist of its own cross-country expansion, as is EQ Virtual, a B.C.-based service that just launched in Quebec.
While there are limits to what doctors can treat via a virtual interaction, there is much they can do that government-funded alternatives, such as Ontario's Telehealth, cannot. While Telehealth calls are answered by nurses – often with limited acute care experience, according to a recent auditor general report – Maple's patients, for example, are guaranteed a doctor whose experience corresponds to their needs.
When an issue cannot be safely treated through virtual interaction, patients are not charged (they are typically sent to the emergency room, Dr. Belchetz said). But the number of instances are infrequent. At Maple, doctors have a 99-per-cent resolution rate, Dr. Belchetz said.
His company's market research showed that 40 per cent of respondents would be willing to pay for more convenient access to family doctors. "That's just an absolutely enormous marketplace to tap into," Dr. Belchetz said. "There are 180 million visits to the doctor every year in Canada. If you believe about half of them can safely be made online, that's 90 million. Forty per cent of those is 36 million visits. If we really crack this market open … we would be overwhelmed with demand."
Some big players in the health-tech space disagree. Prakash Chand, the Toronto-based co-founder of Askthedoctor.com, helped launch that online service about a decade ago. Set up to allow users to submit questions to board-certified doctors (payment is required for rapid responses), the service pilot-tested video interactions a few years ago but quickly abandoned the project, Mr. Chand said. The market, he said, wasn't there.
In the United States, though, where virtual doctor services have been around for about a decade, there is proof the model works. Kaiser Permanente, the country's largest health-care provider, has more than 100 million patient-physician encounters per year. More than half – 52 per cent – are digital, the company's chief executive officer, Bernard Tyson, said earlier this year.
Canadian providers' biggest obstacle is the fact that virtual interactions are not covered in most provinces. British Columbia is the exception; there, EQ Virtual has grown quickly over the past three years and has recorded 90,000 consultations. But CEO Daniel Martz said he sees opportunity for growth in other provinces, regardless of public coverage. Insurers and private employers are showing interest in offering digital doctor interactions as employee benefits or as part of health spending accounts.
"It saves the system money, the employer money and the employee," Mr. Martz said. "It pretty much saves everyone."
Dr. Belchetz says Maple offers doctors a way of providing extra hours of care when clinics or offices are closed, or in the case of ER doctors, when they are not on shift. "Our service is meant to be a complement to the health-care system, not a replacement," he said.