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Ontario’s top health officials are urging the province’s physicians to resume more in-person visits and cut back on virtual appointments, which became more common under COVID-19 safety protocols.

In a joint letter sent Wednesday to around 45,000 doctors, three health officials said they expect that all physicians are now providing in-person care. The letter was signed by Ontario’s Chief Medical Officer of Health, Kieran Moore; Patrick Dicerni, an assistant deputy minister of the Ontario Health Insurance Plan at the Ministry of Health; and Nancy Whitmore, registrar and chief executive officer of the College of Physicians and Surgeons of Ontario.

While virtual visits were encouraged earlier in the pandemic, the “pressures” on the health care system – such as a lack of personal protective equipment and the severity of COVID-19 cases – have since diminished, the letter says.

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“We know that many physicians are striking the right balance between virtual and in-person care, however, collectively we are increasingly hearing about physicians’ offices that are not providing in-person care,” the letter says.

“While virtual care has enabled access to care during the pandemic, given broad vaccination coverage and fully accessible PPE, COVID-19 should no longer pose a barrier to in-person practice.”

According to the college, emergency departments have seen a “significant increase” in the number of patients who would be better managed in other settings.

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In addition, the college says referrals to specialists must have an appropriate physical exam “that in some circumstances could alter the need for a referral.”

The letter says there are limits to what can be done virtually, “and the standard of care is often difficult to meet in a virtual care environment.”

“While physicians are ultimately responsible for determining the appropriateness of providing virtual care in the circumstances presented, it is important to remember that the standard of care must always be met,” it says.

“In-person care is essential for certain conditions and services or where physical assessments are necessary to make an appropriate diagnosis or treatment decision. There are many patients for whom the standard of care cannot be met in a solely virtual care environment.”

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For example, some appointments, such as newborn or prenatal care, pap smears and cancer tests require physical assessments in-person, as do treatments for infections, postoperative care and chronic disease management.

Alexandra Hilkene, a spokesperson for Health Minister Christine Elliott, said the proportion of in-person visits has averaged about 50 per cent during the past year but has been increasing in the past four months with 56 per cent of all visits in July provided in-person. She said guidance was released to doctors in July to encourage “primary care providers to offer in-person care according to patient need and to ensure access.”

In a press conference last week, Dr. Moore said there should not be further delays in giving basic vaccines, cancer screenings or physical examinations. He said emergency room visits are back to around 20,000 a day across Ontario, “which is a high volume.”

“It’s certainly my hope that more physicians are providing direct in-person care. I think that’s essential for the health of Ontarians and for the patient-physician relationship and essential screening,” he said.

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