I’ve watched Calgary’s healthcare landscape shift dramatically over the past few years. The pandemic forced changes nobody saw coming. Virtual care exploded overnight. Doctors started doing phone appointments. Patients downloaded apps. Everyone thought this was the breakthrough we needed.
Turns out, we might have been a bit too optimistic.
New research from the University of Calgary’s School of Public Policy is raising some uncomfortable questions. The study, published in BMC Primary Care, suggests virtual healthcare isn’t solving our biggest problems. In fact, it might just be moving them around.
Myles Leslie, one of the researchers behind the study, put it bluntly. “It isn’t providing more access to care,” he said. “The doctor is still the bottleneck.”
That hit me hard when I first read it. I’d been covering stories about virtual care like it was medicine’s next frontier. Patients loved the convenience. Doctors appreciated the flexibility. Politicians celebrated the innovation. But Leslie’s team found something critical that most of us missed.
Virtual care in Alberta mostly means phone calls. And phone calls take time. The same time, actually, as seeing someone in your office. A fifteen-minute appointment is still fifteen minutes, whether the patient is sitting across from you or talking through a speaker.
The researchers interviewed twenty-five healthcare professionals across Alberta, Ontario, and Nova Scotia. They wanted to understand how virtual care actually works on the ground. Not the glossy promotional version. The real, day-to-day experience.
What they found was complicated.
Calgary has roughly one point six million people. Many of them don’t have a family doctor. Across Canada, that number sits around seventeen percent. Virtual care was supposed to help with that. More efficiency means more patients seen, right?
Not exactly.
Dr. Christine Leulo has practiced family medicine in Calgary for over twenty-five years. She’s seen plenty of changes in how healthcare gets delivered. Virtual care, she says, has definite benefits. It’s great for follow-ups. Perfect for sharing test results. Helpful for quick check-ins.
But there’s a catch.
Alberta’s fee-for-service system creates some weird incentives. Before the pandemic, Leulo could only bill for seven phone calls per week. She sees twenty-five to thirty patients daily. The math didn’t work.
Things have improved since then. Now there’s no cap on billable calls. A phone appointment gets billed the same as an in-person visit. That sounds fair until you dig deeper.
Complex calls can run long. Really long. But they’re still billed at the same rate. In-person appointments offer more flexibility. Doctors can charge more for extended visits when needed. The system rewards seeing patients face-to-face.
Leulo described it as the “whites of the eyes” requirement. Physical presence has always been the gold standard in billing codes. Virtual care challenges that, but the payment structure hasn’t fully caught up.
I’ve talked to several Calgary physicians about this over the past year. The theme keeps repeating. They want to use virtual care more creatively. They see its potential. But the financial realities push them back toward traditional appointments.
There’s another problem that surprised me. Virtual care could involve entire teams. Nurses, pharmacists, diabetes specialists, mental health counselors. All working together, using technology to coordinate care.
That’s not happening much.
Under current billing rules, doctors can’t charge for work done by other team members. A specialized nurse handling diabetic patients? The doctor doesn’t get paid for those visits. But the nurse still needs a salary. The clinic still needs to cover rent and utilities.
One healthcare professional quoted in the study said something that stuck with me. Virtual care teams can be “almost too efficient” because they start “robbing” doctors of billing opportunities.
Think about that. Efficiency becomes a financial liability. Better patient care means less revenue. The system is literally working against itself.
Leslie pointed out that some Alberta clinics are trying different approaches. They’ve moved away from the traditional fee-for-service model. The province introduced new compensation options last year. These encourage doctors to take more patients outside regular hours. Some physicians are gravitating toward these alternatives.
But change is slow.
I covered the rollout of several virtual care initiatives during the pandemic. The excitement was real. Patients in rural Alberta could finally connect with specialists without driving three hours. Elderly folks could get care without risking exposure to COVID. Young professionals could squeeze appointments into lunch breaks.
Those benefits haven’t disappeared. Virtual care surveys show high patient satisfaction. People genuinely appreciate the convenience. For certain types of appointments, it’s clearly superior to traditional visits.
The study’s respondents acknowledged this. Most said they’ve seen improved efficiency. Leulo’s patients gave virtual care a thumbs up in recent satisfaction surveys. It works well for specific situations.
But it’s not the system-wide solution we hoped for.
Leslie argues we need a cultural shift. Healthcare has to move beyond the one-doctor, one-patient model. Teams need to work together. Pharmacists should handle medication questions. Nurses should manage chronic conditions. Specialists should weigh in remotely when needed.
Technology could enable this. Secure messaging systems. Video conferencing. Shared digital health records. The tools exist. We’re just not using them effectively.
I’ve seen glimpses of what this could look like. A clinic in northeast Calgary started experimenting with team-based virtual care last year. Patients text their concerns. A nurse triages. A pharmacist handles prescription renewals. The doctor steps in only when necessary.
Early results looked promising. More patients getting help. Faster response times. Lower costs. But scaling that model requires changing how we pay for healthcare.
That’s the hard part.
Alberta’s healthcare system is massive and complex. Changing billing codes involves negotiations between government and physician groups. Everyone has competing interests. Progress happens in small increments, not revolutionary leaps.
The pandemic created a rare opportunity. Crisis forced experimentation. Rules got loosened. Innovation accelerated. We learned virtual care could work.
Now we need to learn how to make it work better.
Leslie’s research doesn’t suggest abandoning virtual care. That would be foolish. Instead, it’s a reality check. Phone calls alone won’t fix our doctor shortage. Convenience doesn’t equal access. Technology is a tool, not a solution.
Calgary needs more family physicians. Virtual care doesn’t change that equation. What it can do is make existing doctors more effective. But only if we redesign the systems supporting them.
The seventeen percent of Canadians without primary care won’t be helped by video calls if there aren’t enough doctors to take those calls. Virtual care shifts where medicine happens. It doesn’t multiply the people delivering it.
I’m still optimistic about healthcare technology. The potential remains enormous. But potential and reality are different things.
Leulo summed it up well. Virtual care is a good addition to her practice. It helps with specific tasks. Patients like it. But it’s not replacing the fundamental work of medicine.
Maybe that’s the lesson here. We got caught up in the technology. We focused on the delivery method. We missed the bigger structural issues.
Virtual care works best when it complements traditional medicine. When teams use it strategically. When payment models support innovation rather than discourage it.
Alberta has started moving in that direction. Slowly. The new compensation models are a step. Some clinics are experimenting. Doctors are adapting.
But we’re not there yet. The bottleneck Leslie described is real. Until we address it, virtual care will remain underutilized.
That’s frustrating because the potential is sitting right in front of us. We have the technology. We have willing patients. We have innovative doctors.
We just need systems that let them work together properly.
