The rapid expansion of virtual healthcare services, accelerated by the COVID-19 pandemic, promised to revolutionize access to specialized medical care, particularly for patients living in rural and remote areas. However, recent research published in the Canadian Medical Association Journal challenges the assumption that virtual care has effectively broadened the geographical reach of specialist physicians in Ontario, Canada. Contrary to expectations, the study reveals that despite widespread adoption of virtual consultation technologies and updated remuneration frameworks, there has been no significant increase in specialists’ engagement with patients residing at greater distances from their practice locations.
Dr. Natasha Saunders, a pediatrician at The Hospital for Sick Children (SickKids) and an associate professor at the University of Toronto, led this comprehensive observational study which scrutinized patient-specialist interactions before and after the integration of virtual care billing codes and infrastructure in Ontario. The study spanned two distinct periods: a pre-virtual care phase from January to November 2019 and a virtual care phase from January to November 2022. Over 11,000 specialists and more than 5.3 million patients were analyzed, encompassing in excess of 25 million healthcare visits during the virtual care period alone. The core metric examined was the driving distance and time separating patients and their specialist providers.
Despite the increased convenience virtual care inherently offers, the data demonstrated negligible changes in patient-to-specialist travel distances across most medical specialties. Psychiatry emerged as a modest outlier, experiencing slight shifts across distance metrics, signaling a somewhat higher adoption or acceptance of virtual modalities for mental health services. Yet, for the vast majority of specializations, virtual consultations did not translate into broader geographical patient coverage. This finding punctuates the complex and multifactorial barriers that persist in equitably extending specialist care beyond densely populated urban centers.
This investigation sheds light on the persistent paradox faced by rural Canadians: although approximately 18% of the country’s population resides in rural areas, only a mere 2.2% of specialists practice there. Virtual care had been widely heralded as a potential equalizer, capable of circumnavigating the logistical challenges of distance and transportation that disproportionately burden rural patients. However, the study’s findings suggest that simply enabling virtual platforms and compensating providers for their use does not automatically dismantle entrenched systemic patterns.
One significant insight proposed by the researchers centers on referral dynamics. The study authors hypothesize that the shortage of rural reach may partly stem from providers referring patients to specialists within their existing regional networks, effectively limiting patient access to distant experts. This localized referral habit may reflect a lack of awareness or familiarity with specialists practicing further afield, highlighting an underappreciated bottleneck in healthcare access. The authors advocate the consideration of centralized referral systems, which could catalog specialist availability comprehensively and facilitate matching patients to appropriate experts irrespective of geographic constraints.
Moreover, the study underscores the critical role of patient preferences in the uptake of virtual care. While virtual consultations may alleviate challenges such as transportation difficulties, time constraints, and health limitations, their benefits may not be fully realized unless patients are empowered and encouraged to choose virtual visits when appropriate. As such, aligning healthcare delivery models with patient needs and preferences emerges as a strategic imperative for optimizing virtual care’s impact in rural and other underserved populations.
From a technological perspective, while Ontario established the necessary billing codes and infrastructure enhancements to allow and incentivize virtual care, these system-level adaptations have not automatically translated into practice pattern shifts among specialists. The findings indicate a nuanced interplay of technological, systemic, and behavioral factors shaping care delivery. The mere availability of virtual tools does not guarantee their integration into practice in ways that broaden spatial access.
The modest changes observed in psychiatry could reflect the unique characteristics of mental health service delivery, where diagnostic evaluations and therapeutic interactions may be more amenable to virtual formats compared to procedural or hands-on specialties. This disparity suggests a need for tailored approaches when designing and implementing virtual care pathways across different medical fields.
Addressing the stagnation in spatial reach requires multifaceted strategies. Enhancing provider education about the benefits and possibilities of virtual care, incentivizing cross-regional collaboration, and restructuring referral networks could realign healthcare delivery with the promise of digital health innovations. Such reforms should be complemented by engaging patients directly, ensuring they have the agency and resources to access virtual care options that best suit their circumstances.
The study’s implications extend beyond Ontario, serving as a cautionary tale for health systems globally that anticipate technology alone will overcome geographic barriers in specialty care. Policymakers and healthcare leaders must consider the social determinants, referral practices, and patient engagement factors that critically influence whether virtual care achieves its intended equity goals.
In conclusion, the research underscores that despite the technological advancements enabling virtual healthcare, significant structural and behavioral challenges remain in expanding specialist reach to rural populations. The scholars advocate for a holistic approach that transcends technology deployment to actively address referral patterns and patient preferences. Only through concerted and coordinated efforts can virtual care fulfill its potential as a tool for equitable healthcare access across diverse geographic landscapes.
Subject of Research: People
Article Title: Changes in driving distance to specialist physicians in the era of virtual care: a population-based cohort study in Ontario, Canada
News Publication Date: 22-Sep-2025
Web References: 10.1503/cmaj.250166
Keywords: Health care delivery, Health disparity, Health equity, Health care policy, Family medicine, Medical specialties
