What we learnt launching a Canadian telemedicine clinic

People want to see their doctor online. Whether it’s for prescription refills, requisition forms, sick notes, or simple medical questions – a good number of GP visits today can be replaced by online consultations. So why isn’t this happening today and how do we make it a reality?

Last year, as an experiment, we launched an online clinic to explore this. We had one Ontario GP on-staff ready to see patients by video. We called it MDKonsult and ran this service and within the first month had 10 patient visits. Here is what we learnt.

Are Doctors allowed to See Patients Online?

Before launching this service we first checked what medical regulations had to say about telemedicine. The CMPA – which provides malpractice insurance for Canadian doctors – is an excellent resource for this. They have several articles covering the do’s and don’ts of telemedicine including practical cases and advice. You can also call them with questions.

Our conclusion was a GP can see patients online as long as these patients live in the jurisdiction that GP is licensed in. For example, our Ontario GP could only see Canadian patients residing in Ontario. So we limited the initial service to Ontario patients.

Is Telemedicine Covered by Health Insurance?

The million dollar question. Only two provinces so far have a fee code for telemedicine consults – BC and Nova Scotia. Alberta also seemed open to telemedicine billings for specific situations but does not have an official fee code. Ontario’s only funded telemedicine program is OTN which allows physicians to be remote but patients would still have to walk into an approved facility with an approved OTN kiosk to perform the call.

Unlike OTN, MDKonsult was open to any Ontario patient wherever they are. This type of service is not covered by OHIP so we charged $20-$40 per visit. We tried to recruit GPs in Nova Scotia as the service would be covered by insurance there, but we couldn’t find the right match in the short time we had. BC already had several virtual clinics running so we didn’t bother testing there.

Now How to Get the Patients?

We tested three marketing channels – Google Ads, Facebook Ads, and Reddit. We paid $550 in Google Ads and that got us 3 paid consults. $181 in Facebook ads and got nothing. We submitted our site to Reddit and were upvoted to front page of the Ontario subreddit which got us good traffic and 7 eventual visits.

It was a surprise that Reddit was much more effective at attracting quality traffic than Google or FB ads. And it was free. The audience was more engaged, had great questions, and were eager for a new way to see the doctor. Looking back, it makes sense. The post was organic and Reddit is an early adopter crowd.

After our 5th patient visit we began to see repeat customers, referrals and word of mouth happening. 3 of our 10 visits were repeat customers and 4 of the 10 were from word of mouth.

What Kind of Cases Did We See?

We helped a lady with urinary tract infection get antibiotics from her local pharmacy at 10pm when all walk-ins were closed. We comforted an older lady who wanted to talk to a doctor right away about new pain she felt. We advised a patient with chronic pain on what medications would work best for them – but at the end couldn’t prescribe the narcotic they wanted. We had people ask us about medical marijuana. And we helped several patients get sick notes for school and work.

Most of our repeat customers and word of mouth referrals came from students needing sick notes for school and work. It seemed like we hit on something there – getting a sick note from a doctor is a pain and time waste for both student and doctor. It is a service not covered by OHIP either way so people are used to paying for it, and it can be done more efficiently online. Because of this we launched DrSickNotes.ca to streamline and optimize how people get doctor notes.

So is there a business in this?

We charged $40 per patient visit and followed the standard split of 70% to pay for the doctor’s time and the rest for the company. So each visit brought $12 net. To do this profitably, we’d have to run like a traditional family doctor’s clinic – line up patients back to back with minimal downtime and run through each visit as fast as possible. Considering the marketing costs, limitations of what can be done medically without a physical exam, and time overhead involved in arranging a synchronous video call between patient and doctor, it was just not worth it.

There are specific niches where telemedicine businesses could work better however. You’d want to focus on asynchronous requests where patient and doctor don’t need to see each other at same time. Dermatology is one example. A physical exam is needed in dermatology but most diagnosis can be made from picture alone. Sick notes and requisition forms are another example, which we have now launched into a separate doctor’s note service. There is probably also an opportunity in medical marijuana consultation and prescriptions.

At the end of the day – we still think telemedicine is the future and will replace many traditional doctor visits. It just can’t be done wholesale. You need to find the right segment where the medical, regulatory, and financial aspects all make sense.