Response

We thank Dr William Cherniak and colleagues for their response¹ to our article, “Typology of virtual primary care in Canada. Making the implications clear,”² published in the November/December 2024 issue of Canadian Family Physician, and are happy to address their concerns.

With respect to the scope of our article, we discuss models of virtual primary care, not hospital care or other specialist care. With respect to jurisdiction, in Table 3 we cite Rocket Doctor as an example of a commercial, standalone, private-pay model in Ontario only, not British Columbia.²

Further, we define standalone care as care not integrated into ongoing, comprehensive, in-person care with the same primary care provider or team. As such, Rocket Doctor appears to conform to this subtype of virtual care.^3,4 We appreciate Dr Cherniak’s description of the company’s different approaches to integration and billing across Canada, which we believe highlights the broad variation in models of service provision, justifying the importance of a clear typology of virtual care.

We agree Canadian physicians who work in the commercial models are often contractors, not employees. It is worth noting that in this model of care, the for-profit corporations manage the platform and thus are in the position to oversee the delivery of care.³ For example, if physicians working in the commercial models had full autonomy, within each jurisdiction we would expect some to bill privately and some publicly. Instead, billing practices are uniform within a jurisdiction and do not vary by individual physician.

We would also expect variations in advertising, websites, data handling practices, private billing rates, and platform interfaces. The lack of variation in all these aspects indicates corporate oversight of care delivery through the platform.

We also note the article cited in support of fully virtual care was conducted by employees of the same virtual care platform being studied.³ In contrast, there exists a robust body of literature developed by authors free of financial conflicts of interest, indicating standalone virtual care leads to discontinuity of care, inappropriate prescribing, and increased health system use.^5-11

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