Abstract
BACKGROUND: Whether virtual health care has changed access to services for patients living far from a specialist physician is unknown. We aimed to determine whether driving distances between patients and their specialists had changed following increased availability of virtual care in Ontario, such that specialists saw patients from farther away. METHODS: We performed a population-based cohort study using linked health and administrative databases. We included all specialist physicians working in Ontario from Jan. 1, 2019, to Nov. 30, 2019 (pre-virtual care period) and from Jan. 1, 2022, to Nov. 30, 2022 (virtual care period), and their patients. Outcomes were measures of proximity between specialists and their patients including differences in 90th-percentile driving distance, mean driving time, and the proportion of patients with driving times longer than 60 minutes between time periods. We used multivariable linear regression models to compare outcomes across physician specialties, adjusting for physician age, sex, practice size, and location. RESULTS: We included 11 096 specialists (4232 surgical and 6864 medical; 0.8% rural). After adjustment, we found no meaningful changes in the 90th-percentile driving distance between time periods for surgical (difference 6.7 km, 95% confidence interval [CI] -4.1 km to 17.5 km) or medical specialties (difference 1.3 km, 95% CI -6.6 km to 9.2 km). For surgical specialists, the proximity measures of mean driving time increased by 5 minutes (95% CI 1 min to 10 min) and the proportion of patients living more than 60 minutes away increased by 2.1% (95% CI 0.7% to 3.9%), but we saw no significant change for medical specialists. INTERPRETATION: After expansion of virtual care, the distance between specialists and patients did not meaningfully change. To make virtual care more accessible, especially for those living in rural areas, attention should be paid to other factors such as referral patterns and the role of patients in determining the type of visit they prefer.