Newfoundland and Labrador telehealth line advises most callers to go see a doctor

ST. JOHN'S, N.L. — Reports from the company running Newfoundland and Labrador's public health line show more than three-quarters of callers looking for advice about symptoms are told to seek emergency services or see a family doctor.

The reports filed last year by Fonemed, which operates the province's 811 HealthLine, show the service grappling with an increasing demand for health care in a province where over a quarter of the population is without a family doctor, according to the provincial medical association.

Fonemed reports covering the period from January to November of last year were obtained through an access to information request. They list many comments from callers who said the HealthLine 811 was their only option outside of an emergency room. "If it wasn't for 811, I don't know what I'd do," said feedback included in the August report. "I don't have a family doctor."

Others were frustrated. "I called to get medical help because I had no doctor," said a comment from May. "So it's not much good for them to tell me to see a doctor."

Fonemed's contract with the province shows that it is paid more per call than doctors receive per in-person visit.

The province's 811 line performs a variety of services, from connecting callers with dietitians to providing a mental health crisis line. It also offers an outbound service calling people who left emergency rooms before they were seen.

Callers looking for help with symptoms can speak with a registered nurse for advice. They can also arrange an appointment with a nurse practitioner, who can offer advice and prescribe some medications.

The reports obtained by The Canadian Press show 811 handled on average more than 15,000 calls per month between January and November of 2022. Most calls were seeking general information, but an average of nearly 5,800 people a month called looking for advice about symptoms.

The reports show 18 per cent of those callers were told to call 911 or go to the emergency department. Another 58 per cent were told to see their family doctor.

Though the number of people calling specifically about symptoms fluctuates from month to month, the reports show an upward trend from 4,883 such calls in January to 6,752 calls in November.

As numbers increased, more people were upset with the wait for a nurse practitioner appointment. "I sat in an ER for 8 hours for medication that could have been done over the phone," said one comment from September 2022.

In December, the Newfoundland and Labrador Medical Association drew attention to Fonemed's current $31-milliion contract, which pays the company between $82 and $92 per call for 72,000 serviced calls a year. For each additional call, the province pays between $57.70 and $66.10.

The province pays family doctors about $37 for a standard in-person visit and $47 for a virtual care visit, with a cap of 40 virtual appointments per day, the association has said.

Dr. Alison Drover, a family physician in the St. John's area, worries the province is relying on 811 as a "Band-Aid solution" for its doctor shortage.

The 811 HealthLine is a necessary service, she said in an interview. "You have to be able to call someone when you have a serious medical question or if your kid just drank something weird," she said.

But it can't fill in for physicians, and it becomes inefficient when it's the only option for so many people, Drover said. The province pays twice when 811 sends callers to the emergency department or tells them to see a doctor, she said: once to a private company for the call, and again when they arrive in the emergency room or walk-in clinic.

The provincial Health Department said in an emailed statement that it recognizes strains on the health-care system are taxing the 811 service. It pointed to the government's announcement last month of a $30-million investment in doctor recruitment and retention, as well as its efforts to establish collaborative team clinics.

"As greater access to primary care through the collaborative family care teams increases, there will be less pressure on the 811 service and the number of secondary referrals will decrease," spokesperson Jennifer Konieczny said.

Fonemed is also recruiting more nurse practitioners, the statement said, adding that less than one per cent of patients who have an appointment with nurse practitioners need additional in-person care.

Dr. Alika Lafontaine, president of the Canadian Medical Association, said doctor shortages mean systems like Newfoundland and Labrador's 811 line are overburdened across the country.

"At some point this made sense," he said about the HealthLine. "The issue is that the world has changed around us, and health care has yet to catch up."

This report by The Canadian Press was first published March 14, 2023.

Sarah Smellie, The Canadian Press