Provinces are relying on virtual doctors to keep smaller ERs open. Here's how it works

Dr. Michael Ertel starts his emergency department shift at about 8 p.m., after making himself a cup of coffee and saying goodnight to his golden retriever, Norman. But he's not going to the hospital.

"Time to head down into the bunker," he said.

The "bunker" is the basement of his home in Kelowna, B.C., where he fills in for an emergency department he's never set foot in. It's hundreds of kilometres away in Mackenzie, B.C., a small community of about 3,300 people.  

"Sometimes if we can't do it, they shut down overnight," Ertel told Dr. Brian Goldman, host of CBC's White Coat, Black Art, during a Wednesday night shift in late 2024. 

Ertel works virtually through a program called Virtual Emergency Room Rural assistance (VERRa), which deploys emergency physicians to work overnight shifts virtually for smaller emergency departments in B.C. 

This virtual physician coverage is an attempt to keep rural ERs open for patients while health authorities in B.C. and across the country are trying to find and keep staff working in rural or remote areas.  

In some communities, emergency centres close for hours or days when there isn't enough staff.

Health authorities in several provinces are increasingly turning to virtual emergency care — in this case, when a physician is virtual and works with nurses on the ground to see patients over a video call as needed.

In addition to B.C., Nova Scotia, Newfoundland, and Saskatchewan are also relying on similar virtual emergency care models. In Newfoundland, the virtual physician coverage is done by a private company, Teladoc Health. 

Ertel sees value in the virtual coverage for both patients and local physicians but ultimately would prefer to see staff on the ground instead.

"Until that happens, we'll do our best to help out," said Ertel, an emergency physician who also works in-person at Kelowna General Hospital.

Some, however, aren't completely sold on virtual emergency coverage. There are concerns around the quality of patient care and the costs of virtual care when a private provider is working in the public healthcare system.

Physicians also say it has to be used with in-person care. 

"It would surprise me if it was really able to provide high quality care for the things that people might be coming into the emergency room for because the physician isn't seeing the patient. It's all virtual," Fiona Clement, an associate professor and director of the University of Calgary's Health Technology Assessment Unit, said in an interview about Teladoc Health in April.