Trans and gender-diverse people in Ontario fear that the potential loss of a virtual clinic offering gender-affirming care will leave the community with even fewer options to access what they describe as support vital.
“You have a lot of people who have found their way and suddenly feel stuck,” said Lex, a 28-year-old patient at Connect-Clinic.
“It’s a very scary thing and it can be dangerous, especially if you’re in a situation where it’s kind of life or death.”
Connect-Clinic, which has 1,500 patients — and 2,000 more on a waiting list — offers hormone therapy and surgery referrals for trans and gender-diverse people across Ontario through appointments. you completely virtual. Starting next month, it will no longer be accepting new patients due to changes in Ontario’s funding agreement with doctors.
“My patients are very distressed,” said Dr. Kate Greenaway, the clinic’s founder and lead physician. “I had a patient who told me that he had waited over a decade to receive gender-affirming care because he had no way to get out of his community to access it.
“It is certain that this patient still has no means of accessing gender-affirming care within his community.”
The changes, which come into effect on December 1, are part of a three-year medical services agreement between Ontario physicians and the provincial government which was ratified in March. The agreement establishes permanent funding for virtual healthcare in the province.
As a virtual-only clinic, doctors at Connect-Clinic will be able to charge $20 per video appointment and $15 per phone — lower rates than the previous $67 or more. Greenaway says the new rates won’t cover the depth of care his clinic provides, making it impossible to add new patients.
On Friday, Greenaway learned that the new rates would also apply to the practice’s existing patients, despite previous assurances that they would remain on the previous billing schedule. Greenaway said Connect-Clinic is legally bound to continue caring for these patients.
The Ontario Ministry of Health says the new agreement aims to strike a balance between in-person care and virtual care. “Virtual care is intended to complement in-person care, not replace it,” the ministry wrote in a statement.
The government says it has taken “additional steps” to fund team-based care, such as Community Health Centers (CHCs), to improve access to primary care, and that many health care teams health offer programs specific to LGBTQ communities.
Greenaway says CHCs are a good option, but the current system is “overloaded” and those offering gender-affirming care don’t reach all areas of the province.
Day 69:43Gender-affirming care clinic in Ontario threatened by changes to virtual care
Not all family physicians specialize in affirmation of care
When Lex began her transition, she first contacted her family doctor for advice on hormone therapy.
“My family doctor was very supportive early on in my transition, but was unable to answer questions about things like estrogen side effects, for example,” Lex said. CBC withholds Lex’s last name for security reasons.
“Talking with a doctor who is an expert in gender-affirming care has allowed me to make confident decisions about my health.”
Virtual access to this care is more than a matter of convenience for Lex. It’s comforting to know that the doctor you’re speaking with is knowledgeable in transition-related health care, she said.
“I can talk to someone from the comfort of my own home in conditions in which I feel safe, as opposed to, for example, going to a walk-in clinic, asking if they prescribe [hormones] and find a transphobic doctor who will ruin my day,” Lex said.
The capacity of clinics specializing in gender-affirming care is also limited, with some patients waiting months or years, depending on the treatment, to access them.
In a 2019 Trans Pulse Canada survey of transgender and non-binary people aged 14 and older from across Canada, nearly 45% reported having an unmet health care need. Among those who had not completed gender-affirming care, 40% of respondents said they were on waiting lists, most often for surgery.
According to the American Medical Association, the majority of transgender and gender-diverse people who receive a gender-affirming care report improved mental health and reduced suicide rates.
“People call it gender-affirming, but it’s life-affirming in so many ways,” Lex said.
“A lot of people going through a period of transition aren’t in the right place, and transition is a way to heal, move on and grow as a person – and not being able to access it just prolongs the feeling of insecurity.”
“I did not understand the number of people who would need our services”
Connect-Clinic was created in 2019 in response to this lack of capacity, Greenaway said. At the time, she had a family practice in Toronto and was adding more and more patients away from the city.
She wanted to see if a virtual clinic offering gender-affirming care could better support people outside of the province’s major urban centers. When the clinic analyzed postcode data for its current patients, it reported that two-thirds were outside of these centers.
“I thought there would be people who would need it, but I didn’t understand how many people would need our services,” Greenaway said.
This is not care you want to interrupt… We are committed to helping find a solution for our patients.– Dr. Kate Greenaway, Founder and Chief Medical Officer of Connect-Clinic
Connect-Clinic originated as part of the Ontario Telemedicine Network, but when the pandemic forced all kinds of health care onto virtual platforms, the clinic was integrated into mainstream care.
This pandemic-induced shift has been a boon for people seeking gender-affirming care, said Dr. Wayne Baici, psychiatrist and clinical chief of the Adult Gender Identity Clinic at the Center for Addiction and Mental Health in Toronto.
“It was difficult to access gender-affirming care before the pandemic. Certainly the pandemic has also put all kinds of barriers to receiving care,” he said. “I think virtual care was the only silver lining in terms of improving access.
“So if virtual care is compromised by changes in these [billing] codes, not allowing health care to continue, it’s obvious that trans people are going to suffer.”
A medical association says the problem is an ‘unintended consequence’
The Ontario Medical Association (OMA), which represents the province’s physicians and negotiated the agreement with the provincial government, says the new agreement is intended to “encourage the patient-physician relationship” and divides care into “full” and “limited” practices.
Comprehensive care requires patients to have an in-person relationship with patients alongside virtual care.
In a statement, an OMA spokesperson acknowledged that Connect-Clinic’s funding difficulties are an “unintended consequence” of the deal.
Greenaway says the government could make an exception for gender-affirming virtual care, as it has done for other medical disciplines such as addiction services, or develop a new funding model that would allow the clinic to charge outside the provincial health insurance system.
“It’s not care you want to interrupt,” Greenaway said. “We know that our patients’ mental health will really suffer, as well as their physical health.
“That’s why we didn’t give up. We are committed to helping find a solution for our patients.”
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