December 9, 2021 — To reduce the spread of COVID-19 during the first wave, physicians provided in-person care in urgent situations only and offered virtual care appointments where possible. In the first 13 months of the pandemic, many family physician consults and visits were conducted virtually, with some variation across provinces. While the physician billing codes are different across the 6 provinces for which we have information, we can use the data to understand the effect of COVID-19 on physician services and the people who accessed these services from March 2020 to March 2021.
After a drop during Wave 1, physician care returned to previous levels
Looking at all physician activity — visits, consults, psychotherapy, deliveries and procedures provided by family physicians, medical specialists and surgeons — we saw a drop during Wave 1 compared with the previous year (pre-pandemic). While the physician billing data is different across jurisdictions, a similar pattern was observed across all provinces where data is available.
Initially, surgeons were more affected than family physicians or medical specialists. As many planned surgeries were cancelled during Wave 1, surgeon activity dropped by 41% to 60% in April 2020 compared with April 2019 (this varied by province). Family physicians and medical specialists had smaller drops in activity in Wave 1, and their services rebounded to near pre-pandemic levels by Wave 2, with some provincial variation. This could be because these physicians could provide more of their services virtually, which could also account for some of the increases we saw at the start of Wave 3.
Note: For this analysis, the term “wave” refers to significant surges of community cases of COVID-19 infections in Canada overall, although we recognize that the timing and size of the waves may vary by jurisdiction.
Change in physician activity during the pandemic, by province, March 2020 to March 2021
| Month | Nova Scotia | Ontario | Manitoba | Saskatchewan | Alberta | British Columbia | Monthly COVID-19 community cases |
|---|---|---|---|---|---|---|---|
| March 2020 | -11% | -17% | -1% | -11% | -12% | -7% | 8,533 |
| April 2020 | -34% | -42% | -27% | Not available | -35% | -26% | 44,688 |
| May 2020 | -36% | -36% | -17% | Not available | -29% | -22% | 37,711 |
| June 2020 | -14% | -14% | 4% | Not available | -6% | 3% | 13,257 |
| July 2020 | -11% | -12% | 1% | -3% | -7% | 1% | 12,108 |
| August 2020 | -7% | -6% | 1% | -3% | -6% | 1% | 12,636 |
| September 2020 | 0% | -3% | 4% | 0% | -2% | 7% | 29,810 |
| October 2020 | -2% | -5% | -1% | -5% | -8% | 1% | 76,686 |
| November 2020 | -6% | -4% | 0% | -4% | -5% | 5% | 142,695 |
| December 2020 | 2% | -4% | -1% | -4% | -6% | 7% | 203,288 |
| January 2021 | -11% | -12% | -3% | -12% | -8% | Not available | 198,426 |
| February 2021 | -1% | -2% | 5% | -3% | 1% | Not available | 87,841 |
| March 2021 | 11% | 6% | 14% | 0% | 8% | Not available | 114,416 |
Notes
Data for Saskatchewan from April 1 to June 30, 2020, is not shown; it is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
Data for British Columbia has not been submitted for January to March 2021.
Sources
National Physician Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to March 2021 (pandemic data), Canadian Institute for Health Information. Open-year data; data reported to CIHI as of July 1, 2021.
Public Health Agency of Canada. COVID-19 daily epidemiology update. Accessed September 24, 2021.
Virtual care helped increase access to care
In the early months of the pandemic, family physicians rapidly shifted to virtual care for visits and consults. Prior to March 2020, almost all visits and consults were conducted in person. Ministries of health and medical associations supported physicians’ shift to virtual care by introducing mechanisms such as new billing codes. Virtual care delivery has continued throughout the pandemic, with the proportion of services provided virtually fluctuating with COVID-19 case counts and changes in public health restrictions.
Proportion of family physician consults and visits provided virtually during the pandemic, by province, March 2020 to March 2021
| Month | Ontario | Manitoba | Saskatchewan | Alberta | British Columbia | Monthly COVID-19 community cases |
|---|---|---|---|---|---|---|
| February 2020 | 0% | 0% | 0% | 4% | 1% | 0 |
| March 2020 | 22% | 19% | 26% | 14% | 30% | 8,533 |
| April 2020 | 55% | 56% | Not available | 46% | 71% | 44,688 |
| May 2020 | 50% | 44% | Not available | 38% | 66% | 37,711 |
| June 2020 | 47% | 34% | Not available | 28% | 61% | 13,257 |
| July 2020 | 42% | 28% | 44% | 24% | 57% | 12,108 |
| August 2020 | 38% | 27% | 42% | 22% | 56% | 12,636 |
| September 2020 | 39% | 29% | 42% | 22% | 57% | 29,810 |
| October 2020 | 38% | 30% | 44% | 22% | 55% | 76,686 |
| November 2020 | 39% | 39% | 50% | 25% | 58% | 142,695 |
| December 2020 | 42% | 43% | 52% | 32% | 60% | 203,288 |
| January 2021 | 46% | 40% | 49% | 29% | Not available | 198,426 |
| February 2021 | 45% | 39% | 48% | 27% | Not available | 87,841 |
| March 2021 | 43% | 36% | 47% | 25% | Not available | 114,416 |
Notes
February 2020 data is provided for context only.
Data for Saskatchewan from April 1 to June 30, 2020, is not shown; it is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided.
Data for British Columbia has not been submitted for January to March 2021.
Data for Nova Scotia is not shown; due to data limitations, services provided virtually could not be explicitly identified.
Sources
National Physician Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to March 2021 (pandemic data), Canadian Institute for Health Information. Open-year data; data reported to CIHI as of July 1, 2021.
Public Health Agency of Canada. COVID-19 daily epidemiology update. Accessed September 24, 2021.
The proportion of family physician consults and visits provided virtually averaged between 27% and 57% among the 5 provinces for which data is available. While virtual care helped increase access to family physician services, the data doesn’t tell us about the quality and appropriateness of the care provided.
Change in family physician activity varied by age of patient
During the first 13 months of the pandemic, family physician activity was below pre-pandemic levels. The biggest decrease occurred for children and youth age 0 to 17 — this group typically makes up about one-tenth of family physician activity, with some provincial variation. A similar drop was seen in emergency department visits for children and youth. Public health measures may have had an impact on the need for care among children and youth — school closures, physical distancing and wearing masks resulted in fewer injuries and reduced community transmission of many seasonal respiratory viruses.
Patients age 65 and older, who typically make up about one-third of family physician activities (with some variation by jurisdiction), showed the smallest drop in 3 provinces and a slight increase in 1 province compared with pre-pandemic levels. This suggests that most older people with chronic conditions were still able to access the care they needed from their family physicians.
Change in family physician activity during the pandemic, by age group and province, March 2020 to March 2021
| Province | Percentage change in activity from 2019, age 0 to 17 | Percentage change in activity from 2019, age 18 to 64 | Percentage change in activity from 2019, age 65+ |
|---|---|---|---|
| Nova Scotia | -24% | -10% | -2% |
| Ontario | -34% | -10% | -6% |
| Manitoba | -25% | 0% | 3% |
| Alberta | -36% | -9% | -5% |
Notes
Data for Saskatchewan and British Columbia is not shown because we do not have comparable data for the March 2020 to March 2021 period. Data for Saskatchewan from April 1 to June 30, 2020, is under-reported because physicians who were part of the Pandemic Physician Service Agreement during this time did not submit claims for the services they provided. Data for British Columbia has not been submitted for January to March 2021.
Source
National Physician Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to March 2021 (pandemic data), Canadian Institute for Health Information. Open-year data; data reported to CIHI as of July 1, 2021.
What we don’t know from this information
- Who was unable to access physician care at all and why?
- Did virtual care meet patients’ needs?
- What were the barriers to accessing virtual care?
Featured resources
Data tables
These data tables contain information on the services billed by physicians for 2 periods: pre-pandemic and pandemic, to help understand the impact of COVID-19 on physician services.