Introducing DermCafé, a publicly funded virtual dermatologist's office

Canadians wait months, sometimes even years, to see a dermatologist. While more urgent cases—like suspected melanomas and other cancers—see shorter wait times, Canadians wanting to talk to a dermatologist about more minor skin concerns like acne, eczema, rashes and facial discolouration are stuck in line. Enter DermCafé, a national, publicly funded, rapid-access virtual dermatologist clinic. The platform was founded by dermatologist Dr. Annie Liu who says that she wanted to solve the long dermatologist wait times for Canadians by creating a digital platform. “There’s no bottle neck, it’s not a physical clinic where there’s a capacity, we’re constantly expanding our team, so our wait times are a week or less,” she explains. Dr. Liu was particularly inspired by the potential for a digital solution to long wait times during her training, when she did a few elective courses and mini-rotations in the U.S. and Europe. There, she saw how quickly patients with less serious skin concerns were seen. “I was always under the impression that Canada is the gold standard, that we have the best healthcare system in the world. But I came home feeling like, 'oh my God, we have a lot to improve on,'" she says. DermCafé launched in May 2020, but it was slow going. When Dr. Liu first started developing clinic, she felt the friction of the protective and conservative nature of medicine as a field. Doctors, Dr. Liu says, are told to stay in a bubble and not rock the boat. “Even if something is logical and needed, there can still be tremendous resistance to it,” she says.Looking internationally, she saw how advanced other countries’ digital healthcare offerings were, and thought that using modern technology to “improve access in healthcare for Canadians was a no brainer,” she recalls. “It’s low cost, it works, it’s safe and it helps!” Non-serious skin conditions can still have a big impact on patients’ self-esteem, confidence and quality of life. And, they're common enough to take up the vast majority of dermatologists’ time. Unlike cancers and other serious concerns, these minor ailments can also be assessed through photos and online, which Dr. Liu says is how dermatologists learn to diagnose anyway. “During my residency, we trained through photos and through visual inspections,” she says. Though obviously, “any sort of mole or lesion where the dermatologist needs to be closely inspected, we don’t accept those on DermCafé.” By treating these minor afflictions, Dr. Liu says she hopes it takes these cases out of the bottleneck waitlist for a real-life dermatologist appointment. In turn, freeing up appointments so those with serious skin concerns can see a doctor quicker. For patients, the platform is simple to use: after being referred by a family doctor, patients upload images of their skin and then book a virtual video appointment with a dermatologist. For patients without a family doctor, DermCafé has a number of family doctors who can assess and refer them. All patients must have referrals, given the rules surrounding publicly funded dermatological care. In fact, a major tenant of DermCafé is that it’s publicly funded, so appointments for patients in British Columbia, Alberta, Ontario and Nova Scotia are covered by their provincial healthcare plan (patients in other provinces can still access the services, but must pay out-of-pocket). “The goal, ultimately, was to provide free access,” Dr. Liu says. “If we’re improving access, there shouldn’t be a cost because true access means affordability.” Looking to the future, Dr. Liu hopes to expand DermCafé to all provinces and territories. To her, some of the rules around what is and isn’t covered by provinces goes right back to her frustrations around the medical field in Canada’s sluggish attitude to change and new technology. Dr. Liu believes the rules sometimes make it too hard for doctors to provide virtual care. While she acknowledges the rules surrounding safety and data security are important, it often feels like some restrictions actively “discourage access, because when the patients are able to access the healthcare system, it costs the system money,” she says. “So they put up strict and unreasonable rules around the types of platforms that can be used and limit the software we can use, like video calling, to such an illogical point that it’s not about safety. It’s about restricting initiatives in the field.”For now, Dr. Liu is hoping to expand her roster of doctors from all parts of Canada. Most of the dermatologists on the platform do DermCafé on the side—often a few days a week to supplement their in-clinic work. Looking towards the future, aside from expanding to new provinces, Dr. Liu hopes to partner with local healthcare groups to make an even bigger difference. That might look like triaging patients and sending them to in-person clinics and make the backlog of patients waiting shrink. “There’s no way that dermatologists can [really make a dent in access issues for dermatology] alone, there are fewer than 700 dermatologists for our 40 million population,” she says. “We need to work together with family physicians, nurse practitioners and everyone in the community to make quality care accessible.”

Introducing DermCafé, a publicly funded virtual dermatologist's office

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