By physician referral only: Virtual dermatology platform cuts wait times from months to weeks

Dr. Annie Liu is often asked if the virtual dermatological care platform she co-founded and launched in 2020 is a “COVID clinic.” “Not at all—we started building prior to the pandemic,” explained the Toronto dermatologist and co-founder of DermCafé, which has about 30 doctors serving patients in British Columbia, Alberta, Ontario, New Brunswick and Nova Scotia. “In fact, this is the kind of technology we should have been using 10 years ago.” Already Canada’s first national telemedicine platform for dermatology, DermCafé apart is different from similar services because it requires patients come with a physician’s referral, since its doctors bill provincial health plans for their services. By comparison, other virtual dermatology services typically charge consultation fees ranging from around $80 to more than $100. “The biggest pain point we’re addressing is access to dermatological care,” said Dr. Liu. “There are fewer than 700 dermatologists in Canada and in places like Ottawa the wait times are over one year.” Read: Communicating with telemedicine is an art and science While the vast majority of DermCafé patients present with non-critical skin conditions, “for a teen suffering with bad acne, the pain from that long wait time is critical and very real,” said Dr. Liu. “And the physical impact can be long lasting—most acne will leave scarring on the face which, if not treated soon enough, can remain for life.” Patients who request an appointment with DermCafé get one scheduled within two weeks, which may change as the site gets busier. They’re given specific instructions on how to best take several photos of their problem areas, and to upload the images ahead of their appointment. All new patients meet with a board-certified dermatologist. Once their condition is stabilized, they can continue their follow-up appointments with family physicians with provincially approved dermatology training designations. “This helps to ensure our dermatologists’ calendars don’t get clogged up,” said Dr. Liu. “At the same time, patients have full control over which dermatologist they want to see. There are patients who have specific preferences, like some Asian patients who prefer an Asian doctor because they feel they’ll have a better understanding of their condition, or some who prefer doctors who focus on LGBTQ patients.” So far, since May 2020 the platform’s doctors have completed more than 45,000 virtual visits with over 25,000 patients. There’s no signup or other user costs for doctors who join the platform. Because dermatology is a specialization, doctors’ fees for DermCafé appointments are, for the most part, unaffected by recent post-pandemic changes to virtual care billing Dr. Liu pointed out, however, that Ontario’s decision to pay only 85% of virtual care delivered by phone—versus 100% when delivered by videoconference—doesn’t make much sense for DermCafé’s doctors, who base their diagnoses largely on patients’ photographs. Read: Helping patients find the best treatment plan for their facial and truncal acne “We won’t diagnose based on a fuzzy video call, especially when we’re seeing a patient who has a poor Internet connection,” she said. For those wondering about the accuracy—and safety—of photograph-based diagnoses, Dr. Liu pointed out that in medical school, diagnosing from photos is part of the training for future dermatologists. She also emphasized that DermCafé is not a replacement for in-person dermatological care. “Some conditions need to be seen in person—things like skin rashes or conditions that require the doctor to perform a procedure,” said Dr. Liu. “I think of ourselves as a micro-clinic that can effectively address conditions like acne, rosacea, melasma or, to a limited extent, eczema.” So far, many general practitioners and pediatricians have reacted positively to DermCafé, said Dr. Liu. Many are relieved to learn their patients don’t have to wait months to see a dermatologist, she added. Reactions among dermatologists, however, have been mixed. “I think the vast majority of negative reactions were the result of misunderstanding what we do—they may assume we’re doing skin checks online, which we don’t do,” said Dr. Liu. “We’re not looking to provide unsafe care. There are certain services that, when appropriately selected, can be delivered with excellence through virtual care. From my perspective, it’s a no-brainer.” Read: Evidence-based suggestions to promote antibiotic stewardship in dermatology

By physician referral only: Virtual dermatology platform cuts wait times from months to weeks

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