Trans people across Ontario are worried they may lose a critical source of healthcare.
Ontario’s Connect-Clinic—an online clinic that offers telehealth services for trans people seeking gender-affirming care—is no longer taking new patients because of the province’s new funding agreement with doctors, CBC reported. One of few resources for trans people seeking hormone therapy and surgery referrals, particularly those outside of urban centres, the clinic has 1,500 patients and a 2,000+ waiting list.
The Ontario Medical Association (OMA), the group that negotiated the new funding agreement with the government, said that the new policy reflects the importance of “the patient-physician relationship,” with healthcare being split into “comprehensive” and “limited” practices. Rather than the previous CAD $67 or more per visit, the clinic, under the agreement, can only bill $20 per video call and $15 per phone call—rates that wouldn’t cover the depth of care the clinic provides.
“Virtual care is intended to complement in-person care, not replace it,” the Ontario Ministry of Health said in a statement to CBC.
Kristyn Wong-Tam, a member of Provincial Parliament, challenged this idea in an open letter to Sylvia Jones, calling on the minister of Health to help the “vital” service the clinic provides.
“Access to gender-affirming healthcare in Ontario has always been inconsistent and limited,” Wong-Tam wrote. “The pandemic made gender-affirming healthcare even harder to access, as the strain on our healthcare system has led to even longer wait times and has squeezed healthcare workers beyond their capacity to support Ontarians.”
Dr. Kate Greenway, the clinic’s lead physician and founder, told CBC that her patients were already “distressed” about this source of care possibly being taken away.
“I had one patient who told me they’d waited more than a decade to receive gender-affirming care because they had no way out of their community to access it,” Greenway said. “Certainly that patient still has no way to access gender-affirming care within their community.”
Lex, a twenty-eight-year-old patient of Connect-Clinic, told CBC that potential patients of the clinic suddenly found themselves without a path to access the care that they’d been waiting for.
“You have a lot of folks who have found their way forward and suddenly feel stonewalled,” Lex said. “It’s a very scary thing, and it can be dangerous—especially if you’re in a situation where this is kind of a life-or-death thing.”
Still, Lex emphasized the importance of virtual care for trans patients.
“I can talk to somebody from the comfort of my own home in conditions that I feel safe in as opposed to, for example, going to a walk-in clinic, asking if they prescribe [hormones] and getting a transphobic doctor who’s going to ruin my day,” Lex told the broadcaster. “A lot of people who hit a period of transition are not in a good place, and transition is a way to heal and to move forward and to grow as a person—and to not be able to access that just prolongs feeling very unsafe.”
Connect-Clinic was founded in 2019 by Greenway, in response to a lack of access to gender-affirming care in the province. After running a family practice, she wanted to offer virtual care to trans patients, especially those living outside of major urban centres—today, two-thirds of the clinic’s patients live outside of these centres.
“I thought there would be people that would need it, but I did not understand the number of people that would need our services,” Greenway said.
Greenway’s experience reflects a dearth of sources of trans healthcare in Canada. In a 2020 survey by Trans Pulse Canada, 45 percent of trans people surveyed had one of more unmet healthcare needs in the past year. Twelve percent said that, even though they needed care, they avoided going to the emergency room because they were trans.
The survey revealed similarly alarming figures regarding mental health: 56 percent of respondents rated their mental health as fair or poor (the lowest rating in the survey). Nearly a third of respondents had considered suicide in the past year, and 1 in 20 had attempted it. Gender-affirming care is crucial to trans people’s mental health: one study found that for trans youth, receiving gender-affirming care lowered the odds of depression by 60 percent and suicidality by 73 percent.
Wayne Baici, a psychiatrist and the clinical head of the Adult Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto, said that virtual care had been key to improving trans people’s lives.
“It was hard to access gender-affirming care before the pandemic. Certainly the pandemic put in all sorts of obstacles to receiving care as well. I think virtual care was the one silver lining in terms of improving access,” Baici told the outlet. “So if virtual care is impaired by changes in those [billing] codes, not allowing for healthcare to proceed, obviously trans folks will suffer.”
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