Fast food medicine?

This editorial examines the rapid expansion of virtual urgent care (VUC) and broader virtual primary care that accelerated during COVID-19, questioning whether convenience-driven models provide care quality comparable to in-person medicine. Using examples of misdiagnosis and duplication of care prompted by virtual consultations, the piece contextualizes a VUC pilot in Ontario and raises concerns about clinical accuracy, continuity, cost-effectiveness, and equity. The purpose is to evaluate whether further shifts toward virtual walk-in models improve outcomes or instead fragment care and strain primary care capacity.

The editorial synthesizes evidence and policy statements on virtual care. Reports indicate a dramatic rise in virtual visits during COVID-19 with sustained high usage post-pandemic, especially among family physicians. Literature notes potential benefits for prescription refills, counseling, chronic disease follow-up, and access in remote settings, but finds limited evidence that virtual care reduces health system costs except when travel is significant. Challenges include overuse/inappropriate use, inability to examine or perform procedures, diagnostic uncertainty and delays, misdiagnosis, missed nonverbal cues, difficulties forming new therapeutic relationships, and need for subsequent in-person visits. Position statements caution that episodic, stand-alone telemedicine rarely meets expected standards and risks lower quality, fragmented care with unnecessary antibiotics and duplication. Studies also suggest virtual users skew younger, wealthier, and already attached to primary care teams, potentially worsening inequities. Commentary highlights corporate expansion into VUC and system-level impacts on primary care workforce and care continuity.

• In an Ontario VUC pilot (McLeod et al.), surveyed users had mean age 27; 73% female; 87% with higher than post-secondary education; 90% already had a primary care provider; 72% triaged CTAS 4–5. About two-thirds were discharged; the remainder were referred to an ED or another provider. Most were very satisfied. The study did not evaluate whether VUC reduced ED visits.
• Virtual care utilization trends in Ontario: pre-COVID 1.2% of primary care visits were virtual; during the pandemic 71%; post-pandemic stabilized at ~40% overall and 52% for family physicians. A 2021 survey reported 64% of physicians intend to maintain or increase virtual visits.
• Identified drawbacks of virtual care include: overuse and inappropriate use; costs of virtual infrastructure; limited provider training; inability to perform physical exams or basic procedures; increased clinical uncertainty; misdiagnosis; diagnostic/treatment delays; difficulty establishing new relationships; challenges interpreting complex mental health issues; missed nonverbal cues; and need for second in-person visits when exams are required.
• Virtual walk-in models (episodic care without ongoing accountability) may compromise continuity, promote fragmented lower-quality care, drive up costs, and are associated with incorrect diagnoses, unnecessary antibiotics, and duplication of care. Regulatory bodies have warned that stand-alone episodic telemedicine rarely meets standards for most episodic concerns.
• Equity concerns: virtual care users tend to be younger, wealthier, with lower health needs and existing primary care attachments, potentially exacerbating inequities for marginalized or elderly patients with limited technology access.
• System impacts: Attractive convenience and corporate entry into VUC may draw clinicians away from comprehensive primary care, exacerbating shortages and not demonstrably improving outcomes or reducing costs.

The evidence and examples presented argue that while virtual care offers convenience and selective advantages (e.g., refills, counseling, chronic condition follow-up, remote access), it is generally inferior to in-person care for new or complex problems requiring examination and procedures. The Ontario VUC pilot’s satisfaction results do not address critical outcomes such as diagnostic accuracy, safety, healthcare utilization (e.g., ED avoidance), or total system costs. Episodic virtual walk-in models risk fragmented care, duplication, and inappropriate prescribing, undermining continuity and quality. Persistent high virtual use appears driven more by convenience than by demonstrated outcome or cost benefits, and may worsen inequities by favoring already well-connected, lower-need populations while creating barriers for marginalized groups. Additionally, the growth of virtual walk-in services and corporate involvement may divert physicians and nurses from high-value, longitudinal primary care, worsening access problems despite rising physician numbers. Overall, the editorial contends that in-person care remains superior for most clinically significant issues and cautions against endorsing further shifts toward virtual walk-in models without robust outcome data.

The editorial cautions that expanding virtual walk-in/urgent care, despite convenience and patient satisfaction, risks inferior clinical quality, fragmented and duplicative care, inequities, and further erosion of comprehensive primary care. Virtual care should be targeted to appropriate use cases (refills, counseling, chronic disease follow-up, remote contexts) rather than replacing in-person assessment for new or complex concerns. The author calls for evaluation of outcomes beyond satisfaction—such as diagnostic accuracy, safety, ED visit reduction, equity impacts, and cost-effectiveness—before further endorsing VUC models, and urges health systems to prioritize strengthening in-person primary care continuity.

This is an editorial commentary with no original data collection or formal methodology. Conclusions rely on cited studies, reports, and policy statements. Generalizability is limited, and causal claims about system impacts are inferential. The referenced VUC study did not assess critical outcomes such as ED visit reduction or diagnostic accuracy, constraining interpretation.