Eligible doctors in Alberta can work in both public, private systems starting this fall

The Alberta government says its new dual practice health model, which allows some physicians to practise in both the public and private systems, will begin to be rolled out in September.

The province says an expression of interest process for eligible physicians will open June 22, followed by a formal application process later this summer.

In order to be eligible for dual practice, doctors must do a minimum number of hours in the public system first. The province says those hour requirements along with other safeguards will protect the public system.

The province announced the dual practice model in November, prompting calls from doctors to ensure the program has strong oversight.

Adriana LaGrange, minister of Hospital and Surgical Health Services, said in a news conference Thursday the dual practice model will help shorten wait times.

“The status quo is not working,” LaGrange said. “It’s time to do things differently and to learn from systems that are getting better results.”

The provincial government has repeatedly compared its dual-practice system to those in countries like Sweden, the United Kingdom and France, but critics say it’s closer to a United States model.

“Albertans do not want American style two-tier system in this province,” Sharif Haji, NDP critic of primary and preventative health services, said after the government announcement. Haji also said Premier Danielle Smith did not campaign on this idea in 2023.

“Call it what it is and then put it on a ballot,” he said.

Chris Gallaway, executive director of the advocacy group Friends of Medicare, said he’s not reassured by the safeguards the province proposed. He also said many questions regarding the model are unanswered.

“The only way a two-tier healthcare system is profitable is if you have long wait times because no one would pay to skip the queue if there wasn’t a long queue,” Gallaway said.

The regulations for the program were developed after consulting some health care professionals, the province said. 

The province has not disclosed the number of hours physicians must dedicate to the public system, but those requirements will be set for each specialty and geographic area by Acute Care Alberta and the ministries of health. 

LaGrange said the hours will be tailored to individual doctors based on the normal amount they work.

“We have to make sure that what they’re currently doing, they will continue to do or expand upon doing.”

If physicians don’t fulfill their public hours on an ongoing basis, they will lose their dual practice status.

Eligible procedures include those offered at non-hospital surgical facilities like carpal tunnel release, joint surgeries, or some laparoscopic surgeries for endometriosis for example. 

It will not include cancer surgeries or procedures for other life-threatening conditions. 

LaGrange said no one will be denied access to service because of an inability to pay.

“Expanding access through dual practice does not take away from that, it adds to it. This is not an either or debate.”

Family doctors will be excluded from the dual practice model except when they have a subspecialty in anesthesia or surgical skills, the government said. 

Dual practice doctors will have to maintain separate records for private systems and do mandatory reporting to the province.

Dr. Henry Fung, an ophthalmologist with the Central Alberta Vision Institute, was at the province’s news conference. He said some patients are travelling out of province to get faster access to procedures like cataract surgery.

“Right now I feel that my hands are cuffed in order to do the work I was trained all these years to do.”

Fung said under the dual practice model, he could work additional evening hours privately alongside the public queue.

“We should provide a local solution in Alberta. “

Dual practice in public hospitals

Acute Care Alberta will be looking at expanding the model in the future to include dual-practice private surgeries in public hospitals where there’s underused operating rooms. 

The reason there are empty operating rooms is because the public system lacks the workforce to keep them full, partially because of the private system, Gallaway said.

“You break a hip, you’re waiting for days now and it’s because we’ve pulled the resources out,” he said. “So it’s not just about the surgeon choosing to opt in or out of the public private system. It’s everyone else around them.”

LaGrange said on Thursday that chartered surgical facilities have the support staff available to help deliver these private procedures without public resources.