Doctors call for strong oversight, workforce protections as Alberta works towards dual practice model

The Alberta Medical Association is calling on the provincial government to adopt dozens of safeguards as it crafts regulations designed to allow physicians to practise in both the public and private systems.

Legislation paving the way for the so-called “dual practice” system passed late last year.

And the Alberta government is currently developing regulations that will greenlight the controversial model.

“There are many, many ways that this could go wrong. And it’s a very narrow path to do it right,” said Dr. Brian Wirzba, president of the Alberta Medical Association (AMA).

“I do think that there are opportunities to be there early on to make sure that these safeguards are there for all Albertans so that the public system, which is in crisis, doesn’t get worse.”

Health-care advocacy groups across the country warned earlier this year that the Alberta government’s plan may violate the Canada Health Act, and they called on Prime Minister Mark Carney and federal Health Minister Marjorie Michel to intervene.

The province has refuted that claim.

“We need to be very cautious as we move forward” said Wirzba, noting the AMA doesn’t endorse the government’s dual practice plans, but it is also not opposed to components of private pay.

The AMA formed a taskforce to identify the risks of such a venture, and the group developed a list of 70 proposed safeguards it says are designed to protect patient safety and access to care as well the integrity of the public health system. The document was submitted to the Alberta government at the end of April.

“We need to recognize that it has not necessarily gone well everywhere else — that places that have dual practice do have safeguards in place and are seeing challenges,” said Wirzba.

Among the recommendations, the doctors are calling for strong oversight. They want the province to set up a single provincial statutory oversight body with authority across public and private spheres of practice.

They’re also calling for a separate, non-partisan auditing body to address compliance and spot emerging risks.

Plus, the AMA wants the provincial government to put protections in place to ensure the private system doesn’t drain much-needed staff from the public system.

That includes clearly defining and enforcing public service participation, according to the document, and putting mechanisms in place to limit private work when public system capacity is at risk.

“If we start opening up new private models where quality of life is better, the hours are better, you’re not doing overnight or weekend service, we are going to be losing people to those [private practices], and there has to be a mechanism to make sure that that doesn’t occur,” said Wirzba.

He noted many Albertans are already waiting too long for surgeries, and public hospitals are already struggling with shortages of health care workers, including anesthesiologists.

“We certainly do not want a system where the patient’s ability to pay allows them better access to care than everyone else,” he said.

Regulations in the works

CBC News reached out to the Ministry of Primary and Preventative Health Services for a response to the doctors’ recommendations. The press secretary for Minister Adriana LaGrange said more information is coming.

“We are developing the regulations needed to implement dual practice responsibly, informed by evidence and engagement with a range of stakeholders, including the Alberta Medical Association,” Maddison McKee said in an email

“We look forward to sharing more in the coming weeks.” 

The ministry did not respond to questions about the association’s specific recommendations.

The province has previously said it planned to exclude family doctors from the dual practice model, at least to start. It has also said emergency care, including surgeries and cancer treatment, will remain entirely publicly funded.

In addition, the government promised safeguards would be put in place, including potentially limiting the number of procedures a doctor can perform in the private system or restricting private surgeries to evenings or weekends.

According to Wirzba, the recommendations were shared with Premier Danielle Smith, LaGrange, and the Minister of Hospital and Surgical Health Services Matt Jones.

The AMA said the taskforce included seven physicians from varying backgrounds, specialties, and with different views on dual practice.

The document also reflected what the organization heard through a member survey conducted in November, the AMA said.