Medicine is a science of uncertainty and an art of probability.
Dear Members,
I am writing to provide an update on self-referred private pay diagnostic imaging and screening laboratory services, and to encourage you to attend an upcoming information session on youth proxy access through MyHealth Records.
Self-referred private pay diagnostic imaging and screening laboratory services
Last week, the Alberta Government introduced Bill 29: The Health Statutes Amendment Act, 2026. This legislation proposes to allow patients to directly purchase diagnostic screening tests like MRIs, CT scans and laboratory bloodwork without a physician’s referral. The AMA previously undertook an environmental scan to examine the impacts of the proposed changes. We have since added this as a new topic on InformedReform.ca, along with a short explainer video to help members and the public understand the implications.
As physicians, we understand why this is happening. Our patients are frustrated. They are facing unacceptable delays for tests we have already ordered, often waiting months for answers that dictate their treatment and peace of mind.
In this letter, I want to clarify three key points: why more tests do not automatically mean better care; why physician involvement is essential in choosing and interpreting tests; and how Bill 29 could affect patients and the health system overall.
On the surface, self-referral for screening tests looks like an easy win for access. However, as physicians we hold a key accountability to the patient in front of us and also to the sustainability of the health system that serves all Albertans. Our duty is to ensure that access translates into better care and better outcomes, not simply more tests. Paying out of pocket may speed up the test but it does not create timelier access to a physician to interpret results and guide next steps.
A scan or blood test is only one step in a care pathway. Removing the physician from the decision to order a test, and from reviewing and acting on the result, creates real risks for patients and added pressure on the system.
The crux of the issue with Bill 29 is removing the physician’s vital role in recommending the most appropriate test and in reviewing and interpreting results in context to support a clear treatment plan. In the absence of that clinical pathway, patients may face uncertainty, unexpected findings or delayed follow-up, all while limited physician resources become even more strained.
Why does this matter? The evidence on broad, self-directed screening shows how easily good intentions can lead to harm and added strain on the system.
The appeal of a “full-body scan” is understandable, but the evidence tells a cautionary tale. Screening tests for healthy individuals must meet a particularly high bar because the benefit-to-harm ratio must be overwhelmingly favourable. Even when risks are low, physicians play a vital role in choosing the right test for the right person. Screening tests are designed with high sensitivity to find everyone who might be sick. Guidelines determine when these tests should be used, based on evidence that shows detecting an abnormality is likely to improve outcomes, and that the benefits outweigh potential harms and system costs.
Using whole-body MRI as an example, evidence suggests about 30% of these scans (depending on the population studied) produce a “positive” finding that requires further investigation. This means 30 people out of 100 will be told something is abnormal even if it is likely to be harmless. At the same time, confirmed cancer detection rates in asymptomatic individuals are often only 1.1% to 1.57%, and potentially even lower in low-risk populations.
Another way to describe this is the Number Needed to Scan (NNS): to find one actionable cancer in an otherwise healthy person, we must scan approximately 91 individuals.
We cannot ignore the importance of that diagnosis to the one person helped — for them this could be lifesaving. However, we must also consider the other 90 patients: out of 91 people scanned, about 27 will receive a “positive” result requiring follow-up. Although one individual might gain, the remaining 26 may find themselves caught in a stressful loop of specialist appointments and potentially unnecessary treatments, typically paid for by a public system that is already facing capacity challenges. This can lengthen the queue for everyone, including our sickest patients.
When we order tests for someone with symptoms or specific risk factors, we are answering a focused clinical question. When we test without a clear clinical indication, results are more likely to be ambiguous, incidental or misleading, and that can create worry and extra follow up rather than clarity.
That added anxiety and stress takes a psychological toll on patients. False positives or incidental findings (things that were never going to harm the patient) can also trigger a medical cascade of repeat imaging, specialist consultations and invasive biopsies.
We have seen this pattern in Alberta: when testing expands without tight clinical targeting, volumes and costs rise faster than meaningful treatment benefit.
According to a Canadian Journal of Cardiology report, between 1998 and 2020, Alberta saw a 3.95-fold increase in the rate of outpatient cardiac imaging. This growth was driven almost entirely by publicly funded but private, for-profit facilities. The critical finding? Despite nearly quadruple the number of tests, the rate of invasive cardiac treatments like angioplasty or bypass surgery did not increase substantially. This indicates that a sizable portion of the increased testing was of low clinical value, meaning tests were conducted on low-risk patients for whom results are rarely meaningful and the likelihood of false positives is high.
No matter who pays for a test, patients still need a clinician to interpret results, explain implications and coordinate next steps. Follow-up testing, referrals and treatment planning typically return to the public system and depend on limited physician capacity.
That increase in non-invasive cardiac testing above predicted levels cost Alberta over $694 million (in 2020 dollars) since 1998. That same cost could have been redirected into opportunities to support patients and the system alike.
Rather than removing the physician’s role, we should focus on solutions that expand evidence-based diagnostic capacity and reduce low-value testing. Both are needed to truly improve patient care.
The AMA is committed to working with the government through the Resource Stewardship and Optimization (RSO) Program to reduce inappropriate testing (“Less, but Better”). True access means the right patient gets the right test at the right time. We believe the solution to wait times is to increase capacity for evidence-based, physician-guided, publicly funded diagnostics — not to encourage a direct-to-consumer market that risks destabilizing our workforce and deepening health inequities.
Allowing a direct-to-consumer market risks shifting limited human resources away from the sickest patients to those who can afford to join a new, unproven queue. We will continue to advocate for an evidence-based system where medical need, not a credit card, determines the path to care.
Youth proxy access
Members are encouraged to join an upcoming information session on recent changes to youth proxy access in MyHealth Records. This session supports the AMA’s ongoing work with government and provincial health agencies.
The session will outline what has changed, clarify the updated processes (including how proxy access can be reviewed or revoked) and provide time for questions. Panelists will include clinical and system experts from across the health system, with representatives from the AMA including the Section of Pediatrics and the Informatics Advisory Committee, Alberta Health Services, Health Shared Services, the Canadian Medical Protective Association and Primary and Preventative Health Services.
The members-only information session is on April 29 at 6 p.m. To register, visit the event web page.
If you are unable to attend, a recording will be posted on the AMA website along with additional physician resources. We will share more information as it becomes available.
Regards,
Brian Wirzba, MD, FRCPC
President, Alberta Medical Association