Dear Members,
On November 18, I issued my first statement on Alberta’s plan to allow physicians to work in both public and private systems. On November 19, the Premier released a video outlining her vision for the Dual Practice Surgery Model — providing some insight into rebalancing public and private health care. That same day, Alberta’s Auditor General reported on the failed DynaLIFE Dx lab privatization — terminated after eight months due to governance and procurement failures, lack of a business case and major service disruptions, costing taxpayers $125 million (Lab colleagues have commented). This follows an earlier proposal to expand private-pay diagnostic imaging without a physician requisition — announced during an ongoing market rate review aimed at significantly reducing government remuneration for diagnostic services.
These announcements share a common, two-part theme: (i) lack of information on “how it will be done,” to demonstrate a clear understanding of the feasibility of the proposed policy and (ii) uncertainty about the likelihood of success under current conditions (the business case).
If the government has completed this required analysis, it has not yet been shared with health system stakeholders or with Albertans. I have been assured by Minister LaGrange that the AMA will be engaged in the development of regulations and policies coming out of any legislation, and we will be holding her to that commitment. Planning should be the thread that holds the patient journey together and ensures that all Albertans have the robust and timely access to the care they deserve, regardless of their ability to pay. Engagement with the AMA physician community by government will be essential if these health system policy shifts are to succeed.
AMA physician leaders understand the leading global health system practices referenced as models to emulate by the Premier. We have members with deep experience practicing medicine in the countries cited and they know that there is a significant difference. Those jurisdictions have health system capabilities and services that are precursors to success in balancing public and private care — and that are still lacking in Alberta’s refocused health system. Expanding private surgical capacity does not create new surgeons, anesthesiologists or nurses — it redistributes the same limited workforce, increasing strain on public hospitals and risking longer waits for urgent cases. Unless other measures and incentives are introduced, elevated payments in private settings will inevitably draw specialists away from the public system, forcing cancellations and eroding emergency coverage in public hospitals and facilities.
We’re talking about the fundamentals: centralized, real-time triage, referral and wait-list management; existing command-center capabilities for optimized resource management; post-operative care capacity; timely and transparent reporting; and accurate operating room utilization data.
Without these prerequisites, the Dual Practice Surgery Model will not achieve its intended outcomes, and these policy shifts may cost Alberta taxpayers more than just dollars. There are numerous risks that need to be mitigated, including:
- Entrenching a two-tier surgical system, where itinerant surgeons from other provinces perform private work while local surgeons manage complications and emergency coverage.
- Rural service degradation as private facilities cluster in urban centers, decimating surgical programs outside Edmonton and Calgary and disadvantaging patients who cannot easily travel.
- Inability to access required surgical workforce talent for trauma, obstetrics and urgent surgeries when every minute counts.
The AMA is ready to collaborate with government on solutions — but those solutions must strengthen, not destabilize, Alberta’s publicly funded surgical system and the promised engagement must be meaningful. This must include discussion about how dual practice may be rolled out to physicians other than surgeons as the Premier's comments suggested may be the case. Policy decisions that reshape care delivery cannot succeed without the input of those who deliver care. Physicians bring practical insight into workforce realities, patient safety and system capacity to inform planning, test assumptions, mitigate risks and successfully achieve intended outcomes.
Much more to come, but I urge you to stay informed, engaged and to share your thoughts with colleagues in your sections and communities, and with RF delegates and Board members. Later today, you’ll receive a five-question pulse survey by email. It takes just a few minutes to complete on your phone or any device and explores key questions about dual practice. Your voice matters in planning and policy, so please help us keep our fingers on the opinion pulse of membership.
Regards,
Brian Wirzba, MD, FRCPC
President, Alberta Medical Association