Alberta’s doctor plan to allow dual public-private practice raises concerns over burnout, nurse shortages, insurance changes and Canada Health Act risks.
Alberta’s Doctor Plan Raises Insurance, Staffing Fears
A New Direction for Alberta’s Health System
Alberta is preparing legislation that would let physicians work in both the public and private systems simultaneously—a first in Canada. Premier Danielle Smith revealed the plan earlier this month, saying it could boost access to surgeries and reduce wait times. With the fall legislative session ending next week, the government has not confirmed when the bill will be introduced or what specific rules it will contain. Officials say the model would never force Albertans to pay out-of-pocket for medically necessary care, but critics argue the proposal still leaves major unanswered questions.
Context From Other Provinces
The Canadian Medical Association says no province allows the same kind of dual practice Alberta is considering. Quebec comes closest, but recent legislation there has actually restricted private-sector growth by requiring new medical graduates to stay in the public system for at least five years. Quebec has more private-practice doctors than the rest of the country combined, leading some specialists to pursue greater flexibility. Supporters say private clinics help patients who face long waits for family doctors; opponents warn that Alberta may be opening a path for the same large-scale shift toward privatization.
Physician Burnout and Workload Pressures
Under Alberta’s plan, surgeons would need to complete a required number of public procedures before performing additional private surgeries, possibly during evenings or weekends. National surveys already show high levels of burnout among physicians, prompting concerns about patient safety and surgeon fatigue. CMA President Dr. Margot Burnell cautions that surgical care delivered at the end of a long workday increases risks, while some Alberta surgeons acknowledge the financial incentives may attract interest regardless of capacity constraints. The Alberta Medical Association says it has been promised a role in shaping the regulations but still lacks critical details.
Implications for Nurses and Surgical Teams
Nurses’ organizations fear the hybrid model could siphon skilled staff from public hospitals to private facilities. The United Nurses of Alberta, which represents more than 30,000 registered nurses, says the province already faces staffing shortages with no immediate way to expand the workforce. Health leaders note that surgeries require entire teams—including anesthetists, specialized nurses and support staff—who may be drawn to higher-paid private positions. Critics say Alberta risks weakening the public system if team members migrate to private clinics, a trend they argue is already occurring in chartered surgical centres.
Legal and Constitutional Questions Ahead
Experts warn Alberta’s approach may collide with the Canada Health Act, which prohibits charging patients for publicly insured services. If the federal government concludes the legislation violates the act, Ottawa could withhold health transfers, although historically such penalties have been slow and limited. Legal scholars note that Alberta’s strained relationship with the federal government may make the province less likely to retreat if threatened with funding cuts. Judicial review is possible, though courts have generally avoided requiring governments to expand or guarantee specific levels of health services.
How Insurance Markets Could Shift
Premier Smith has suggested that private surgeries could be paid through personal funds or insurance plans, raising questions about the future of private coverage in Alberta. Health policy researchers say the change could invite more insurance companies to offear parallel coverage for procedures performed outside the public system. Startup insurers and industry executives view the proposal as an opportunity to broaden benefits packages. Employers could eventually adjust workplace plans to include more private surgical coverage, although that may boost costs. Major insurers, including Alberta Blue Cross, say they will evaluate the implications once the legislation is released.
