Alberta Health Advocates Warn ‘Dual Practice’ Plan Could Impact Public Wait Times

Health advocacy groups and medical professionals are raising concerns over a provincial proposal in Alberta that would allow physicians to practice simultaneously in both the public and private sectors. Critics of the "dual practice" model warn that the shift could inadvertently lengthen wait times for public patients by diverting limited medical resources and personnel.

The Proposed Shift to Dual Practice

The Government of Alberta is exploring policy changes that would permit doctors to maintain a "dual practice," a system where a single physician can see patients within the publicly funded health system while also operating a private, out-of-pocket, or insurance-based practice. Currently, most Canadian provinces maintain strict "bright line" rules that require physicians to opt entirely into or out of the public system to prevent conflicts of interest and ensure equitable access.

Proponents of the plan suggest that allowing dual practice could help retain specialists within the province by offering more flexible financial arrangements and potentially increasing the total number of procedures performed in Alberta. However, the Canadian Medical Association (CMA) and various provincial health advocacy groups have expressed skepticism, citing historical data suggesting that such models often prioritize those with the ability to pay.

Concerns Over "Queue-Jumping" and Staffing Drains

A primary concern highlighted by health advocates is the potential for "queue-jumping." Under a dual practice model, critics argue that physicians may be incentivized to reserve limited appointment slots for private-paying patients, who can access services in a matter of days or weeks, while those relying on the public system face waits of several months.

In a statement regarding the proposal, some experts noted that the dynamic could lead to a strategic allocation of physician time. In some clinical scenarios, a specialist might save several spots per week to "squeeze in" private clients, effectively reducing the available capacity for the national public waitlist.

This tension is exacerbated by Alberta's current physician-to-population ratio. Data indicates that Alberta has approximately 2.4 physicians per 1,000 people, a figure significantly lower than international peers like Australia (4.2) or Germany (4.6). With a limited pool of doctors, advocates argue that any time diverted to private practice is time directly subtracted from public care.

Historical Precedents and International Comparisons

Advocacy groups are pointing to other jurisdictions as cautionary examples of how dual practice can impact the economy of healthcare. Quebec’s experience is frequently cited; prior to 2017, the province saw a shift where approximately 2,000 more procedures per month were moved to private settings following specific policy shifts. Critics note that when physicians are allowed to straddle both systems, the performance and reliability of the public system often deteriorate.

Similarly, an auditor general’s report from Ireland found that safeguards intended to limit the amount of time physicians spent in private practice were routinely violated. Advocates warn that without rigorous, near-constant oversight, a dual practice model in Alberta could see the public system become a secondary priority for specialists.

Why It Matters

The debate over dual practice in Alberta centers on two fundamental issues: healthcare accessibility and system capacity. If the model leads to a "brain drain" from public hospitals to private clinics, the resulting increase in wait times could impact the most vulnerable Albertans who cannot afford private insurance or out-of-pocket fees.

Furthermore, as the industry of healthcare continues to grapple with post-pandemic backlogs, the decision on how to manage physician labor will define the stability of Alberta's medical infrastructure for the next decade. Ensuring that the public system remains the primary focus for the province’s limited number of specialists is, according to advocates, the only way to maintain the principle of universal, equitable access.

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