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A new bill aimed at allowing Alberta physicians to practise in both private and public health-care systems will keep family doctors out of the private system — for now.
“At this time, family medicine providers will not be eligible to be flexible participants within this new model,” the provincial government said in a news release on Monday, the same day that Bill 11, the Health Statutes Amendment Act, was introduced in the Alberta legislature.
The proposed legislation seeks to implement a “dual practice system.”
The dual model was previously announced by Premier Danielle Smith last week.
Chris Gallaway, executive director of the advocacy group Friends of Medicare, has expressed concern about whether family physicians could become part of the dual practice system. On Monday he said the fact family physicians are not currently included in the plan gives him no comfort.
The proposed legislation also keeps emergency medicine and surgeries for life-threatening conditions, including cancer, within the public system.
The Alberta government says measures in the bill do not violate the Canada Health Act.
Matt Jones, minister of hospital and surgical health services, said the dual system could act as a physician recruitment measure.
“Alberta is not an island. Alberta competes for health-care professionals all across Canada, North America,” he said at a news conference Monday.
“So I would more look at it as we have an ability to allow physicians to do some private activity while making them responsible to do the majority or some portion of the public system.
“That’s a compelling recruitment, attraction and retention tool for physicians and health-care professionals.”
The province intends to consult with health-care providers and organizations on potential limits to the public-private system.
For example, the province is considering having surgeons perform a set number of publicly funded surgeries as a condition for being allowed to practise in the private system. Another option is setting a minimum number of years in the public system before entering the private system.
Other possible guardrails include only allowing private surgeries in the evenings, weekends or at underused rural hospitals and prohibiting certain specialists from moving into private practice if there aren’t enough of them to sustain the public system.
The government will require physicians who practise in both the private and public systems to keep separate records to avoid mix-ups in what gets paid by Alberta Health. The system will be set up so they can toggle back and forth between the systems.
The wide-ranging legislation also lays out rules to improve food safety oversight, tightens rules to prevent improper billing by doctors and clinics, and sets out a new process for renewing health cards.
Devil in the details
The organization that represents Alberta doctors said it was not consulted on the bill prior to its release.
Dr. Brian Wirzba, the president of the Alberta Medical Association and an internal medicine specialist in Edmonton, said he believes the devil in Bill 11 could be in the details.
He said the AMA is not opposed to changes, but added that members are concerned about moves that would destabilize and compromise access to the public system.
“The literature would suggest that’s a big challenge,” Wirzba said. “Most places that have tried this run into problems.
“From our perspective at the AMA, we think that it’s going to be really important to have the details really well laid out, a good plan in place about monitoring safeguards.”
Wirzba said he wants the government to consult with his members and discuss how far it plans to go with the private delivery option. He said any plan needs to be well-thought-out and not improvised with each step.
As for the suggestion surgeons could perform private procedures in the evenings and on weekends, Wirzba said there may not be enough anaesthetists and surgical nurses to assist with extra procedures.
Gallaway said he believes Bill 11 creates a two-tiered system similar to the American health-care system. He said people with money to pay for procedures will be able to buy better access than those who need to use the public system.
Gallaway said Smith did not have this in her campaign platform in the 2023 election.
“None of this was something that Albertans were asked about in an election,” he said.
“And now it’s being rammed through the legislature without any consultation with stakeholders, let alone Albertans.”
Gallaway said the province could shorten surgical wait times by ensuring public operating rooms are fully used and by setting up central referral lists for surgeries.
He said his group has been calling for the province to come up with a health-care workforce plan to show exactly where in the system staff are needed.
