What Alberta’s public-private doctor plan could mean for insurance, physician burnout, nurses and more

Alberta Premier Danielle Smith’s plan to allow physicians to dabble both in the public and private systems at the same time would be a Canadian first, and has drawn mixed reaction from critics and supporters alike.

It has also prompted a number of questions. 

Adriana LaGrange, minister of primary services and preventative health services, would not elaborate further on the legislation prior to it being tabled.

And the government did not respond as to when the bill might be tabled. The legislative calendar indicates the fall sitting will end next week.

LaGrange said in a statement the government is committed to “ensuring that under no circumstances will any Albertan ever have to pay out-of-pocket to see their family doctor or to get the medical treatment they need.”

In a statement, Alberta Medical Association President Dr. Brian Wirzba said the announcement lacked details on “how it will be done.”

He said he’s received assurances from LaGrange that the AMA will be involved in the development of these regulations.

So what implications could the bill have?

Have any provinces done something similar?

While the Canadian Medical Association (CMA) confirms this would be a first, in a statement it drew comparisons to the model in Quebec, noting how that province has cracked down to stem the bleed of physicians to the private sector. 

This year, the Quebec government enacted a law requiring new med school grads to work in the public sector for five years before they are allowed to go private. 

Quebec has more doctors working in the private system than all other provinces combined, according to the CMA.

Dr. Martin Potter worked in the public system for two decades before opening a private clinic, where he says he has more freedom to hire as he wants and see patients as he pleases.

“I see a lot of patients who already have a family doctor, but they can’t see them in a timely fashion, so they make an appointment with me, and I’m happy to help them out,” Potter said.

“People who don’t believe in private care won’t come and see me. But the people who do see me … the majority are very happy.”

Quebec cardiologist Dr. Christopher Labos said the desire to go private has become common water cooler chatter.

“What used to be a verboten topic of conversation has now become almost commonplace with doctors asking each other, ‘Hey, are you thinking of going private?’” said Labos.

Are doctors interested?

The plan outlined by Smith and Matt Jones, minister of hospital and surgical health services, would require surgeons to perform a set number of procedures within the public system before choosing to take on additional private surgeries.

Smith said the legislation could potentially restrict private surgeries to weekends or after-hours.

Dr. Margot Burnell, president of the Canadian Medical Association, said physicians are already reporting in the organization’s national surveys that they are burnt out.

“I don’t want a surgeon operating on me at the end of their day or at night. I want them when they’re fresh and keen and well-rested,” said Burnell.

Red Deer orthopedic surgeon Dr. Keith Wolstenholme agrees burnout is a common complaint. He is not sure how many have the capacity to take on more work.

“Now, that’s not to say that surgeons aren’t gonna jump at the opportunity to do the same work for more money,” said Wolstenholme. “Absolutely, everybody’s gonna jump at that opportunity.”

What does this mean for nurses?

The Alberta government has not yet said what the legislation could entail for nurses.

“Surgery doesn’t happen in isolation with just the patient and the surgeon — you need a team,” said Burnell.

She worries Alberta’s plan will drain the public system of those team members, like anesthetists and nurses. 

“If you allow more and more private clinics to operate, they will start poaching personnel from the public system,” said Labos.

It’s a concern shared by the United Nurses of Alberta, the union that represents more than 30,000 registered nurses in the province. 

“There’s a limited number of physicians and nurses and other health care providers in the system,” said Danielle Larivee, the union’s first vice-president. “There’s no magic wand we can wave to increase the number of of health care providers.”

She worries this could open the floodgates to more nurses moving from the public to the private system, something she said is already happening as nurses choose to work in chartered surgical facilities, for example.

Larivee said the union wants to see the government backtrack on the proposal.