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Can Ottawa and Alberta actually work together?
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Adriana LaGrange is not waiting for permission. Alberta’s minister of hospital and surgical health services is rolling out a dual-practice model that lets some surgeons work in both the public system and a private-pay lane at the same time — something no other province allows. The question hanging over it is not just whether the model works. It is whether Ottawa and Edmonton can drop the familiar script — western grievance versus federal lecture — and treat a provincial experiment as a chance to fix something both sides say is broken.
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When I catch up with LaGrange in late August, she is not in campaign mode. She is in implementation mode. Legislation passed last December created a new category of “flexibly participating” physicians, mainly surgeons. Starting this fall they can do publicly funded work and, on a case-by-case basis, privately paid elective procedures: hip and knee replacements, cataracts, hernia repair, selected ENT, gynecology, dermatology and plastic surgery. Emergency care, cancer treatment and family practice stay fully public.
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Right now, she says, Alberta has two camps: physicians who are “fully opted out” or “fully opted in.” She puts the opted-out group at about 15 — doctors who do only private work. Everyone else stays inside the public system. Dual practice is the attempt to stop the binary. Doctors keep a public contract, meet a minimum number of public hours with Alberta Health Services or Covenant Health, then add private volume in approved facilities. At first, those will be accredited non-hospital surgical facilities.
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The Alberta Medical Association neither endorses nor opposes the plan. It has spent months pressing for guardrails so the private lane does not lengthen public waits, poach staff, or slide into queue-jumping by ability to pay. LaGrange says that is her test too. “What we want to do, pre-emptively, is make sure we have those strong guardrails in place so we are protecting our public system first and foremost.” Dual-practice doctors, she says, “would have to put the minimum public surgery hours in before they could actually do private surgeries.”
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Her pitch: Albertans already leave the province — and the country — for these surgeries. “Alberta doctors are flying out, Alberta patients are flying out, and we have other provinces, their patients and their doctors flying here to do those surgeries here. It just doesn’t make sense.” Keep the work here, she argues, and you add capacity, keep complications inside a system that will treat them anyway, and give patients a local choice for elective care.
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She keeps drawing the line. “I emphasize elective, not medically needed at this moment, because of course if it was an emergency or if it was cancer, that would be done here, no cost, no impediment to that whatsoever.”
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Federal Health Minister Marjorie Michel is not convinced the model fits the Canada Health Act. In mid-August she told the Toronto Star she was “very concerned” and did not see how dual practice could operate within the Act. Her office confirmed a July 24 letter asking Alberta to protect the public system. Reporting around that interview floated discretionary penalties — an unusual step beyond the deductions Ottawa already takes from health transfers when provinces allow patient charges.