Alberta has launched a dual-practice health-care model that permits surgeons to operate within the public system while simultaneously performing privately paid procedures, raising an immediate and pointed question about who, in practice, stands to benefit — and whether the arrangement will meaningfully reduce the surgical backlogs that have left thousands of patients waiting in pain.
Under the new framework, surgeons employed in public hospitals are authorized to offer elective surgeries on a fee-for-service basis outside of their publicly funded hours, a structure the provincial government contends will unlock additional surgical capacity without drawing physicians away from the public system. The argument, in its most optimistic form, holds that more hours worked by more surgeons means more procedures completed, and that the overall queue — public and private alike — should therefore shorten for everyone.
Critics are not persuaded. They point directly to Quebec, which introduced a comparable dual-practice arrangement and found that it did not meaningfully clear surgical backlogs. The concern is not merely theoretical: when a surgeon’s most lucrative and professionally rewarding hours migrate toward privately paying patients, the incentive structure of medicine shifts in ways that are difficult to regulate and easy to obscure.
The risk, as opponents frame it, is a two-track system in which access to timely surgery becomes a function of personal wealth rather than medical need. A patient with the means to pay privately moves to the front; a patient without those means waits longer, not because the system has fewer surgeons, but because those surgeons’ discretionary time has been quietly redirected.
Alberta’s health-care system, like those across Canada, operates under the foundational principle that medically necessary services must be provided on the basis of need rather than ability to pay — a principle embedded in the Canada Health Act. Whether dual practice, as designed by the province, runs afoul of that principle or merely tests its edges is a legal and constitutional question that has not been resolved, and one that federal health authorities will likely be pressed to address as the model takes shape.
The timing matters. Alberta, like every other province, emerged from the pandemic years carrying a substantial surgical backlog, and the political pressure to demonstrate progress is real. The dual-practice model offers the government a visible, market-oriented response to that pressure — one that avoids the slower, more expensive work of expanding public surgical capacity through infrastructure investment and physician training pipelines.
Whether it delivers on its promise, or instead replicates the Quebec experience by offering the appearance of reform without the substance of equity, will depend on how rigorously the province monitors outcomes, enforces wait-time benchmarks, and ensures that public-system obligations remain the primary claim on a surgeon’s time and attention. Those enforcement mechanisms, as yet, remain to be tested.
