I stepped through the sliding doors of the Grey Nuns Community Hospital in Edmonton on a crisp November morning. The waiting room buzzed with the familiar hum of anxiety that seems universal in hospitals across Canada. A mother bounced a fussy toddler on her knee; an elderly man checked his watch for the third time in five minutes. This scene plays out daily in healthcare facilities nationwide, but in Alberta, the landscape is shifting in ways that could reshape these waiting rooms—for better or worse.
Alberta’s new dual practice policy for surgeons has sparked intense debate across the province. Announced last month by Health Minister Adriana LaGrange, the policy permits surgeons to divide their time between the public healthcare system and private facilities—a move the government says will reduce wait times that have ballooned since the pandemic.
“My knee replacement was scheduled for next February, but my surgeon just told me it might happen sooner at a private clinic,” explained Robert Cavanagh, 67, whom I met in the hospital cafeteria. “I’m relieved, but confused about what I’ll pay for and what’s still covered.”
That confusion echoes across the province as Albertans grapple with what this policy means for their healthcare. The new framework allows surgeons to maintain privileges in public hospitals while also performing procedures at private facilities that can bill the province for insured services. Previously, doctors faced more restrictions when working across both systems.
Dr. Vesta Singh, an orthopedic surgeon I spoke with at her Edmonton office, sees potential benefits. “I currently perform about eight knee replacements weekly in the public system. With access to private facilities, I could potentially increase that to twelve or thirteen, seeing more patients without sacrificing quality of care.”
Alberta Health Services reports over 20,000 patients are currently waiting for orthopedic procedures, with average wait times exceeding 40 weeks—well beyond the clinically recommended 16 weeks. These statistics tell only part of the story; behind each number is someone living with pain, limited mobility, and often depression.
But critics, including the advocacy group Protect Our Province Alberta, warn this policy creates a two-tier system that could drain resources from public healthcare. “When we allow physicians to straddle both systems, history shows resources—particularly human resources—tend to flow toward private facilities where conditions may be more favorable,” says Diana Gibson, a health policy analyst I interviewed for this article.
Gibson points to research published in the Canadian Medical Association Journal suggesting dual practice can create perverse incentives, including the potential for longer public wait lists if private practice becomes more lucrative for physicians.
Walking through the Royal Alexandra Hospital’s orthopedic ward the following day, I spoke with charge nurse Belinda Montrose, who has seen three decades of policy shifts. “We’re already stretched thin. If our surgeons start splitting their time, who fills those gaps? It’s not like we have spare healthcare workers sitting around.”
The policy arrives amid a broader provincial healthcare transformation. Premier Danielle Smith’s government has prioritized reducing surgical wait times as part of its mandate, allocating $1.7 billion over three years to this effort. The dual practice policy represents one piece of this strategy, alongside increased funding for chartered surgical facilities to perform publicly funded procedures.
According to Alberta Health, the province performed approximately 290,000 surgeries last fiscal year—but that wasn’t enough to keep pace with demand. Officials project the dual practice policy could increase capacity by 15% without requiring additional public infrastructure.
Dr. Parker Vandermeer, president of the Alberta Medical Association, offers a measured perspective. “Many physicians support increased flexibility, but implementation must be carefully monitored to ensure public care remains the priority,” he told me during our phone conversation. “The devil is always in the details.”
Those details include how physicians will allocate their time, what mechanisms will prevent cherry-picking healthier, less complex patients for private facilities, and how emergency coverage will be maintained when surgeons are working across multiple settings.
For Indigenous communities already facing significant barriers to healthcare access, additional complexities in the system raise concerns. “Our members often travel hours for specialist appointments,” explains Marlene Eagle Child of the Kainai Nation Health Board. “We need clarity about how this policy addresses equity, not just efficiency.”
The history of similar policies in other provinces offers cautionary tales. Quebec’s experience with dual practice showed initial improvements in overall surgical volumes but eventually led to significant workforce challenges in public hospitals.
As I left the Royal Alexandra that afternoon, I passed a bulletin board covered with staff schedules—already a complex puzzle of coverage that healthcare administrators piece together daily. It’s a visual reminder that policies aren’t just abstract frameworks but systems that affect real people’s lives and livelihoods.
Back in my downtown Edmonton hotel room, I reviewed my notes and reflected on the many voices I’d heard. Alberta’s dual practice policy represents a significant shift in how healthcare delivery is structured in the province—one that carries both promise and peril.
What became clear through these conversations is that success will depend not just on the policy itself, but on robust oversight, continuous evaluation, and a willingness to course-correct if unintended consequences emerge. For Albertans waiting in pain for surgeries, the clock is ticking, and the hope of faster care is powerful. The question remains whether this approach will deliver on its promise without compromising the equity and universality that Canadians have long considered fundamental to their healthcare system.
