Choosing your doctor’s care path
Alberta has introduced a “dual practice” healthcare system, permitting doctors to see patients through both public and private channels. The change began with surgical procedures but may extend to other specialties, establishing two levels of care.
Patients who can pay may avoid wait times that often exceed months. Others will remain in the public system, where demand exceeds available resources.
One clinic, two lines
A pediatrician in Alberta, writing under the pseudonym The Small Voice, described how the shift works in practice. During a recent discussion with a parent, the doctor outlined options for a child needing an ADHD assessment.
“I must disclose that we’re having this conversation because you asked about our private-pay option,” the doctor said. “I haven’t received the public referral from your family physician yet.”
The parent responded that the referral had been promised a month earlier. The doctor confirmed the public waitlist for an initial appointment could take six to eight months or more. Privately, the child could be seen immediately.
“You’re here now. Intake today. Follow-up in two to three weeks,” the doctor said. “And you pay.”
The parent asked why the clinic had started offering private services. The answer was direct: “Need it to keep the lights on.”
Rent and staff expenses had doubled since the pandemic. Public fees had not increased at the same rate. “If I stayed fully public, I’d be working to pay my staff and landlord, with nothing left over. Some months I’d actually lose money,” the pediatrician explained.
A system that struggles to meet needs
The parent, whose child was struggling in a classroom of 38 students, said the school provided no extra help. The family faced a choice between waiting months for public care or paying for private services.
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“She cries every morning. And every night. Sometimes during class,” the parent said.
The doctor understood the frustration. “Parents want the schools to step up, schools want the docs to step up. Every day, same thing, over and over again.”
If the family chose the public route, they’d wait until the referral was triaged and their name reached the top of the waitlist. The doctor noted that even then, there was no guarantee they would see the same physician. Privately, the process could begin immediately.
The parent asked what those who couldn’t pay would do. “I hear that every day… they wait,” the doctor said.
The doctor added: “Same clinic. Same doctor. Same child. Same care covered by provincial insurance, just faster. And you pay extra.”
The parent paused. “You said that out loud.” The doctor answered, “I had to. The new rules require it.”
The Alberta government has presented the dual practice model as a solution to reduce wait times while preserving public care. Opponents say it will worsen inequalities, giving quicker access to those who can afford it.
The change currently applies only to surgeries, though officials have suggested broader expansion. If that happens, the pediatrician’s experience may become common.
The Small Voice, whose identity and credentials have been confirmed, uses a pseudonym to avoid professional backlash. Some provinces have welcomed doctors from other regions facing similar pressures, but Alberta’s approach differs by allowing existing physicians to split their practice.
