Opinion: Fix health-care’s foundation before adding dual-practice

Universal health care is only meaningful if people can access it. In Alberta and across Canada, the care itself is excellent once you get into the system, but far too many people wait until they are sicker, older, or in crisis.

Article content

Reform is needed. If we want to fix the system, we must focus on the right parts, in the right order.

Article content

Recommended Videos

Article content

I’ve been an ER physician for more than 30 years and recently stepped down as board chair of Health Quality Alberta (formerly HQCA), the province’s non-partisan health data agency. I have reviewed Alberta’s performance data closely.

Together, we have lived through two major restructurings. In the 1990s, every province lost hospital beds, physicians, nurses, and health-care staff after cherry-picking from the Barer–Stoddart report.

In 2009, merging nine health regions into one created years of turbulence. The results were the same: instability, declining morale, staff departures, longer waits, unnecessary suffering, and higher costs.

Article content

Alberta has now undergone the largest restructuring in its history, dividing Alberta Health Services (AHS) into four new service agencies and new regional health corridors, during a major capacity crisis and amid massive population growth. On top of this, dual practice is being introduced. Supporters and critics are passionate, understandably.

Dual practice — allowing physicians to work in both the public and regulated private systems, is not inherently harmful; many countries use hybrid models effectively. The issue is timing and sequencing.

Reform is not the enemy; disorder is. In a stable system, dual practice can add capacity. In a strained, understaffed system, it siphons away the professionals needed to keep the public system afloat, leaving the sickest patients behind and worsening waits, inequity, and burnout, while benefiting those who can afford to pay.

Article content

Countries like Denmark, the Netherlands, Germany, and Australia are often cited as proof hybrid models can work, because those nations first built the foundation of a high-performing system:

1. Accessible, high-quality preventive and primary care;
2. Strong home care, rehabilitation, and continuing care;
3. Adequate acute-care capacity;
4. Integrated community-hospital data systems;
5. A stable workforce.

More importantly, none adopted dual practice as a quick fix in the middle of a system crisis.

You cannot take the “hybrid” while ignoring the “foundation.” That’s cherry-picking, which in a crisis can make the situation worse. Alberta built a strong health system for four million people, but we now have five million.

Article content

Every week in the ER, I see the human cost: seniors waiting months or years for basic care, parents spending all night in ERs with sick children, and families who cannot find a family doctor.

Recent AHS data shows that on any given day, roughly 1,400-1,700 of Alberta’s 8,700 acute-care beds are occupied by alternate level of care patients (ALCs): medically stable, fragile seniors waiting for community supports. That backlog forces hospitals to operate at 95-113-per-cent occupancy, far above the safe benchmark of 85 per cent.

This leaves urban emergency departments gridlocked with 50-80 per cent of ER beds filled with admitted patients. ER staff spend most of their time on admitted patients instead of new emergencies. The result is six-12-hour ER waits and eight-20 per cent of urban patients leaving without ever being seen. These are the markers of a system under extreme stress.

Article content

We absolutely need to restructure our health system, and that begins with prevention, primary care, and community care, the backbones of every successful system, all of which have been chronically under-resourced.

Investing here would prevent illness, reduce delays in care and hospital admissions, and save billions. Nearly one in five Albertans and Canadians has no family doctor, and those who do often wait weeks for appointments. Without strong primary care, people get sicker, ERs get busier, hospitals get fuller, outcomes worsen and costs escalate.

Community care for seniors, the frail, and the vulnerable has not kept pace with population growth. Caregiver burnout is widespread, and families are struggling.

Article content

Without readiness and proper sequencing, dual practice risks fragmenting the system even further. Guardrails may look responsible on paper, but guardrails do not create staff or capacity. Only investment, training, and retention can do that.

Alberta has the resources and talent to build a world-class health system. Let’s fix the foundation, repair the roof, and then renovate, in that order.

What we need is discipline and sequencing. Albertans’ lives depend on getting it right.

Dr. Raj Sherman is an emergency physician, former board chair, Health Quality Alberta (formerly HQCA) and former MLA.

Article content