Alberta's minister of hospital and surgical health services, Adriana LaGrange, has introduced a dual-practice model that allows some surgeons to work in both the public system and private-pay facilities simultaneously. The model aims to provide elective care options for patients while keeping them within the province, but federal Health Minister Marjorie Michel is skeptical about its compatibility with the Canada Health Act. Legislation passed in December created a new category of "flexibly participating" physicians, mainly surgeons, who can do publicly funded work and private paid procedures on a case-by-case basis. Currently, 15 doctors in Alberta only perform private work, while others stay within the public system.
Written by the local model on 2026-09-04,
using this article's own text rather than the other coverage of the
same event (that is the story summary below).
Can Ottawa and Alberta actually work together?
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Ottawa → work → ?
Adriana LaGrange is not waiting for permission.
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LaGrange → wait → 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.
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province → roll → time
The question hanging over it is not just whether the model works.
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model → hang → it
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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sides → drop → something
When I catch up with LaGrange in late August, she is not in campaign mode.
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she → catch → mode
Legislation passed last December created a new category of “flexibly participating” physicians, mainly surgeons.
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Legislation → pass → physicians
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.
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they → start → basis
Emergency care, cancer treatment and family practice stay fully public.
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care → stay → ?
Right now, she says, Alberta has two camps: physicians who are “fully opted out” or “fully opted in.”
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who → say → camps
She puts the opted-out group at about 15 — doctors who do only private work.
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who → put → work
Everyone else stays inside the public system.
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Everyone → stay → system
Dual practice is the attempt to stop the binary.
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practice → stop → 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.
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Doctors → keep → facilities
At first, those will be accredited non-hospital surgical facilities.
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those → accredit → ?
The Alberta Medical Association neither endorses nor opposes the plan.
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Association → endorse → 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.
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lane → spend → ability
LaGrange says that is her test too.
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that → say → ?
“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.”
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we → want → system
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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they → say → surgeries
Her pitch: Albertans already leave the province — and the country — for these surgeries.
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Albertans → leave → 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.
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provinces → fly → surgeries
It just doesn’t make sense.”
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It → 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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that → keep → care
She keeps drawing the line.
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She → keep → 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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that → emphasize → that
Federal Health Minister Marjorie Michel is not convinced the model fits the Canada Health Act.
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model → convince → 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.
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practice → tell → Act
Her office confirmed a July 24 letter asking Alberta to protect the public system.
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office → confirm → 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.
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provinces → report → charges
That is where the relationship gets tested.
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relationship → test → ?
LaGrange says Alberta had already sent Ottawa the draft regulations “and some of our thoughts around the safeguards that we’re putting in place to protect the public system.”
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we → say → system
The letter back, she explains, was that Ottawa would “monitor,” had “some concerns that it may not adhere to the spirit of the Canada Health Act,” and that the two departments should keep talking.
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departments → explain → Act
Then came the Star piece.
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piece → come → ?
“That’s why I was quite surprised by the tone and somewhat implied threat of discretionary penalties.”
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I → ’ → penalties
She is still waiting for a straight answer.
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She → wait → answer
“From their perspective, they would say it’s not in keeping with the spirit of the Canada Health Act, and I keep asking for clarity on that.
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I → say → that
So that’s where I would say we differ, because I do believe it does keep with the spirit of the Canada Health Act.
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it → ’ → Act
The federal statute dates to 1984 and has never been rewritten.
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statute → date → 1984
Long waits, workforce shortages and private delivery already exist across the country under different provincial rules.
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waits → exist → rules
…and 21 more, not listed.
