Edmonton orthopedic surgeons are warning of widespread surgery cancellations in coming weeks due to a funding dispute over how Alberta compensates another group of hospital doctors.
Patient care disruptions are likely when stipend contracts for surgical hospitalists expire as of April 1, according to both the surgeons and provincial health officials. Surgical hospitalists manage pre-and post-operative care, allowing surgeons to remain in the operating room.
In a statement, officials from Acute Care Alberta say they are closely monitoring staffing levels to ensure surgical access is maintained after the stipend contracts come to an end.
“While we acknowledge there may be a need to reschedule some orthopedic surgeries in Edmonton due to potential changes to perioperative support, [Alberta Health Services (AHS)] and Covenant Health are actively working to enhance alternative support for perioperative care,” the agency said Monday in a statement to CBC News.
“Operating rooms will not sit empty; they will be used for other surgeries. If we receive formal cancellation notices from surgeons, we will support patients with rescheduling and arrangements for alternate care will be provided.”
Correspondence outlines concerns
The impending risk of surgical cancellations are outlined in a letter from Dr. Angela Scharfenberger, divisional director of orthopedic surgery at the University of Alberta Hospital and interim lead of orthopedic surgery in the Edmonton region.
An email sent by Scharfenberger to members of the orthopedic service was accompanied by a background paper and briefing note, dated March 13. The email stated those documents had been sent to Primary and Preventative Health Services Minister Adriana LaGrange and Hospital and Surgical Health Services Minister Matt Jones.
Scharfenberger has not responded to interview requests. Her correspondence was obtained Tuesday by CBC News and verified by four medical professionals in Edmonton who said they received it.
In the documents, Scharfenberger says the likely loss of surgical hospitalists would have “immediate and profound impacts.” These could include the closure of orthopedic inpatient services at multiple Edmonton hospitals, significant delays in trauma surgery, the cancellation of elective inpatient procedures, including joint replacement, and increased pressure on emergency departments and internal medicine services.
According to the documents, the impact would be most acute for inpatient orthopedic surgeries — that is, procedures for bone and joint repair that require extended hospital stays for recovery and rehabilitation.
“Following April 1, 2026, it is expected that inpatient orthopedic surgery across all sites in Edmonton would be cancelled due to the lack of safe medical co‐management and adequate acute care coverage,” Scharfenberger writes.
‘A compensation dispute’
When asked about the correspondence at the legislature Tuesday, Jones said the province has not received any formal notification from physicians that they plan to withdraw or change their provision of services following the contract change.
“No formal notification has been provided, but of course we’re planning in case there is some service withdrawal,” Jones said from the legislature on Monday.
“I hope that we get through what this is, which is a compensation dispute, and ultimately, that we put patients first on April 1.”
LaGrange’s press secretary said the minister declined to comment on Scharfenberger’s correspondence.
A letter sent by a group of doctors to two Alberta cabinet ministers last month, which was shared with CBC News, warns of possible surgery cancellations if a deal isn’t in place by April 1 to compensate hospitalists. Natasha Riebe has the details.
Changing model of payment
Hospitalists, many of whom are family physicians, are currently paid through a hybrid model that includes fee-for-service payments plus stipends. The latter were introduced in the late 1990s, according to Scharfenberger.
But the provincial government and Alberta Health Services are terminating the stipends in favour of “alternative relationship plans,” known as ARPs. Acute Care Alberta said Monday that the current stipend payments offered to hospitalists are outdated and inequitable.
Scharfenberger’s correspondence is dated about a month after surgical hospitalists in Alberta Health Services’ Edmonton Zone issued their own letter, warning provincial health officials about the end of the hospitalists’ contracts.
In her letter, Scharfenberger warns that if hospitalists are not working, the co-managed care model shared by orthopedic surgeons and surgical hospitalists will break down, making orthopedic inpatient services across Edmonton unsustainable.
“The Misericordia Hospital, Royal Alexandra Hospital, Orthopedic Surgery Centre and University Hospital all depend on hospitalist co‐management. Inpatient orthopedic elective surgery will cease,” Scharfenberger wrote.
“Without the surgical hospitalists co-managed care, orthopedic residents will need to be consolidated to a single site for call coverage. Trauma care delays and cancellation of elective joint replacement surgeries are expected.”
The letter states inpatient orthopedic services at the Misericordia would no longer be viable, as fracture care and joint replacement admissions would cease. Inpatient orthopedic services, including trauma and arthroplasty care, at the Royal Alexandra Hospital would also be paused.
The University of Alberta Hospital, she wrote, would become the sole functional inpatient orthopedic site in the Edmonton region and would rapidly become overwhelmed.
In their Feb. 11 letter, surgical hospitalists in the AHS Edmonton Zone said their work would no longer be financially viable without stipends.
The hospitalists said “immediate, unavoidable surgical cancellations” will begin in mid-March for safety reasons, as there won’t be enough staff to care for patients after their operations.
The result may be a situation where most of the roughly 65 Edmonton Zone hospitalists — each of whom is often responsible for dozens of patients on a given shift — are no longer doing the work.
‘Only part of the equation’
In an interview Tuesday, Dr. Paulose Paul, an orthopedic surgeon who has worked in the Edmonton Zone since 2002, said the documents were shared with members as doctors attempt to prepare for a significant strain on resources.
Without the support of hospitalists, Paul said surgical procedures will have to be cancelled or diverted to ensure patient safety.
“It’s hard to imagine that we’d be able to deliver the same amount of care with fewer bodies. So as much as [health officials] want to hang this on the contract, that’s only part of the equation.”
Paul said the compensation issues are part of a much larger resourcing crisis which has been escalating for years in Alberta hospitals as orthopedic patient loads grow larger and more complex.
“There’s been no accommodation for growth of the service as the population has expanded, as the service demands have expanded,” he said.
“And it’s something that we have been warning the government and administration about for over 15 years. And so to think that we’re going to find a 15-day solution is unrealistic.”
Risk and reward
In its statement to CBC News Monday, officials with Acute Care Alberta — the provincial health agency responsible for managing emergency, surgical and inpatient services — said the warnings were inaccurate and lacking in context.
Acute Care Alberta said the stipends, when first introduced, were intended as temporary recruitment tools for unpredictable clinical volumes. The government said maintaining these payments creates more risk, as they cause dissatisfaction among physicians who do not receive them.
Transitioning family physicians off stipends by March 31 follows recommendations from a joint working group and aligns with standard fee-for-service and on-call models used effectively across Alberta, Acute Care said.
According to Alberta Medical Association documents from 2017, stipends comprise 40 to 50 per cent of a hospitalist’s earnings. Acute Care Alberta said in its Monday statement that the figure is closer to 11 per cent.
The agency said it will be proactive in ensuring patient care is maintained. AHS and Covenant Health will rely on associate physicians, physician assistants and nurse practitioners to maintain surgical operations, said the statement.
“If there are areas where service disruption is likely due to a physician formally changing their practice, both AHS and Covenant Health would proceed to fill roles, as necessary,” it said.
