Alberta patients no longer have to wait for MRI, CT scans, ultrasounds, and X-rays, if they are willing to pay for the tests themselves. Patients also no longer need a referral to access scanning.
Canadian Doctors for Medicare , Friends of Medicare , and the Alberta Medical Association warn that Alberta’s changes undermine medicare, that self-pay and self-referral will increase costs, worsen wait times and expose patients to unnecessary risks.
In reality, critics seem to care most about protecting the medicare system, not improving patient care itself. They make hypothetical arguments and reference isolated cases of poorly designed health care.
Alberta has forced a debate: do we care most about patient care or medicare?
Certainly, no one copies Canadian health care anymore. We have the last government monopoly single-payer system that eschews private medical insurance, a holdout in a crowd of better options. Indeed, given the critics’ warnings, it’s a wonder that the 30 other high-income universal healthcare systems in the world function at all. Somehow, they have minimal wait times , universal care, lower costs and cover medical appliances and medications, not just medical services.
These critics argue Alberta will divert doctors, nurses and technicians to work in the private sector, increasing wait times in the public system. They warn that patient self-referral will create false positive tests, adding work for the public system to sort out. They believe that only physicians and nurse practitioners should order tests; patients cannot decide on their own. They argue that Alberta should instead improve system efficiency by training more staff, expanding digital solutions, purchasing more medical equipment and adopting central referral systems.
Finally, critics claim that self-referral and self-pay normalize direct access, which could push Canada toward a two-tier U.S.-style approach to health care.
What’s really going on?
Certainly, Canada faces healthcare staffing challenges. But the idea that medical professionals are abandoning Canada for private-pay systems is a bait and switch. Staff shortages often exist because the strain of working within the current medicare system drives professionals out of practice. For instance, a 2025 study found that nearly 40 per cent of all Canadian nurses under 35 quit the profession within five years of graduation citing complaints including involuntary overtime, high stress and working conditions.
When Canadian medical professionals do leave for the U.S. or beyond, it is often not by choice. For instance, The Globe and Mail reported in 2019 that nearly one in five specialist doctors couldn’t find full-time work in Canada after graduation: “Those who want to practice can’t get their foot in the door,” said a senior official with the Royal College of Physicians and Surgeons of Canada.
Surgeons with hospital privileges in Canada can only access a fraction of the operating time available per surgeon in the past. Dr. Brian Day wrote that in the 1990s, surgeons in B.C. had more than 22 hours of operating room time per week plus unlimited access while on call after-hours. Today, they have less than five hours per week and must ask permission before starting any emergency operation after-hours.
Meanwhile, Canadian doctors are experiencing higher levels of burnout compared to their international peers. Pre-pandemic, the average retirement age for Ontario community physicians was 70.5 years. Post-pandemic, it’s closer to 55.
Fear of losing health-care workers assumes a zero-sum, fixed-pie system: gains in one area can only come from losses somewhere else. This assumption rests on the logic that the only way to increase care is to spend more, train more and hire more clinicians.
This zero-sum assumption is false. Saskatchewan’s Surgical Initiative offers a case in point. They used private, for-profit clinics to deliver medically necessary care. As a result, between 2010 and 2014, provincial wait times dropped from 26.5 weeks down to 14.2 weeks, with private clinics costing 26 per cent less for the same procedure as delivered in the public system. Patients got more access, closer to home, with shorter waits, because Saskatchewan allowed blended funding.
Finally, worries about self-referral increasing demand on public resources are a stretch. A clinician can see, examine and reassure a patient that her headache is most likely a migraine or tension headache, if she already has a self-paid normal MRI result. It takes far more time, follow-up appointments, referrals to specialists and publicly funded tests to reassure someone she does not have a brain tumour.
Most patients seek faster access to a test because their physicians told them they needed it.
Wealthy people have accessed more tests with shorter waits for three decades in Canada. We’ve lost the moral high ground. It’s time to move past fear-mongering.
Given long wait times, most Canadians support access to care outside medicare. Alberta’s policy change puts patient care first, while protecting the public system. Let’s hope the federal government doesn’t shut it down.
National Post
Dr. Shawn Whatley is a physician, author, and a Munk Senior Fellow at the Macdonald-Laurier Institute. A past president of the Ontario Medical Association, Whatley’s most recent book is When Politics Comes Before Patients – Why and how Canadian Medicare is failing
