Private vs Public Surgeries
Where is Alberta after spending Public Dollars to increase Private Surgeries
Are private surgical companies making hip, knee, and shoulder surgeries more available to the public? How does this affect complex surgeries?
Availability of Hip, Knee, and Shoulder Surgeries via Private (Chartered) Facilities
In Alberta, chartered surgical facilities (CSFs), privately owned but publicly funded clinics, have been increasingly used since the 2019 Alberta Surgical Initiative (ASI) to perform routine orthopedic procedures like hip replacements, knee replacements, and shoulder surgeries. These are fully covered by public health insurance, with no out-of-pocket costs for patients (unlike fully private pay options).
On November 14th, the Alberta Government announced:
https://www.alberta.ca/acute-care-action-plan
Quick facts: *Taken from the Alberta Government Website)
In 2024-25, 318,920 surgeries were completed in Alberta, higher than the original target of 310,000 and a 4 per cent increase from the previous year.
Alberta continues to perform better than the national average for wait times in four areas: hip replacement, hip fracture repair, knee replacement, and radiation therapy. *Not true
Alberta has exceeded its own 2019 performance in the percentage of patients receiving hip, knee, and cataract surgeries, as well as MRI scans, within the recommended wait time benchmarks. Additionally, wait times for knee surgeries remain the same.
Alberta now has a record 12,769 physicians registered to practice across the province, an increase of 643 from last year.
Physician growth now exceeds population growth, with increases recorded in all five health zones. *Not all physicians registered are practicing in Alberta, many are licensed here, but come in to cover other Doctor’s leaves - Locums in Emergency Rooms.
There are currently 8,764 acute care beds in Alberta.
Goal:
Delivering 50,000 additional surgical procedures over the next three years by leveraging chartered surgical facilities to expand operating room capacity to reduce surgical wait times. *these are primarily day surgeries and patients are sent home to recover.
Targeted investments at the Royal Alexandra Hospital to enhance triage, speed up patient flow, and help patients move efficiently through the system.
Questions:
Are they are going to open up the Orthopedic Center for operations?
Are any of the doctors coming to practice in Alberta full time?
Are any of the doctors Anesthesiologists? There is a shortage with many of these working in private CSF’s.
Are all the doctors registered in Alberta actually working in Alberta and if so why are there so many emergency and OB Gyn Centers closed all the time.
See YYCCowboy and Frazzlehead’s weekly Substacks on hospital closures/wait times in Alberta.
Increased volume in CSFs: CSF orthopedic surgeries have grown significantly. For example, contracted volumes rose approximately 48 - 55% from 2018-19 to 2023-24, with CSFs handling between 4,100 - 65,000 procedures annually in recent years (depending on the category; overall CSF surgeries reached about 65,720 in 2025 projections). Total provincial orthopedic surgeries hit about 35,000 in 2023 - 24 (up about 2,800 from the prior year and 5,000 above pre-pandemic).
Government rationale: The UCP argues this adds net capacity by offloading straightforward, low-risk cases from public hospitals, allowing more procedures overall without building new public ORs immediately. (Even though the Royal Alex Orthopedic Center is not being used at capacity, partially because Acute Care/formerly Alberta Health via Alberta Health Services fails to pay internists $250,000 to run it for 6 months)
July 3, 2024 - 90 surgeries postponed:
December 15, 2024 - 1000 surgeries affected by the government’s refusal to fund the Royal Alex Orthopedic Center, failing to fund it for $240,000 to pay internists to provide coverage for 6 months.
Has this made surgeries more available (shorter waits)? Mixed evidence, leaning toward limited or no net improvement for most patients:
Some recovery post-COVID peak (e.g., hip waits down from 38 weeks in 2022 to approximately 19 weeks in parts of 2025), but overall waits for hips/knees remain longer than pre - 2019 in many metrics, and Alberta ranks poorly nationally.
Critics (e.g., Parkland Institute reports, 2023-2025) argue CSFs have not reduced waits meaningfully because they compete for the same limited pool of surgeons, anesthesiologists, and nurses — often poaching staff from public hospitals with better hours/pay.
Impact on Complex Surgeries
The core government strategy is to shift routine orthopedics to CSFs, theoretically freeing public hospital ORs for complex cases (e.g., revisions, trauma, cancer-related orthopedics, or multi-procedure/comorbid patients that require ICU/overnight stays).
Negative effects observed:
Public hospital surgical volumes declined ~1 - 12% while CSF volumes rose, as staff migrate to private clinics for predictable 7 - 5 schedules vs. public hospitals’ emergencies and long shifts.
This has left some public ORs underutilized due to staffing shortages, worsening access for complex/urgent cases (e.g., increased diversions for emergencies like appendicitis; rising waits for cancer surgeries — lung +48%, colorectal +8%).
Private clinics “cherry-pick” healthier, low-risk patients (no emergencies, no complex comorbidities), leaving hospitals with harder, costlier cases but fewer resources.
Overall assessment:
For straightforward hip/knee/shoulder cases, CSFs provide an alternative pathway and have increased raw procedure numbers in some years, but wait times have not consistently shortened and remain among Canada’s longest in many categories.
For complex surgeries, the shift has often had the opposite effect: destabilized public hospitals, longer waits for non-routine cases, and higher costs (private procedures 50 - 133% more expensive per case in documented contracts).
Independent analyses (Parkland Institute, CIHI data) conclude the ASI has diverted resources without net gains in capacity or timeliness, while government data emphasizes volume increases and blames COVID/population growth.
Alberta continues to expand CSFs (e.g., new contracts in 2025 targeting more orthopedics), but evidence to date shows limited success in broadly improving public access.
Wait Times Comparison for Hip, Knee, and Shoulder Replacement Surgeries (as of late 2025)
The pan-Canadian benchmark for hip and knee replacements is 26 weeks (182 days) from the decision to treat (specialist consultation) to surgery. Shoulder replacement (rotator cuff repair or arthroplasty) is not a nationally tracked priority procedure like hips/knees, so data is less standardized and often grouped under broader orthopedic categories. Wait times are typically reported as:
% completed within 26 weeks (higher = better access)
Median or 90th percentile wait in weeks (lower = better)
Data sources: Canadian Institute for Health Information (CIHI) reports for April–September 2024 (latest national comparison, released 2025), provincial dashboards (Alberta Surgical Initiative, BC Surgical Wait Times, Ontario Health Wait Times), and secondary analyses. National averages for 2024: ~68% of hips and ~61% of knees within benchmark (still below pre-pandemic ~75%/70%).
Key Observations
Alberta ranks among the worst nationally for % within benchmark (especially knees), despite volume increases via chartered surgical facilities. Waits have improved slightly since the COVID-19 peaks but remain longer than pre-2019 for many patients.
British Columbia performs better than Alberta but has regional variations (e.g., Interior/Vancouver Island longer). Centralized referral helps, but overall orthopedic waits are mid-pack nationally.
Ontario (including Ottawa region) consistently has the shortest waits and the highest % meeting benchmark, due to efficient centralized intake, higher surgical volumes, and better resource allocation. Ottawa-specific data (e.g., from The Ottawa Hospital) aligns closely with provincial averages.
Shoulder data is patchier; waits generally follow knee/hip patterns, but can be longer for complex revisions. No province routinely meets the benchmark for 90%+ of patients.
Wait times fluctuate by hospital, surgeon, patient priority, and season. For the most current individual hospital data:
Alberta: albertahealthservices.ca/wait times
BC: swt.hlth.gov.bc.ca
Ontario: ontariohealth.ca/wait-times
Chartered Surgical Facilities (CSFs) in Alberta Performing Orthopedic Surgeries
Alberta has dozens of accredited non-hospital surgical facilities (also called chartered surgical facilities or CSFs), most of which focus on lower-volume or specialized procedures (e.g., ophthalmology, plastics, dental/oral, gynecology). As of late 2025, the province has approximately 48 active CSF contracts for publicly funded (insured) surgeries, though the exact number fluctuates with new approvals and renewals. The full list of all accredited CSFs (not just contracted ones) is maintained by the College of Physicians and Surgeons of Alberta (CPSA) and was last updated November 7, 2025 (a 6-page PDF listing ~50-60 facilities province-wide, including many non-orthopedic ones).
However, only a small number of CSFs are contracted to perform high-volume orthopedic procedures such as hip replacements, knee replacements, and shoulder surgeries (which are resource-intensive and require overnight stays in some cases). These contracts expanded significantly under the UCP government’s Alberta Surgical Initiative (2019) and subsequent Refocusing on Health reforms (2023–2025). Contracting authority shifted from Alberta Health Services (AHS) to Acute Care Alberta (ACA) on April 1, 2025. (These Contracts are what Athana Mentzalopolous was investigating)
Key CSFs Contracted for Hip, Knee, and Shoulder (Orthopedic) Surgeries
Notes on the list:
The above are the primary facilities handling the bulk of contracted orthopedic outsourcing as of November 2025. Many other CSFs (e.g., oral surgery, ophthalmology, or plastics-focused) do not perform hip/knee/shoulder replacements.
No major new high-volume orthopedic CSFs have been announced or opened in rural/northern Alberta yet; most capacity remains in Calgary and Edmonton.
In November 2025, Premier Danielle Smith announced further expansion of CSF contracts (targeting 50,000 additional surgeries over 3 years), but specific new facilities or locations were not named.
https://albertasurgicalcentre.ca/
https://surgicalsolutionsnetwork.ca/locations/calgary-ab-rockyview/
https://www.southlandsurgical.ca/
Background on Contracting and Expansion
CSFs have existed in Alberta since the 1990s (initially ~43 under contract pre-2019).
Expansion ramped up post-2019 Alberta Surgical Initiative to address backlogs: RFPs issued in 2020 – 2022 for Calgary/Edmonton (orthopedics/ophthalmology), then South/Central zones.
By 2023–2025: Focus shifted to orthopedics due to the longest waits; contracts now emphasize “net public benefit” (e.g., freeing hospital ORs).
Costs and volumes: Orthopedic procedures in CSFs often cost 50–133% more per case than in public hospitals, with total public payments to CSFs rising from ~$28M (2022–23) to ~$56M (2023–24).
Growth outpacing public hospitals: Between 2018–19 and 2022–23, public payments to CSFs rose 66%, while public hospital operating-room expenditures grew only 12%.
Volume of surgeries: CSFs performed about 15% of Alberta’s annual surgeries (approximately 44,000 out of 290,000 in 2020), with orthopedic procedures being a major focus.
In Summary
The Alberta Surgical Initiative (ASI), launched in 2018–19, aimed to reduce wait times by outsourcing more procedures to CSFs.
However, reports from the Parkland Institute argue that this shift has not improved overall surgical capacity or wait times for most priority procedures, while costs have escalated.
Former Alberta Health Services CEO Athana Mentzelopoulos alleged that contracts with CSFs were extended under political pressure despite concerns about inflated prices.
Implications
Financial strain: The doubling of payments in one year suggests that outsourcing is becoming a major budgetary burden.
Equity concerns: Since CSFs handle routine, lower-complexity procedures, the higher costs cannot be explained by case complexity.
Policy debate: Critics argue that diverting funds to CSFs undermines investment in public hospitals, potentially worsening wait times in the public system.
So where do we go from here? This is a private system within Public Health Care - much like a Soveriegn Alberta within a United Canada. We can’t fix it overnight, but we can look at funding our public system with public dollars - the same argument that is being put forth for Education.
For the most current full accredited list (all CSFs, not just orthopedic), download the CPSA PDF here: https://cpsa.ca/FacilityListing/Accredited%20Facility%20Listing_NHSF.pdf (as of Nov 7, 2025). Active contracts are posted on the Acute Care Alberta site (acutecarealberta.ca). If you need details on a specific facility or zone, let me know!
You are right Doug, we have to bring awareness to the masses.
tRump wannabe Smith and her yahoo party are privatizing Health Care based on the USA model. Screw patients it is all about profits for the capitalists.