Insiders Detail Ways Alberta’s For-Profit Surgery Push Is Failing

Posted on November 17, 2025 in Health Debates

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TheTyee.ca – News
17 Nov 2025.   By Charles Rusnell

The shift strong-arms doctors but hasn’t saved money or shortened waits for critical operations, sources say. A Tyee investigation.

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Dr. Ken Cheung struggles for a few seconds to describe how he views himself within Alberta’s rapidly privatizing health-care system.

“I feel like I’m a conscientious objector,” said Cheung, an anesthesiologist for 25 years at Calgary’s Foothills Medical Centre.

As a supporter of public health care, Cheung said he objects to a policy that requires him to work in one of Alberta’s private, for-profit chartered surgical facilities, or CSFs.

Those CSFs are now churning out tens of thousands of surgeries, mostly in Calgary and Edmonton, every year under a United Conservative Party government.

Cheung, who is nearing full retirement, and another Calgary anesthesiologist, with decades of work ahead of her, have so far avoided being forced to work in CSFs by trading shifts with colleagues.

Both said they resent being directed to help establish the for-profit surgery industry in Alberta when there are clear signs it is undermining the timely care of patients in the public system.

“I am not working in those facilities because I find it morally inappropriate to do so, and I don’t want to be part of that,” the second anesthesiologist said.

On Friday, the UCP government doubled down on its CSF strategy, announcing it would be funding an additional 50,000 procedures over the next three years in chartered surgical facilities “to reduce surgical wait times.”

But a Tyee investigation found:

“There is an anesthesiology shortage,” said one former senior health executive who had urged the prioritization of critical surgeries.

“But they [the UCP government] did not want to slow down the volume of surgeries in CSFs, and the problem just got worse.”

While some wait-lists for simple surgeries have been marginally reduced, sources say, others for complicated surgeries, including for cancer, have been increased.

“Alberta Health didn’t seem to care who gets surgery,” said Dr. Braden Manns, a former vice-president of Alberta Health Services, or AHS. “They care about how many surgeries get done in a year.”

Climate of fear

To report this story, The Tyee interviewed, in addition to the Calgary anesthesiologists, four former senior AHS executives with direct knowledge of the introduction and management of the UCP government’s Alberta Surgical Initiative. An anesthesiologist and a surgeon in Edmonton provided background information but declined to be interviewed.

The surgical initiative is a policy to expand the use of private surgical facilities for cataract, podiatry and particularly orthopedic surgeries such as knee and hip replacements in an attempt to reduce chronically long wait times.

Most spoke on condition of anonymity because they variously said they were bound by non-disclosure agreements or feared it would affect their current or future employment.

All referenced a climate of fear within the health-care system, engendered by a string of high-profile dismissals, including the entire AHS board of governors — twice — and former CEO Athana Mentzelopoulos, whose wrongful-dismissal lawsuit has spurred a criminal and several other investigations.

Three former executives independently described a culture in which some senior government politicians and their staff displayed open mistrust of data and advice. They also describe an ideologically based “hatred” for AHS, the giant organization that for more than a decade managed the province’s public health-care system.

The government is in the process of dismantling AHS and replacing it with multiple agencies, which health policy experts and staff have said is unnecessary and is causing chaos.

“We would bring the data to the ministers and deputy ministers and senior staff but they didn’t trust AHS, they didn’t trust us, and they didn’t want to listen,” said one former senior AHS executive.

“So part of it is ideology, part of it is that no matter what you said to them, they didn’t believe it. They didn’t care.”

Studies challenge the value of the private surgery industry

The Tyee investigation reflects several of the main findings of a Parkland Institute report by Andrew Longhurst, a B.C.-based health researcher.

The report detailed how the expansion of private surgery had — as forewarned by health policy experts — siphoned funding and a scarce pool of critical staff, including anesthesiologists and operating room nurses, from the public system, increasing wait times for cancer and other priority surgeries.

Most troubling for Longhurst was his finding that the number of surgeries in public hospitals was lower than even before the pandemic.

In dismissing the report, Alberta Primary and Preventative Health Minister Adriana LaGrange called the Parkland Institute the “unofficial research arm of the NDP.”

“The use of chartered surgical facilities has played a key role in reducing wait times and improving patient care, yet these successes are often dismissed or downplayed in favour of an ideological stance that does not reflect the actual progress we have made,” she said.
 LaGrange did not respond to an interview request.

The Tyee has obtained another as-yet-unpublished review by a health researcher and two Alberta doctors. The review is based in large part on internal AHS data, supplemented by national data.

It shows the private surgical initiative has marginally reduced wait times for “low-acuity” surgeries such as cataracts and knee replacements, but it has increased wait times for complex cases in the public system, creating “potential inequalities in access and resource strain on acute care centres.”

When the UCP government of former premier Jason Kenney first introduced the Alberta Surgical Initiative in 2019, health policy experts warned the CSFs would skim off the easy surgeries while creating bottlenecks in the public system, which would be left to deal with the more difficult surgery cases.

That is what the new review found. Low-acuity, high-volume day surgeries conducted in CSFs now make up more than 20 per cent of insured surgical procedures in Alberta, and up to 30 per cent in urban centres.

Meanwhile, wait times for nearly all critical cancer and other surgeries are far outside acceptable wait-time standards.

Legislative changes have enabled aggressive expansion of contracting and volumes, but the review said “questions remain about the ability of such an approach to maintain quality, sustainability, and equitable access, especially in areas requiring complex care co-ordination.”

The initial plan for rolling out the Alberta Surgical Initiative was multi-pronged but largely focused on an expansion of both public system capacity through infrastructure investments and the contracting out of surgeries to private, for-profit providers, some with their own purpose-built facilities.

But the expansion of the public system was quickly abandoned and the government set a volume target of 30 per cent of all surgeries within private facilities.

“There was no evidence to support that,” one former executive said, adding that there was no planning for whether the private system could accommodate that volume or what the domino effect might be on the public system in terms of staffing and other resources.

“They just said they want to have a third of the volume being done in private facilities.”

Political directive

At that time, there were about 290,000 surgeries each year in Alberta, and about 38,000 — 13 per cent — of those were done in private facilities, a large proportion of which were cataract surgeries. That figure jumped to about 65,000 by 2025.

The government, in part, increased the volume of private surgeries by directing senior executives to preferentially schedule anesthesiologists, and surgeons, in some cases, in CSFs.

There was, and still is, a chronic shortage of anesthesiologists in Alberta. Faced with a directive to implement the surgical initiative, AHS executives knew many anesthesiologists would prefer to work in CSFs.

CSF patients generally are in comparatively good health, their cases are routine and less stressful, and since anesthesiologists are paid by the case, they would make more money in the private system.

“Once the decision was made that these things have to operate, and in fact, they have to operate preferentially to the hospitals generally, then there are two ways that can happen,” said Manns, the former AHS vice-president.

“You can just do what we often do, which is let the doctors do whatever the hell they want… or you could control the schedule and say, ‘No, if you want to work, you have to work where we say you work.’ And that is how we generally do it with most of our call schedules,” said Manns.

This caused unhappiness both for those doctors who wanted to work in CSFs and for those who didn’t.

“But then, does it make sense for governments to tell you that you have to preferentially staff out the CSFs first? No, of course not, but we had been given direction to do that,” said Manns.

In Edmonton, there was no consistent co-ordinated citywide scheduling, former Alberta Medical Association president Dr. Paul Parks said.

Each hospital group of anesthesiologists collectively scheduled for their own hospitals. But anesthesiologists were free to work in CSFs. That caused friction because those anesthesiologists would be less available for hospital shifts, and the more difficult surgeries, Parks said.

A former senior executive said the scheduling of anesthesiologists became a political issue, and that political directives were issued.

As the CSFs ramped up surgeries to meet contracted volumes, schedulers struggled to balance the necessity of staffing public hospitals for critical surgeries, including emergency trauma surgeries.

Manns confirmed this.

The schedulers “would try to allocate anesthesiology out to the CSFs — after they had filled the need for acute care,” he said.

But then the CSFs fell behind on their contractual surgery volumes.

“It came to a head where the CSFs complained,” the former senior AHS executive said. “They complained to AHS, they complained to the department heads, and as they typically do, they complained directly to the government, and then the government put their thumb on AHS.”

Two former executives said the schedulers were directed by government officials to provide more resources to the CSFs.

Glitches in private surgery initiative

For all its many faults, Alberta’s health-care system for years had an excellent data system, which generated analytics for tracking performance in all sorts of areas, including waiting lists for specific surgeries and staffing issues.

By 2020, about a year after the launch of the Alberta Surgical Initiative, the government’s own data showed problems were starting to emerge. By September 2024, the data was irrefutable, a former senior executive said.

In confidential monthly briefings and in briefing notes, senior former executives told the AHS board that the major shift to private surgeries was not working.

The first red flag was workforce issues. They told the board they could not fill vacancies for anesthesiologists in Calgary and Edmonton. And, traditionally, there already was a 10 per cent to 12 per cent vacancy rate for nurses.

“The more that they opened up these private chartered surgical facilities, the more staff went out of the public system, and the gap just grew bigger. We just didn’t have enough staff to fill operating rooms in the public system.”

The next red flag was wait times.

“We started to see that cancer wait times were increasing while hip and knee and cataract wait times were decreasing. We all want all wait times to decrease, but you don’t want to be waiting longer for your cancer surgery than you do for your cataract surgery.”

Another red flag was the morale of staff in public hospitals.

Data showed hospitals like the Foothills in Calgary were taking longer to do surgeries, which made them look inefficient. But they were consistently dealing with more difficult, more complex cases.

“It is harder to work in the public system when you have no easy cases,” the former executive said, echoing what other executives told The Tyee.

As waiting lists for critical surgeries grew, it created an ethical dilemma, but not, apparently, for the government.

“The government has said the sickest and those needing the surgery the most should go first,” a former senior executive said. “But because of this overuse of CSFs, we started to see those who were the healthiest weren’t waiting the longest — they were jumping the queue.”

Government ignores warnings

Even before September 2024, the former senior AHS executives told the board that private surgeries should not be expanded further. Instead, there needed to be more investment in public hospitals to address the problem of growing wait times for critical surgeries, and the growing staffing issues.

Bleeding Money: Alberta’s Private Health Shift – https://thetyee.ca/News/2025/04/02/Bleeding-Money-Alberta-Private-Health-Shift/

Several former AHS executives said the board was repeatedly told that further expansion of private surgeries would not reduce wait times and would not save money.

“The government has claimed up and down that we didn’t provide costing to them,” one former executive said. “But there was so much costing done.”

They also evaluated whether CSFs were performing surgeries at lower costs than public hospitals. Again, as foretold by health policy researchers, they found orthopedic surgeries performed in CSFs cost more, in some cases by as much as 50 per cent. The Globe and Mail first reported on the higher costs at the Alberta Surgical Group facility in Edmonton.

“The government committed to releasing the cost of surgeries in private facilities — and then they didn’t,” said one executive. “So where is the costing? They need to release the full costs.”

The warnings fell on the ears of a succession of UCP health ministers and senior political staff who either refused to listen or dismissed outright what they were told. Four former executives told The Tyee that they encountered open mistrust from the politicians and their staff.

Several former executives said there was an irrational hatred for AHS.

The minister and her staff also refused to heed warnings about the knock-on effect of indiscriminate cuts.

“The advice we were trying to provide is that you can’t go in and make what you think is a surgical reallocation or cut unless you understand all of the ways that it is linked to other parts of the system; it is called process mapping,” one former executive said.

“You have to do process mapping because, for example, if you terminate somebody who is monitoring a computer that is receiving referrals, those referrals go off into the ether.

“So we said, ‘You should not do your refocusing without first having done the foundational work in terms of process mapping’… and that was very unwelcome advice.”

Private surgery initiative not supported by evidence

The Pain-Racked Patients Alberta’s Orthopedic Surgery Centre Won’t Take – https://thetyee.ca/News/2025/04/14/Alberta-Orthopedic-Surgery-Centre/

There is an obvious question for the former executives who were directed to implement the UCP government’s expansion of for-profit surgeries.

Before the initiative was launched, what, if any, evidence was there from studies that showed CSFs had reduced costs and wait-lists and improved patient outcomes in any of the other jurisdictions that already had hybrid public-private surgery systems?

The answer was: None. There were no studies, no evidence.

“The evidence will tell you that those places with for-profit facilities don’t do more surgeries because they are using the same surgeons and the same anesthesiologists as in the public system,” a senior former executive said.

In Quebec and Ontario, where governments have released data in response to freedom of information requests, the surgeries performed in for-profit facilities have been shown to be “two or three times as expensive for such operations as cataracts and knees.”

“I mean, it is not as if Alberta is unique. It has not been able to make it work either.”

Charles Rusnell is an independent investigative reporter based in Edmonton.

https://thetyee.ca/News/2025/11/17/Alberta-For-Profit-Surgery-Push-Failing/?utm_source=weekly&utm_medium=email&utm_campaign=171125

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