opinion: why alberta’s medical clinics are going broke to keep you healthy
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community medical clinics are a vital bridge for many people without family doctors.
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primary care in alberta is collapsing, and those who have held it together the longest are being left behind.
for years, a dangerous myth has persisted in the halls of the ministry of health and the alberta medical association (ama): that community medical clinics are simply private businesses that can “run thinner” to survive. as president of the alberta primary care clinic owners association (apccoa), i see the math every day. the reality is that these clinics are not just businesses; they are the essential infrastructure of our public health system. and right now, that infrastructure is crumbling.
the ama and the ministry recently touted the new primary care physician compensation model (pcpcm) as a 25 per cent raise that would rescue family medicine. it was neither. instead of stabilizing the system, the model shifted funding away from clinic operations toward direct physician payments. while this might look good on a paystub, it destabilizes the very walls, staff and technology required to actually see a patient.
the myth of the greedy owner
there is a narrative that clinic owners are raking it in. in reality, many owners in alberta now take home less than the associate physicians they support. at the end of their careers, physicians who have acted as stewards of public healthcare infrastructure are going broke. they have poured their personal savings and thousands of hours of unpaid labor into keeping doors open, believing that eventually, the system would fix what’s broken.
that faith has not been rewarded.
in a single-payer system where the government sets every fee, calling a clinic a traditional private business is a fantasy. we are infrastructure providers in a publicly funded system, yet we are expected to absorb soaring inflation, rent and staffing costs while our fees remain lower than they were five years ago.
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alberta primary care clinic owners association
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why the 80/20 split is a slow death
the medical community is currently obsessed with “percentage splits”—the portion of billings a doctor keeps versus what they pay the clinic for overhead. the popular 80/20 model is often a death knell for quality care. to make those numbers work, you have to strip a clinic to the studs.
nursing teams are cut, minor procedure rooms are shuttered because sterilization is too expensive and administrative burdens shift back to the doctor, who ends up charting until midnight instead of seeing patients.
at my clinic, callingwood crossing, we use a 70/30 split. that 30 per cent isn’t profit; it’s an investment in ai tools, billing experts, and onsite diagnostics. this support allows physicians to actually be physicians. when we starve the infrastructure, we starve the care.
a dereliction of duty
under the medical profession act, the ama has a duty to represent all physicians. yet, when apccoa met with ama leadership, they claimed a “conflict of interest” in representing both clinic owners and associates. this is a distinction without a difference. you cannot have primary care medicine without a place to practice it.
by refusing to advocate for a dedicated infrastructure funding stream, similar to what hospitals and surgical centres receive, the ama is failing the very foundation of the system. their recent programs have bypassed clinics entirely, pitting colleagues against each other and forcing owners to absorb massive financial losses.
the stakes for albertans
between one and two million albertans no longer have a family doctor. this isn’t just a matter of convenience; it is a matter of life and death. the evidence is overwhelming: albertans with a regular family physician live longer, have lower rates of cancer and heart disease, and stay out of overcrowded emergency rooms.
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if the ministry and the ama continue to ignore the financial crisis facing clinic operators, the closures will accelerate. younger doctors have no interest in buying into a failing business model, and older physicians are being forced into bankruptcy or early retirement.
we don’t need more “webinars” or “templates.” we need a dedicated infrastructure fund for community clinics, formal recognition of physician-owned clinics as essential public infrastructure and the inclusion of clinic owners in compensation negotiations.
healthcare is not free; it is funded by taxpayers. when millions of albertans cannot access a doctor because the clinic down the street couldn’t pay its power bill, the system isn’t just broken, it’s a betrayal of the public trust. if the clinics fail, primary care fails. and if primary care fails, alberta’s healthcare system fails with it.
dr. andrew kohler, md ccfp, is the president of the alberta primary care clinic owners association (apccoa) and a clinic owner in edmonton.
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