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"Over the last five years, being a specialist clinic in Moose Jaw has been operationally and financially difficult," he wrote in the statement.

"In early January 2023, these mounting difficulties became a crisis."

Wilkinson said the clinic had a number of resignations due to its inability to pay competitive salaries and provide benefits. It also found it difficult to pay overhead expenses because it operates in a smaller city, about 70 kilometres west of Regina.

The clinic, he said, reached out to its local members of the legislature and the Saskatchewan Medical Association, and met with Premier Scott Moe and former health minister Paul Merriman.

"The rates the Saskatchewan Ministry of Health pays for common cardiac procedures are 20 to 45 per cent lower than both Alberta or Manitoba — which essentially explains why so few specialists call Saskatchewan home," said the statement.

As an example, the clinic said an electrocardiogram is paid at $34.33 per test in Alberta, while Saskatchewan pays $18.90 per test.

Wilkinson said his clinic's advocacy on improvements to fee-for-service rates hasn't received any response from the government or the Saskatchewan Medical Association.

No one from the Saskatchewan Medical Association immediately returned a request for comment.

Saskatchewan Health said in a statement that physicians are legally able to opt out of the publicly funded system and charge patients for services.

"However, this is the first time that a physician has chosen to opt-out," it said.

Wilkinson said he only had three paths forward: close the clinic and leave the province, see more patients and provide inferior care, or opt out of the public health-care system and charge patients.

"As of Oct. 2, 2023, our clinic is now private," said the statement.

"We charge patients directly for their health care. Our consultation rate is $350. Some patients have third-party health insurance which helps reduce or eliminate the cost paid out-of-pocket."

Wilkinson said many patients have chosen to continue using the clinic, which it said on its website has much lower waits than many other cardiologists in the province.

"If a patient is unable to pay, we offer a referral to another cardiologist or followup with their primary care provider if they choose," said the statement.

Saskatchewan Health said there is another cardiologist in Moose Jaw and 13 in Regina who practice within the public system, where payment is not required.

It added that rates for insured physician services are negotiated between its ministry and the Saskatchewan Medical Association, which includes "fair compensation for cardiologists while maintaining our competitiveness across Canada."

Although the Moose Jaw clinic is the first to opt out of the public system in Saskatchewan, there are several private clinics operating in Quebec, Alberta and British Columbia.

The ºÃÉ«tv Medical Association website notes that the vast majority of physicians practise within the public system, but that the Saskatoon Agreement of 1962 permitted doctors to opt out. It says physicians across the country, with the exception of Ontario, can do so.

Some provinces, adds the association, do have barriers in place to limit private practice. Saskatchewan, for example, only permits opting out when it does not compromise patient access to insured services.

This report by ºÃÉ«tvwas first published Oct. 20, 2023.

— By Colette Derworiz in Calgary.