TORONTO – Ontario’s doctors, who have been without a physician services agreement for three years, are set to vote this weekend on a tentative deal that would send contract disputes with the government to binding arbitration.
Seven other provinces and the Northwest Territories set physician compensation through a binding arbitration process, but the Ontario government had rejected the doctors’ demand until reversing course earlier this year.
The Ontario Medical Association, which has about 44,000 members, reached the tentative deal on a binding interest arbitration framework last month, following a years-long dispute that saw doctors protesting in the streets, waging media campaigns and threatening job action.
The framework determines how the doctors’ next contract, and all subsequent contracts, will be settled – first there would be an effort at negotiation, and if a deal can’t be reached, they would go to mediation and then binding arbitration.
The Liberal government has angered doctors by imposing fee cuts for some services and clawing back their pay.
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Doctors voted down a proposal last summer that would have increased the approximately $12-billion physician services budget by more than $1 billion but also included $200 million in fee cuts. They dismissed another proposal last year, saying it was just a rehash of the previous offer.
Binding arbitration has been a sticking point in the long dispute.
There are divisions in the profession, however, with the OMA supporting the latest tentative agreement and some independent physician groups urging doctors to vote it down, saying it doesn’t go far enough.
OMA president Shawn Whatley said the tentative agreement allows the association to negotiate physician compensation through a fair and independent process.
“We’ve been asking for this for years,” Whatley said.
The provincial government appears to have made a significant concession in the agreement, a copy of which was obtained by .
According to a memo prepared by the OMA’s lawyers, the government initially sought a “hard cap” for the annual physician services budget, but eventually agreed not to include that provision in the tentative agreement.
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In previous years, the government capped the budget, which meant that when doctors collectively billed the government more than it budgeted for in a given year, the extra cost was clawed back from doctors’ pay – a move unpopular among doctors.
Under the tentative deal, how cost overruns are dealt with will be negotiated.
“In the past, the government was able to act unilaterally and say this is what we’re prepared to pay and not a penny more,” Whatley said.
“With this offer, that ability to act unilaterally is removed. We have rebalanced power.”
However, a coalition of independent physician groups that led a successful campaign to vote down the last agreement on compensation the OMA reached with the province argue the binding arbitration agreement isn’t good enough.
Kulvinder Gill, head of Concerned Ontario Doctors, said the agreement makes it too easy for the government to later impose a hard cap through the arbitration process, and doesn’t give doctors back any of the money the province clawed back because of hard caps over the past three years.
Gill said the agreement also prevents doctors from striking, and while it’s typical of similar agreements in other jurisdictions, she said this offer goes too far.
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The agreement prevents doctors from withdrawing any service from patients for the purpose of pressuring the government, not only on matters that can be arbitrated under the agreement, but any issue of policy, legislation or regulation. It does not prevent activism such as protesting or letter-writing campaigns.
Gill said some doctors are concerned the government will one day pass legislation to void some parts of the agreement, depriving doctors of binding arbitration, but leave the prohibition on job action in place – similar to when the B.C. government passed legislation in 2002 that cancelled an arbitrated compensation increase for doctors, and ended their right to binding arbitration.
According to a legal opinion sought by the Concerned Ontario Doctors, the agreement also entrenches the Ontario Medical Association as the province’s official bargaining agent for doctors in perpetuity.
Gill said most doctors are unhappy with that status quo – and the majority have said in opinion surveys they would not pay their membership dues to the OMA if they were not mandated to by law.