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Ontario's doctors will vote on their controversial contract offer from the province on Aug. 14, the Ontario Medical Association announced Saturday.
Voting will take place during a general meeting in Toronto, rather than by phone-in plebiscite, a move that is unprecedented.
The general meeting vote will also be binding, unlike the plebiscite, which offers non-binding direction to the OMA council.
The change in procedure came about after a group of dissident doctors who are promoting a "No" vote collected more than 3,000 signatures on a petition demanding a general meeting.
The Ontario Medical Association said in a release that "OMA members must vote in person at the general meeting or by submitting a proxy."
While there were calls for teleconference and remote electronic voting, the OMA said these are not permitted under the rules of the provincial Corporations Act.
There are 33,000 Ontario doctors who are eligible to vote. But the venue where the vote will be held, the Allstream Centre, can accommodate a maximum of 2,000 people.
In the news release, OMA President Dr. Virginia Walley once again urged members to accept the contract, which is known formally as the Physician Services Agreement (PSA).
"While the tentative PSA isn't perfect, with it our profession now has the opportunity to move forward with much-needed stability and predictability," she said.
"That's in stark contrast to the potential outcome of voting no – with continued unilateral action with possible and permanent cuts of more than $1-billion to funding for physician services."
Concerned Ontario Doctors, an ad hoc group that appears to have significant support among the province's physicians, vehemently disagrees with the OMA position.
It argues that the contract offer formalizes and endorses cuts that doctors have already been subjected to, and offers no guarantees that payments will not be reduced further. Ontario spends $11.8-billion a year on physician services, about one quarter of all health spending. Most doctors are independent contractors who bill the province on a fee-for-service basis, and then pay their own overhead and wages to staff.
The OMA announced on July 11 that it has struck a deal with the province. This came as a surprise because doctors had been without a deal for more than two years and, until a few days before the deal was hammered, there had not been any formal talks for at least a year.
During the period when there was no contract, the province unilaterally cut physician fees twice – by 3.15 per cent in February 2015 and 1.3 per cent in October 2016, it imposed additional cuts on physicians who billed more than $1-million a year and targeted cuts in areas like diagnostic imaging and methadone treatment. The OMA demanded binding arbitration and, when the government refused, it launched a lawsuit.
The tentative contract does not reinstate the fees that were rolled back. But it does call for annual increases of 2.5 per cent in the overall physician services budget for four years – twice as much as the 1.25 per cent the government offered previously. It also offers incentives of up to $120-million if the budget is not exceeded. The province will continue to roll back payments to high-billers, with a goal of reducing disparities between what low-paid doctors like family physicians earn compared to highly-paid doctors like, for example, ophthalmologists.
Concerned Ontario Doctors argues that a 2.5-per-cent increase in overall spending amounts to a "hard cap" and, practically, a cut in payments, because the combined costs of inflation, population growth, aging and growing work force far outstrip that hike.
Even after getting the general meeting they requested, Concerned Ontario Doctors remained unhappy, complaining about the date, the lack of remote access and even suggesting the vote was rigged. "Please understand: if you send your proxy to OMA, they will use it for a Yes vote," Dr. Nadia Alam wrote in a mass e-mail.
André Picard