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The Ontario Medical Association (OMA) is warning that “all options are on the table,” including job action, after the provincial government pulled out of an arbitration process that was supposed to settle a protracted fee dispute with physicians.

Nadia Alam, the president of the OMA, said that doctors are enraged at Premier Doug Ford’s government for trying to cancel the arbitration hearings, which were scheduled to resume this Saturday and conclude this month.

“I’ve had physicians who’ve messaged me and asked, ‘Is the [OMA] board going to consider job action?’” Dr. Alam said in an interview. “Right now, the board is considering all options.”

The government doubled down on its efforts to kill the arbitration process on Wednesday by dismissing its own appointee from the three-member arbitration board, Kevin Smith, president of the University Health Network in downtown Toronto.

Leaders of the OMA and many front-line doctors had hoped that the election of the Progressive Conservatives would mean a fresh start for government-physician relations after years of acrimony with the Liberals, who unilaterally cut some physician fees and froze others.

Doctors have been without a contract since March 31, 2014.

Instead, the OMA was stunned when a lawyer for the Ministry of Health and Long-Term Care sent the organization a letter on Monday announcing the government intended to withdraw from binding arbitration because of a “public dispute in the profession” – a reference to an effort by some high-billing specialist physician groups to break away from the OMA and negotiate separately with the government.

“Recent developments within the membership of the Ontario Medical Association have called into question the status of an exclusive representative of physicians. Given the significance of the importance of the issues in the arbitration, the government cannot ignore this matter,” Hayley Chazan, a spokeswoman for Health Minister Christine Elliott, wrote in an e-mail on Wednesday.

She declined to answer any e-mailed questions about what will happen next.

All eyes are now on William Kaplan, the experienced lawyer and arbitrator who chairs the arbitration board. Reached on Wednesday morning, he declined to comment.

Some experts say Mr. Kaplan could continue with the hearings and issue an arbitration decision – even if it’s likely that the government would try to enact legislation to nullify that decision.

Another possibility: Mr. Kaplan and what’s left of the board could ask the OMA to go to court to try to force the government back into the arbitration process.

“Walking out of the process is totally unlawful,” said Paul Cavalluzzo, a constitutional and labour lawyer. “This is unique. Fortunately, in the past, we haven’t had governments act in such arbitrary ways which completely defy the rule of law.”

Dr. Alam said OMA representatives plan to attend the hearing as scheduled on Saturday.

The OMA fought for years to gain access to a third-party mechanism to settle contract disputes. Kathleen Wynne’s government finally agreed to a binding arbitration framework in 2017.

As part of that agreement, the OMA promised it would, “not threaten, condone or encourage strike action by physicians.” At the time that deal was struck, the OMA was contemplating such moves as asking doctors to resign from provincial committees and slow-walk paperwork, not withdrawing services for patients.

Alan Drummond, an emergency-department doctor in the eastern Ontario town of Perth said the OMA and doctors should now take direct political action against the province, as long as that action doesn’t affect patient care.

“I think we should probably withdraw from committee work, both at the hospital and regional and [Local Health Integration Network] level to send a message that reform is necessary and needed, but you can’t do it without physicians," Dr. Drummond said. “You just can’t.”

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