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Ontario doctors have walked away from bargaining with the provincial government once again, calling the breakdown of negotiations a “frustrating development” in the years-long contract battle.

“Unfortunately, the differences between the two sides have proven to be too great and so, mediation ended today,” the Ontario Medical Association (OMA), which represents 34,000 doctors, medical residents and medical students, said in a statement Friday evening. The group has officially triggered arbitration, which will take place from Oct. 22 to Oct. 26, months later than it was originally planned.

Physicians in Ontario have been without a contract for four years, over which time their fees have been cut by approximately 7 per cent. In addition to making up the lost income, the OMA is looking for a 4.26-per-cent fee increase and is fighting a cap being placed on physician-services budget increases. Billions of dollars in health-care spending are at stake in the protracted negotiations.

Earlier this summer, after the change of guard at Queen’s Park, Doug Ford’s Progressive Conservatives expressed a desire to “reset the relationship between doctors and government” that existed under the previous Liberal government. The OMA agreed to “cautiously” return to the bargaining table, instead of proceeding with planned arbitration dates. OMA President Dr. Nadia Alam assured members in June that they could still trigger arbitration if negotiations hit an impasse, with arbitration dates still available in December.

Hayley Chazan, a spokesperson for Health Minister Christine Elliott, said the negotiating teams on both sides met a number of times in July, August and September, with the help of a mediator. The government has extended the OMA a “truly innovative offer,” Ms. Chazan wrote in an e-mailed statement on Friday afternoon. She says the deal includes “significant financial incentives for physicians to drive the responsible change Ontario needs."

At the time of publication, Ms. Chazan had not responded to a request for additional details on the financial incentives offered, or changes the government wants. According to the ministry statement, the government is still “optimistic” about reaching a deal for a new Physician Services Agreement, which it says will “respect doctors while balancing the need to provide patients with the care they deserve and the sustainability and affordability of Ontario’s health-care system.”