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The Ontario Association of Cardiologists sent an emergency e-mail to heart doctors this week encouraging them to join the association and pay its $1,500 membership fee so the group will have enough money to mount an independent campaign against the provincial government if need be.Getty Images/iStockphoto

The organization that represents Ontario's cardiologists is warning that contract negotiations between the province and its doctors are on the verge of collapse, with the government "most likely" preparing to impose fee cuts on physicians as it did when talks fell apart in 2012.

The Ontario Association of Cardiologists sent an emergency e-mail to heart doctors this week encouraging them to join the association and pay its $1,500 membership fee so the group will have enough money to mount an independent campaign against the provincial government if need be.

"The current OMA-Ministry of Health and Long-Term Care OHIP [Ontario Health Insurance Plan] negotiations are in their final days," reads the e-mail, sent Wednesday and obtained by The Globe and Mail. "It looks like they will end within the next 10 days in failure, as they did in 2012. The government most likely will impose unilateral fee cuts on the profession and these will, like in 2012, reduce current cardiology billing codes."

The e-mail is signed by James Swan, the president of the Ontario Association of Cardiologists. He is also the cardiology section chair for the Ontario Medical Association (OMA), the bargaining agent for the province's 28,000 doctors, which means Dr. Swan has been representing heart specialists at the negotiating table.

He declined an interview request while the talks continue, as did Eric Hoskins, the provincial Health Minister, and Ved Tandan, the president of the OMA.

Ontario doctors have been without a contract since March 31, 2014. In a July interview with The Globe, Dr. Hoskins reiterated the Premier's warning that the government has no new money to offer public employees – including doctors – as it works to eliminate the projected $12.5-billion deficit by 2017-2018.

In response, the OMA put out a news release accusing Dr. Hoskins of negotiating through the media. Since then, neither side has spoken publicly about the progress of the talks.

But behind the scenes, the parties have been receiving help from high-profile places. David Naylor, the former president of the University of Toronto, led the facilitation phase of the talks, which wrapped up in October.

Warren Winkler, the former chief justice of Ontario, is acting as a conciliator.

This round of contract negotiations has been less acrimonious than the last, publicly at least.

When talks fell apart in 2012, the government of then-premier Dalton McGuinty unilaterally imposed changes to 37 parts of the OHIP fee schedule aimed at saving $338-million in the first fiscal year after the cuts were enacted.

One of the changes was a 50-per-cent reduction in fees for certain diagnostic exams performed as self-referrals. Self-referrals occur when specialists such as cardiologists, ophthalmologists or radiologists order tests and perform them using their own equipment at a clinic or office.

In 2012, then-health minister Deb Matthews expressed concern that self-referrals were leading doctors to order unnecessary and expensive tests to help pay for their equipment.

The Ontario Association of Cardiologists successfully fought the cuts to self-referral fees, arguing the changes would increase waiting times, endanger patients and drive cardiologists out of the province. The province agreed to drop the cuts and instead appointed an expert panel to weigh in on the self-referral issue.

The province and the OMA reached a deal in late 2012 that 81 per cent of doctors voted to ratify.

In the Wednesday e-mail, the Ontario Association of Cardiologists touted its success in staving off cuts to self-referrals. "Remember, we won the battle on self-referral without the OMA's help in 2012 and we can win again only if we have the support of all Ontario cardiologists," it reads.

A spokeswoman for the Ontario Association of Cardiologists estimated there are approximately 450 cardiologists in Ontario, nearly 250 of whom are its members. She said by e-mail that heart specialists were the hardest hit by the 2012 contract, which saw cardiology fees cut by 30 per cent on average, "the highest of any single physician group or specialty."

The deal the province and doctors reached in 2012 essentially froze the pot of money available for doctors at $11-billion, with some fees going up and others going down. Payments to doctors are the second most expensive item in Ontario's health budget, second only to hospitals.

But the OHIP fees paid to doctors do not reflect take-home pay; many physicians pay staff and lease offices and equipment out of their payments from OHIP.

Ontario's efforts to curb spending on physicians appear to be paying off, according to a September report from the Canadian Institute for Health Information. The federal health-care statistics agency found that in 2012-13, the total amount Ontario paid to all its doctors rose 1.7 per cent. In the three years previous the increases were 9.6 per cent, 5.4 per cent and 6.2 per cent.

Average gross pay for Ontario physicians actually fell by 1.3 per cent in 2012-2013, to $370,731 from $375,543 the year before. OPTIONAL CUT ENDS