With each passing day, Ontario doctors' response to the contract offer from the province increasingly resembles watching Game of Thrones: There are brutal internecine battles, odd plot twists and it's impossible to figure out how it will end – except badly, for pretty well everyone.
On July 11, the Ontario Medical Association announced that it has reached a tentative four-year deal with the province.
This was a surprise because doctors had been without a deal for more than two years and, until a few days before the deal was struck, there had not been any formal talks for at least a year.
During the contract-less period, 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 crackdown on high-billers will continue, with a goal of reducing disparities between what low-paid doctors like family physicians earn compared to highly paid doctors like ophthalmologists.
The OMA has been promised some doctor-friendly changes to the Bill 210, the Patients First Act, and it will also be allowed to continue its lawsuit seeking binding arbitration, which could prove to be a bonanza in the years to come.
Reaction to the contract seemed to fall into two broad camps: Those who would hold their noses and vote "Yes" because the status quo is better than unilateral cuts, and those who were enraged that the OMA didn't get more and vowed to vote "No."
The "No" forces, led principally by the splinter group Concerned Ontario Doctors, went at it tooth and nail, especially on social media. They charged that the deal was negotiated secretly, that the OMA was in bed with the ruling Liberals, and that the negotiated increases actually amount to cuts because they do not adequately cover the costs of population growth and an aging demographic.
Ultimately, however, Ontario's 33,000 doctors were going to decide to accept or reject the deal in a plebiscite, in a vote slated to start July 27.
Then there was another twist. Concerned Ontario Doctors circulated a petition demanding a general meeting. OMA bylaws say that a request from five per cent of members can trigger a meeting, and with 3,000 signatures it will happen.
This is where it gets murky. Will only those who show up at the general meeting vote on the contract? Will proxies be allowed? Will the plebiscite be scuttled altogether?
More importantly, what will happen if the tentative deal is voted down? The OMA council is not legally bound by a membership vote.
Opponents of the deal assume that their "get tough" approach will result in a better offer from the province. That is highly doubtful. The province's position, that the physician services budget of $11.8-billion a year not be exceeded, is a reasonable, fiscally responsible one.
In a contract negotiation, there is nothing one party likes better than an opponent beset by infighting.
While the deal the OMA negotiated may be modest, it's unclear what the "No" forces are proposing other than to throw the provincial treasury vault wide open to doctors.
What Concerned Ontario Doctors are is mad. Mad at the ruling Liberals, mad at the OMA leadership, mad at anyone who dares suggest some doctors are overpaid and should put little water in their fine wine.
In fact, their most frequently stated demand is that everyone who disagrees with them be fired or step down. They have demanded the resignation of Premier Kathleen Wynne, Health Minister Eric Hoskins, OMA president Virginia Walley, the OMA negotiating team and so on.
This is not how labour negotiation works. It's Trumpism pure and simple – lashing out at everything and everyone with self-righteous indignation, but proposing nothing.
Ontario Doctors have a stark choice: They can essentially endorse a satisfactory four-year deal – a peace treaty – or they can declare war on the province, knowing that, on the battlefield, those most likely to knife them in the back are fellow physicians.