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The Coalition of Ontario Doctors, made up of OMA members, formed quickly after a tentative agreement was reached with the province.iStockphoto/Getty Images/iStockphoto

The Ontario Medical Association and its own doctors are battling over the tentative contract reached with the government earlier this summer, waging forceful campaigns and hiring outside firms to help them push their agenda.

The OMA, which represents the province's 42,000 doctors, including students, residents and retired doctors, wants the deal ratified; the Coalition of Ontario Doctors, a group quickly formed after the tentative Physician Services Agreement (PSA) was reached, wants it rejected. It says it represents 20,000 doctors. The fight is rapidly intensifying this week as the final day for accepting or rejecting the offer is Sunday.

OMA president Virginia Walley told The Globe and Mail on Tuesday that she believes the agreement will be supported. To help with that, her association has hired Navigator Ltd., which bills itself as "Canada's leading high-stakes public strategy and communications firm."

Coalition doctors charged the OMA has hired a "pricey Bay Street PR firm" and is mounting an "aggressive" campaign that lacks objectivity. The coalition, meanwhile, has retained Kingsdale Shareholder Services, which specializes in high-profile proxy fights and transactions.

One of Kingsdale's officials participated in a telephone conference call Monday night, telling coalition doctors how to cast their vote and encouraging them to vote online before the meeting Sunday.

On Tuesday morning, the coalition doctors held a news conference where they released an analysis of the proposed deal by University of Toronto emeritus economics professor Jack Carr. He criticized the six-page agreement for lacking detail, and ignoring the "effects of inflation." His report says that patients will be negatively affected by the proposed deal.

In July, the OMA and the government reached a four-year tentative deal that provides a budget of $11.5-billion with annual increases of 2.5 per cent. The agreement also includes funding to increase the number of doctors and a modernization of Ontario Health Insurance Plan fees that will result in $200-million in reductions.

Dr. Carr says in his report that doctors will likely face further cuts in funding, calculating that the 2.5-per-cent increase is really only a 0.5-per-cent increase, given that inflation is at 2 per cent.

"It is difficult to see how real increases in funding of 0.5 per cent can pay for the health-care needs of a growing and aging population and for the cost of new physicians. If the real increases of 0.5 per cent prove inadequate, then the [PSA] mandates for further cuts in funding (in addition to the $200-million dollar cuts in funding already provided in the agreement)," he wrote in his report.

The doctors at the news conference said that patient care will be compromised if the deal is accepted. "I think we all have to understand that with less funding, inadequate funding, we will all suffer as patients in Ontario," said Dr. David Jacobs, a radiologist, who is part of the coalition.

The coalition doctors also want to have binding arbitration. The OMA gave up its insistence on this during the negotiations, which angered some doctors. They say their trust has been broken with the OMA.

As the coalition doctors made their case, about 25 doctors in Sarnia held a 30-minute demonstration outside the local hospital, criticizing the four-year deal.

Paul Dobrovolskis, an anesthesiologist at Bluewater Health and one of the organizers, said it was the first protest at a local level in Ontario. But he said it looks like the start of a groundswell, with doctors in other regions also looking at taking to the streets. "The mood gets angrier daily," he said. "Physicians are beginning to get militant and many are calling for a referendum on the existence of the OMA as they feel abandoned and deceived by them."

Dr. Dobrovolskis said the 2.5-per-cent annual increase for doctors proposed in the OMA accord is not enough to cover health-care costs, which are rising at a faster rate due to growth in population as well as the number of new doctors.

The OMA's Dr. Walley says that her team negotiated hard to win the 2.5-per-cent increase and it believes the increases in the agreement match current utilization of the system and what it will be in the next couple of years.

"I understand there is a great deal of frustration out there," she says. "The last two years have been a period of great uncertainty for our members; they are very frustrated."

The doctors have been without an agreement for two years, and during that time the government imposed unilateral cuts.

"Quite frankly, some of the things the government has done unilaterally have not been in the best interests of patients," she said. "I also know they want to be involved again in decision-making. Nobody knows better how scarce health-care resources should be used than the physicians of this province."