Ontario's doctors are threatening to launch a job action if the provincial government does not grant them binding arbitration as part of their next contract and kill a bill that would restructure the health-care system.
The Ontario Medical Association, which represents 34,000 doctors and medical students, adopted three motions at its biannual council meeting last weekend that contemplate a confrontation with the government.
One says that if Bill 41 – known as the Patients First Act – passes its third reading, the OMA should "lead its membership in job action." A follow-up motion instructs the OMA to develop at least four options and release them to doctors as soon as possible.
A third motion says the OMA should "lead a [public relations] campaign, including possible job actions, in order to secure binding arbitration and a physician services agreement."
None of the motions is legally binding, but their adoption shows that doctors are preparing to escalate their fight against a government that is expected to head to the polls in less than 18 months.
OMA president Virginia Walley said physicians have not decided exactly how they will pressure Premier Kathleen Wynne's government, but she said they have no intention of withdrawing services for patients.
"We don't want to do anything that would impact direct patient care," Dr. Walley said. "Among the many things that frustrate physicians are things around 'administrivia' and duplicative bureaucracy. Perhaps those are the sorts of things that we'll be able to encourage our members to focus their actions on."
Doctors in Canada's most populous province have been without a contract for almost three years. In the meantime, the province has imposed unilateral fee cuts on the profession.
In August, doctors rejected a tentative deal that would have raised the physician services budget – the pot of money Ontario spends on doctors – by 2.5 per cent a year to $12.9-billion by 2020.
Although the OMA endorsed the agreement, members voted it down, revealing a rift between the association's leadership and members who sided with Concerned Ontario Doctors and the Coalition of Ontario Doctors, the groups that led the No campaign.
Dr. Walley said Tuesday that the "fracture" within the profession started to heal at last weekend's council meeting, which was attended by about 250 doctors. "The physicians who were there see the merit of working together as a unified organization and focusing our fight on the government," she said.
The OMA and leaders of the other groups agree on at least two things: Doctors should not return to the negotiating table unless the province first grants them the right to binding arbritation and the government should abandon Bill 41.
The legislation, which is supposed to improve the co-ordination of primary care, would get rid of Community Care Access Centres (CCAC), the controversial agencies that co-ordinate home care in Ontario, and fold their duties into regional authorities known as local health integration networks (LHIN.) It would create 76 new "sub-LHINs," which the OMA is decrying as an additional layer of needless bureaucracy.
"If this government continues to ignore the loud calls of concern and passes Bill 41, Ontario's doctors are prepared to engage in co-ordinated job action," said Kulvinder Gill, a Peel region allergist and pediatrician who is also the president of Concerned Ontario Doctors. "It seems like this may be the only language this government will understand to stop the collision course they are on with Ontario's health-care system."
Health Minister Eric Hoskins, himself a doctor, was not available for an interview Tuesday. A spokesman declined to comment on a potential job action by doctors.
However, in August, Dr. Hoskins made it clear in an open letter to Dr. Walley that he would only consider binding arbitration for physicians if they agreed to form a union and publicly disclose their billings, conditions the OMA has rejected.
After an announcement on hospital funding last Friday – before the OMA passed its motions – Dr. Hoskins told The Globe and Mail there was no sign of talks resuming.
"We're in a situation right now where the OMA really hasn't expressed to us a willingness or an ability to come back to the table," he said.