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It's shaping up to be a showdown at high noon for Ontario's divided medical profession.

The Ontario Medical Association announced on the weekend that the province's roughly 42,000 doctors can vote on their controversial contract offer from the government on Aug. 14. In an unprecedented move, voting will take place during a general meeting in Toronto, where members can vote in person or by proxy. The meeting is slated for noon.

OMA contract ratification is traditionally done in a plebiscite. A phone-in and online vote, scheduled for July 27 to Aug. 3, will no longer occur. The change in procedure came about after a group of dissident doctors who are promoting a "No" vote collected more than 3,000 signatures on a petition demanding a general meeting.

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The venue, Toronto's Allstream Centre, can accommodate up to 4,000 people, but the OMA said the meeting will be live-streamed. Physicians who are not present will have to assign their vote to a proxy. The OMA said remote electronic voting is not permitted under the rules of the provincial Corporations Act.

Nadia Alam, a spokeswoman for the ad hoc group Concerned Ontario Doctors, charged that the proxy system is unfair. She even went so far as to suggest it will be manipulated by the association. "Please understand: if you send your proxy to OMA, they will use it for a Yes vote," she wrote in a mass e-mail.

The tentative contract, which is known formally as the Physician Services Agreement (PSA), was struck on July 11. It came as a surprise because Ontario's doctors have been without a contract for more than two years and there had been no formal talks for about a year.

Since then, OMA leadership has been aggressively pushing the deal as the best possible under the circumstances and warning that, if it is voted down, there is no guarantee a better deal will result.

"While the tentative PSA isn't perfect, with it our profession now has the opportunity to move forward with much-needed stability and predictability," OMA president Virginia Walley said. "That's in stark contrast to the potential outcome of voting no – with continued unilateral action [and] with possible and permanent cuts of more than $1-billion to funding for physician services."

A coalition of physicians, led by Concerned Ontario Doctors, is urging members to vote "No" and force negotiators to hash out a better deal. The coalition, which consists largely of specialists who stand to lose the most in the new contract, argues that the deal formalizes and endorses cuts that doctors have already been subjected to, and offers no guarantees that payments will not be reduced further.

Ontario will spend $11.9-billion on physician services this year, and that will rise to $12.8-billion in 2020 under the proposed deal – an increase of 2.5 per cent a year in overall spending for four years. (That is double the 1.25-per-cent increase the province offered in a deal that the OMA previously rejected.)

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Opponents of the contract argue that a 2.5-per-cent rise in overall spending amounts to a cut because the combined costs of inflation, population growth, aging and a growing work force far outstrip the hike.

David Jacobs, a Toronto radiologist who is a member of the coalition, called the proposed deal a "complete surrender."

Since the last PSA expired, the Ontario government has unilaterally cut physician fees twice – by 3.15 per cent in February, 2015, and 1.3 per cent in October, 2015 – and it imposed additional cuts on physicians who billed more than $1-million a year, and targeted cuts in areas such as diagnostic imaging and methadone treatment.

The tentative contract does not reinstate the fees that were rolled back. But it does allow the OMA to pursue a lawsuit against the province in which it is seeking to make binding arbitration mandatory to avoid this type of drawn-out, internecine conflict.

As doctors fight it out publicly, the focus has also shifted away from the provincial government.

The deal achieves two goals the province has sought: predictability in the physician services budget and reducing the disparities in income between procedure-based specialists and general practitioners and other specialists.

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