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Dr. Hamza Khan and OR nurses prepare for cataract eye surgery at the Royal Jubilee Hospital in Victoria July 14, 2009.John Lehmann/The Globe and Mail

As Ontario remains locked in a standoff with its doctors, B.C. has announced a tentative, four-year deal with its physicians that it says respects a "challenging fiscal climate" while protecting services.

The proposed deal includes a 0.5 per cent per year increase to doctors' fees for the first two years of the agreement and about $90-million for spending in problem areas – such as rural health care and recruiting and retaining specialists – over the same period, according to a government briefing.

"It's a good agreement for patients; it's a good agreement for doctors, and the [B.C. Medical Association] board is recommending that it be accepted," the BCMA's president, Nasir Jetha, said on Friday. "So I'm quite optimistic it will be approved."

BCMA members are expected to vote on the deal before the end of July.

The agreement announced on Friday could ratchet up tension in Ontario, which is locked in a dispute with doctors over fees, and is likely to be closely watched by provinces that are also in negotiations with their doctors, or will soon have to deal with the same issues.

Ontario Premier Dalton McGuinty wrote to his provincial counterparts last month, encouraging them to follow his lead in rolling back doctors' fees for some services that technological advances have made easier or quicker to perform.

Alberta, meanwhile, is looking to overhaul the pay formula for its doctors. Days before the recent election campaign began, the province signed an agreement-in-principle giving doctors an extra $181-million. If finalized, that agreement expires next year.

Saskatchewan Premier Brad Wall sounded lukewarm to the idea, noting that the provinces are at "different spots in their cycle" negotiating with doctors. Agreements in B.C. and Ontario expired last March. Saskatchewan's deal with its doctors expires in March, 2013.

"I don't think you'll find a lot of disagreement in terms of the need for modernizing the fee schedule and compensation for all health care providers," he said during a recent meeting of health ministers in Toronto. How the provinces get there is another matter.

"That's the strength of the federation, that we can follow our own approach in terms of health care," he told reporters.

In Ontario, talks between the province and the Ontario Medical Association broke down last month after the government rejected the OMA's request to hire a conciliator and moved unilaterally to impose fee cuts on services provided by high-paid specialists such as cardiologists.

On Friday, Ontario health minister Deb Matthews said the OMA has not responded to her May 18 letter inviting negotiators back to the table.

"Three weeks is a long time to be waiting," Ms. Matthews said. "Our priority is getting people home from hospital who don't need to be there. Paying doctors more doesn't accomplish that goal."

OMA president Doug Weir called on the McGuinty government to follow the lead of other provinces and work collaboratively with doctors instead of "maligning" them in the media.

"We need to hear from them that it's going to be a fair process, much like it is in the other provinces," Dr. Weir said on Friday.

However, a representative for British Columbia's anesthesiologists did not see his province's deal in such a positive light.

Jeff Rains, president of the B.C. Anesthesiologists Society, slammed the new agreement between the province and the BCMA as a "sweetheart deal" that does nothing to address his group's concerns.

The BCAS has been at loggerheads with the province and the BCMA over issues including waiting lists and a shortage of anesthesiologists. The BCMA negotiates with the province on behalf of B.C.'s 10,000 physicians, including anesthesiologists.

Doctors' fees are part of broader labour woes in both provinces. On Friday, the B.C. Government Services and Employees' Union asked the provincial labour relations board to appoint a mediator in contract talks for 25,000 government workers.

Separately, the BCGEU announced that talks between the government and community social services workers have broken down.

And the governments of both Ontario and B.C. are battling with teachers' unions.

Mr. McGuinty is calling on teachers to take a two-year wage freeze and end retirement payouts for unused sick days.

In B.C., the province in March passed legislation that ended teachers' job action and brought in a mediator, whose appointment the teachers' union is fighting in court.