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It has been the darkest period of governance since Dalton McGuinty's Liberals won power more than nine years ago, with the legislature shuttered as the lame-duck Premier exits amid scandal.

So it's slightly surprising that this fall may also go down as the time that Mr. McGuinty's government made significant progress toward bringing sustainability to the province's health-care system.

Details about the province's new agreement with the Ontario Medical Association are still fuzzy, pending its ratification, and to date much of the public reaction has focused on whether or not it qualifies as a wage freeze.

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But from what we know so far, the deal's most significant achievement is that it has gotten doctors to work together toward modernizing their practices – from performing fewer unnecessary services to better using technology to interact with their patients.

Getting them to take a leadership role on that front has always been pivotal to making practices more efficient, since they understandably tend to chafe at taking directions from politicians or bureaucrats.

But while they have embraced the odd reform in recent years, there has been some degree of institutional resistance to change.

That seemed to remain the case as recently as this spring, or at least the Liberals perceived it to be.

Talks between the government and the OMA toward a new contract proved acrimonious and unproductive, and ended with Health Minister Deb Matthews unilaterally imposing a package of fee cuts heavily targeted toward a few specialist groups.

Over the summer and early fall, something changed.

Liberals suggest the OMA got the message that the government was serious about stopping growth in doctors' bills; the OMA counters that the Liberals, simultaneously fighting bruising labour battles against teachers and other groups, became more open to working co-operatively. Perhaps it was both.

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In any event, it appears that doctors were given incentives to find savings within the system, and proceeded to deliver.

Through working groups, physicians came up with various "evidence-based" reforms to their practices, such as cutting back on gratuitous cardiac testing and making annual physical exams more narrowly targeted; they also committed to communicating with more patients electronically or over the phone, which ideally will both improve services and lower costs.

The ensuing savings allowed the government to limit an across-the-board fee cut – pretty much the epitome of a short-term fix – to just 0.5 per cent, while reversing a few of last spring's universal cuts and providing $100-million over the next two years to pay for new doctors.

Unless there's some sleight of hand that hasn't yet revealed itself, this looks like precisely the sort of process that will be needed to allow the health system to survive both the province's ongoing financial woes and its looming demographic crunch.

The obvious question is whether, rather than just being a one-off, it's the start of something bigger – a serious engagement of doctors in helping flatten annual health spending increases at 2 or 3 per cent.

In the short term, there should be some lingering momentum.

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The Liberals have indicated that the small across-the-board cut – basically the difference between savings identified to date and the government's bottom line – will be made even smaller if more efficiencies are found.

So it's a decent bet we'll soon hear about a few more "evidence-based" changes.

Beyond that point, it's anyone's guess.

The best Ontarians can hope is that whoever is at the table for both sides, in the years to come, will remember that this fall's negotiations were much more pleasant and productive than last spring's.

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