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Ontario Premier Dalton McGuinty, left, and Quebec Premier Jean Charest are seen following a meeting at Queen's Park in Toronto, Ont. March 5, 2012.Kevin Van Paassen/The Globe and Mail

Ontario's Dalton McGuinty is looking to enlist his fellow premiers in his fight to rein in doctors' fees, the latest bid to craft a national health-care strategy without the federal government.

In a letter distributed Sunday, Mr. McGuinty urges the other provinces to follow Ontario's lead in paring back fees paid to physicians, saying that technological advances have allowed some specialists to boost their incomes substantially since they are able to perform operations far more quickly. "… I urge you to consider how we might work together through strong, forward-looking reforms," he wrote.

British Columbia said it is already looking at taking similar action to Ontario in reducing fees paid to some specialists, and health-care experts said the Atlantic provinces could well follow suit.

But any nationwide push will likely screech to a halt on the Prairies, where both Saskatchewan and Alberta have far more fiscal maneuvering room. Alberta, in particular, has been able to promise its physicians substantial increases this year, even as other provinces struggle to contain health-care cost. Its free-spending ways are the most likely target of Mr. McGuinty's missive, said Arthur Sweetman, Ontario research chair in health human resources at McMaster University. "I would bet he's writing to Alberta."

The call to joint action comes months after the premiers set up a committee in January to foster innovation and co-operation in health care, in the wake of the federal government's decision to reduce the expected growth in health-care transfers – but in return, not to attach national goals to that funding.

Mr. McGuinty frames the debate over fees as being driven by technological change. But the province's massive budget deficit is an equal impetus in the drive to freeze overall funding to physicians and to cut some fees within that envelope, said health-policy consultant Steven Lewis.

If Mr. McGuinty is successful, he will have navigated what has been a politically perilous path – cutting doctors' pay, a move often equated in the public mind with attacking health care – and cleared the way for other provinces to follow. "It'll be a bit of a game changer," Mr. Lewis said.

British Columbia, however, is signalling that it is ready to move in concert with Ontario; the B.C. health ministry said the government is already in talks with its doctors on reducing fees, specifically for those paid for cataract surgery.

Doug Weir, the president of the Ontario Medical Association, said Sunday said Mr. McGuinty's letter sends a message to other doctors elsewhere in the country that they are not welcome in Ontario. "He's saying provinces across the country should break contracts and disrespect doctors," Dr. Weir said. "Just by that letter, he is discouraging people from coming to Ontario."

Mr. McGuinty knows that when doctors' salaries have been cut in the past, they have been able to move to other jurisdictions, Dr. Weir said. The OMA has said the changes will mean each doctor's pay will drop by 16 per cent over the next four years, because of an increased number of physicians.

At a meeting last January, premiers struck a working group, chaired by Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz, to find health-care efficiencies through innovation, including reducing the costs of health human resources.

The request for unity, which comes as all provinces and territories are trying to rein in the amount they spend on health services, would limit the ability of doctors who are angry at pay cuts in their own jurisdictions to move to provinces that are offering a better deal. However, health-policy analysts said medical-school enrolments have been soaring in recent years, reducing the threat of any physician shortage.

When the Ontario government announced last week that it was unilaterally cutting doctors' fees, Health Minister Deb Matthews said some specialists are making "windfall profits" because technology has allowed them to perform many more procedures in the course of a day, but the fees have not been adjusted to reflect the increased efficiency.

Mr. McGuinty's Liberal government came to power in 2003 promising to end the discord with the province's teachers and health professionals that had characterized the relationship between the previous Conservative government and the public sector. And, for many years, there was relative harmony – while the Liberal government increased funding. "Until a few years ago, it was 'How can we bribe you to do more?' " said Patrick Fafard, professor of public policy at the Graduate School of Public and International Affairs at the University of Ottawa.

Ms. Matthews said in an interview with The Globe and Mail on Sunday that, when the Liberal government was first elected there were a myriad of health-care problems that needed to be rectified, including doctor shortages and lengthy wait times for key procedures. Improving Ontario's system was the top priority. "Now, I think we are in a position to work in a pan-Canadian way," she said. "We are all dealing with fiscal challenges. Certainly, Ontario is very much dealing with a fiscal challenge."