Ontario doctors have voted to reject a fee deal reached by the Ontario Medical Association and the province's Liberal government.

In a vote yesterday, 63.1 per cent were against the physician services agreement, while 36.9 per cent were in favour.

Fifty-five per cent of the OMA's members — which includes 42,000 physicians, residents and medical students — participated in the vote at a townhall-style meeting on Sunday either in person or by proxy, the association said in a release Monday.

"Members have made it clear that more is required from the Ontario government in order to best serve the interests of the profession and patients," said OMA president Dr. Virginia Walley.

"Physicians haven't been involved working with the government to decide together what's in the best interest of patients so that just has to stop," Walley told CBC News on Monday.

The association's president previously acknowledged the deal wasn't "perfect" but that it improved on an under-funding of growth to the system.

The proposed four-year deal would have boosted Ontario's $11.5-billion physician services budget by 2.5 per cent a year, to $12.9 billion by 2020, and allow doctors to co-manage the system with the Ministry of Health.

It would have also provided one-time payments in each of the four years of $50 million, $100 million, $120 million and $100 million, which would be reduced if actual expenditures exceed the physician services budget.

Access to physicians won't be affected, province says

Originally, the OMA's 275-member council would have decided on ratification, and only taken a non-binding vote by doctors into consideration as it made that decision, but the association agreed to give each member a binding vote after dissidents gathered support on a petition.

The association will now convene a meeting of its board of directors, consult with members on what priorities are to be addressed in future negotiations, and request a meeting with the provincial government to outline its expectations for renewed talks.

Ontario Health Minister Eric Hoskins expressed disappointment at the result, saying the deal would have offered physicians "for the first time, an opportunity to have a seat at the table where decisions are made about spending and the future of our health-care system."

Following the vote, Health Minister Eric Hoskins issued a statement saying he was disappointed doctors rejected the deal. (David Donnelly/CBC)

"I want to assure the people and patients of Ontario that their access to physicians and the health-care system will not be affected," Hoskins said, adding that the result will not affect planned government investments for expanded home and community care funding and more doctors.

Patient care vs. government's budget

Following the vote, Nadia Alam, co-leader of the group Concerned Ontario Doctors that opposed the deal, told CBC Radio's Here and Now the proposed 2.5 per cent hike was "simply not sufficient."

The group had staged rallies and protest marches urging physicians to vote against the deal, warning it doesn't provide adequate funding to offer the services patients need.

To those who note that more than $1 billion could have been added to physicians' budgets through the deal, she responded, "It still doesn't match patient need."

"At the end of the day, if it doesn't cover the number of services patients actually need, it doesn't matter how big the number is," Alam said.

Hundreds of doctors voiced concern at Sunday's meeting about patients' needs not being adequately met, said Alam, which was in large part the reason for rejecting the deal.

Several hundred doctors and patients gathered outside the Ontario Legislature in April calling for the governing Liberals to 'fund health, not scandals.' (Radio-Canada)

"We talked about patients waiting in stretchers in the hallway, patients lined up in [emergency rooms] waiting for hours to be seen by somebody. This is distressing to us," Alam said.

"The government can still do what they want and still sacrifice patient care for an unrealistic budget and physicians are powerless to stop it. So that's what we couldn't agree to. That was our line in the sand."

Doctors want bigger say

Alam said the solution doesn't necessarily lie in increasing Ontario's health-care budget, but rather in better managing how funds are spent. She wants to see doctors have a bigger say in how funds are spent.

As an example of a better management of funds, she said, walk-in clinics could be moved closer to emergency rooms to make it easier for hospitals to redirect patients who show up there but don't necessarily need emergency services.

Other doctors like Brenna Velker worry that not accepting the agreement could result in a worse deal.

"I think the cuts could continue, because we have no protection against unilateral action," Velker said.

The Liberal government imposed fee cuts for some doctors' services last year, but the proposed agreement promised no more unilateral cuts over the four-year deal.