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“In a normal labour dispute, the next steps after a deal is rejected is to go on strike,” said Steven Barrett, a labour lawyer and constitutional expert who has negotiated numerous contracts.

A “no” vote is any negotiator’s worst nightmare, he said, and all sides face “a complete mess and complete uncertainty.”

But since only 55 per cent of doctors voted on the deal, that could take some of the momentum out of any job action, Wiseman said.

Four things, none of which are mutually exclusive, that can now happen:

1. Both sides agree to arbitration. Ironically, Barrett said, arbitrators will normally base a decision on a negotiated deal even after a “no” vote, “so they end up imposing, occasionally with a few tweaks, the same deal.” At different times, both the province and the doctors have called for arbitration. The OMA’s pursuit of binding arbitration is the heart of a current charter challenge to those imposed fee cuts, a different dispute that will take years to make it through the courts.

2. Doctors go on strike. While Walley essentially ruled this out, saying “We’re bound by the ethics of our profession and we will continue to put patients first.” Though doctors are severely limited by ethics and regulation in how they can strike, it’s not wholly unprecedented. In 1986, some Ontario doctors did shutter their offices, one hospital even closed for a day, but the College of Physicians and Surgeons of Ontario warned members of their duties to provide “essential care.” But Barrett said there are some legal strike options, so “we could see pockets of doctors withdrawing their services.”

3. The government imposes the deal that was negotiated, and in turn the OMA exercises it right to challenge that imposition in the courts, perhaps finally settling what rights doctors are guaranteed as a bargaining group.

4. Everyone returns to the table and the deal is amended enough that it doesn’t upset the province’s plans to balance the books in time for the 2018 election and somehow manages to appease angry doctors, upset with years of imposed cuts.