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The whole idea of a doctors’ union is, on its face, preposterous. Doctors are not typically to be found among society’s downtrodden, lacking marketable skills or bargaining power: on the contrary, they are among the highest-paid professionals in the country, and would be with or without a medical association to negotiate on their behalf.

More to the point, doctors are not civil servants. While some are paid a salary or per-patient “capitation” fee, most are in private practice, and charge for each treatment they perform. They are small business operators, really. And yet they are entitled to bargain collectively, like coal miners or factory workers, their fees set not by competition in the marketplace but in marathon negotiations with the government.

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Just now in Ontario this arrangement would appear to have hit a wall. Having negotiated a four-year deal offering average annual fee increases of 2.5 per cent, the Ontario Medical Association executive was dismayed to find it rejected by nearly two-thirds of its members, who complain it does not make up for cuts in fees imposed last year. How things should have broken down to this extent need not detain us here. But it does perhaps point to the need to find another way.