After weeks of nasty infighting, doctors have rejected a controversial four-year contract negotiated by the Ontario Medical Association and the provincial government.

Just over 63 per cent of doctors cast ballots against the pact, the OMA said Monday after votes were tabulated from Sunday’s tense general meeting in Toronto.

“Members have spoken,” OMA president Dr. Virginia Walley — who had stumped across the province urging doctors to approval the deal amid “vigorous debate” — said in a statement.

“More is required from the Ontario government in order to best serve the interests of the profession and patients.”

Voter turnout was 55 per cent, meaning almost half the province’s doctors did not vote on a contract that the association will now seek to renegotiate.

Health Minister Eric Hoskins said the government must still ensure “predictable annual increases” to the $11.5 billion annually now set aside for paying doctors.

“Although the government respects the outcome of the vote, the result is regrettable and will require all parties to reflect carefully on next steps,” he added in a statement.

“I want to assure the people and patients of Ontario that their access to physicians and the health-care system will not be affected.”

The contract would have boosted the pot of money for paying physicians by 2.5 per cent to $12.8 billion by 2020 and put a financial clamp on things like excessive urine testing by doctors at methadone clinics and fee-for-service billings over $1 million a year.

The pact was vocally opposed by two coalitions of doctors some highly paid specialists like radiologists, ophthalmologists and cardiologists, who said the increase would not keep up with demands for care from a fast-growing and aging population, leaving patients in the lurch.

A group called the Concerned Ontario Doctors had called the contract — which would trim $100 million from fees for medical procedures than can now be done faster given technological advances in techniques and equipment — a “complete surrender.”

But the OMA said it was the best bet in tough economic times to secure stability for doctors — who twice endured unilateral cuts from the government in the last two years without a contract — while the association pursues a court challenge in hopes future contracts can be sent to binding arbitration.

Walley said she will “immediately” convene a meeting of the OMA’s board and consult with members on their priorities for the next round of contract talks in hopes of “reuniting and re-engaging our membership.”

Government officials said the pact was also structured to narrow the gaps between specialists like pediatricians who tend to be lower paid than radiologists and others.

The deal was endorsed by pediatricians, anesthesiologists and pathologists, among others, who applauded a provision in the agreement allowing doctors to co-manage the budget for paying physicians and have a strong voice in reforming the system.

“This notion that it’s solely the job of government to ensure the sustainability of the health-care system has got to be over,” Dr. Danielle Martin of Canadian Doctors for Medicare told the Star last week.

Jacobs countered that doctors are not interested in co-managing a budget they consider to be insufficient, leaving them to “ration” care to patients.

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Last week, Progressive Conservative Leader Patrick Brown said he is open to settling contract disputes with doctors using a neutral third-party arbitrator if he is elected premier in 2018.

Previous Conservative leaders have raised concerns about binding arbitration for public sector contracts, saying the system is too expensive for taxpayers.