On 9 February 1991 Cameron became premier when a party convention chose him to replace John Buchanan as Conservative leader. He had campaigned on a platform promising open government free of patronage and a determined effort to reduce the deficit. The first budget introduced by his government froze provincial wages for 2 years and eliminated 300 jobs in the public service, introduced tuition fees at community colleges and raised the price of prescription drugs for seniors. In August 1991 his government lost its 1-vote majority in the Assembly when the NDP captured the seat vacated by Buchanan, leaving the Assembly in a rare even split between government and Opposition. (The Speaker casts the deciding vote in the event of a tie.)
Cameron nursed his government through the remainder of its term, concentrating on deficit reduction. Despite keeping his government free from the patronage scandals that plagued the Buchanan regime, Cameron's Conservatives went down to defeat to the Liberals under John Savage on 25 May 1993. Cameron announced that evening that he would retire from politics.