Should Physicians Be Allowed to Strike?

Sounds wrong, right?

“Even though patients will feel inconvenienced, health outcomes may actually improve with the withdrawal of physician services,” said Ryan Hoskins, MPA, MD, a family and emergency physician in Canada who has written about physician strikes. “One interpretation of this phenomenon is that many elective procedures undertaken under normal working conditions in fact result in higher morbidity and mortality than if these procedures were not undertaken—that doctors are, in fact, causing harm.”

Dr. Hoskins wrote about the correlation between physician strikes and mortality last year in The Boston Globe (February 9, 2016). His piece was based in part on a 2008 report that studied five physician strikes worldwide between 1976 and 2003 (Soc Sci Med. 2008;67:1784-1788). All lasted between nine days and 17 weeks.

The authors of the review reported that, in each of these strikes, rates of mortality either stayed the same or decreased during, and in some cases after, the strike. The research attributes the “paradoxical finding” to several factors: the elimination of elective surgeries, the fact that hospitals often reassign scarce staff to cover care, and, in all strikes studied, availability of emergency care at all times.

Dr. Hoskins and the researchers noted that mortality rates might rise if strikes continued past the 17-week threshold. He also noted that studies of nursing strikes have shown that they have negative impacts on patient care and higher mortality rates.

Still, Dr. Hoskins can’t help but wonder if physician strikes are all bad if they give insight into what happens when less care is provided in certain instances.

“A refrain sometimes heard by senior physicians to doctors in training is “don’t just do something, stand there,” he wrote last year. “Rather than reflexively order a diagnostic test or recommend a surgery to alleviate a patient woe, it is often better to watch and wait. In fact, doctors stepping back more often may be exactly the prescription that the healthcare system needs.”