Echoing Dr. Hoskins’ idea, Kemp said that work stoppages by physicians must be carefully planned. “There can be no massive walk-out or broad refusal to do any work at all,” he said. “Without going into the details of how physicians might organize a strike, I would expect an ethical organized work stoppage at a large, multi-service hospital to involve coordination between departments where physician presence is essential for patient care and departments in which physicians provide primarily elective procedures. The purpose of organized work stoppage is to put administrative pressure on the employer without adversely affecting patient care.”
Kemp urges physicians to become familiar with the federal rules on work actions while also understanding state rules on organized job actions, as those tend to vary.
To Unionize or Not?
Before discussing whether or not a strike is viable, it’s important to note that without physician unions, job actions of any kind can be difficult to organize.
Pamela Wible, MD, a family physician from Eugene, Ore., who has developed a following as a TEDMED presenter and promoter of the “Ideal Medical Practice” movement that preaches patient-centeredness, believes physicians should be able to strike. She also doesn’t believe a union is necessary. “When a group of people boycott an organization, a product, (or) a health system, the power is in the unity of the group,” Dr. Wible said. “They need not be represented by a traditional union. Obviously, some leadership within the group would be essential for negotiation and for group cohesion.”
Dr. Hoskins said that while structured organization can help, a work stoppage can be nearly impossible without a union. “Collective action is difficult to achieve, even in the most unionized environments,” he said. “It is certainly made more difficult in the scenario of physicians who, in most jurisdictions, do not form traditional unions.”
Dr. Hoskins has researched strikes across the globe and says the action is more frequent in health systems where government funds all or most healthcare costs, as with the NHS in Britain. The highest number of documented physician strikes is in Israel, where healthcare is fully paid for by the government.
Making It Work
If a group of otolaryngologists or other specialists did organize to the point of a work stoppage, how would it actually work?
Well, as the athletic adage says, “Failing to prepare is preparing to fail”; the answer is in planning, Dr. Wible said. “Set a date,” she advised. “Plan for coverage of essential services. Involve the media, as the power in a strike often [comes from] bringing the nation together to converse on a topic of concern for the group that is striking.”