Research shows that physicians strike for two reasons: a struggle over employment conditions and concern for the welfare of patients.1 As this research shows, the borderline between the two reasons tends to be unclear and often it is difficult to identify precisely where the physician’s interests end and the patient’s interests begin. In practice, there is a reciprocal relationship between these two purposes: insofar as the system provides better conditions for the physician, it advances the welfare of the patient, and vice versa.2 Indeed, since the 1970s several incidents have occurred around the world in which physicians’ strikes led to policy changes that went beyond an improvement in the physicians’ employment conditions and led to advances in the welfare of patients.
For example, in Cook County in Chicago five hundred medical staff at the hospital went on strike for 18 days in 1975. It was one of the longest physicians’ strikes in American history. The reasons why the strike broke out were a dissatisfaction of the medical staff with the quality of the treatment and the work conditions in the hospital. The strike ended following an agreement between the management and the staff to set up a joint committee to monitor an improvement in patient treatment, including an increase in the number of medical teams, faster receipt of laboratory results and X-rays images, and the fixing of a maximum amount of weekly work hours for an attending physician in an institution (80 hours).3
In New York the interns in two hospitals declared a strike to improve their status in May 1976. After they achieved an increase of 10.5% in their salary, the interns decided to contribute half of the increase to a joint fund that they established in order to improve the quality of the treatment in the hospital by means of buying medical equipment and employing essential manpower.4
In Rhode Island the Medical Association initiated in May 2003 a march with the purpose of directing public attention at the problems of access, insurance coverage and obstacles to an improvement in the quality of treatment in the health system. Some additional medical employees, patients and legislators took part in the march. The media campaign that accompanies the march focused on the financial pressure on the system, which threatened the physician-patient relationship.5 This protest was supported by the medical establishment, because it was intended to strengthen the whole medical system, and thereby first and foremost benefit patients. This occurred only one month after the American Medical Association and the Medical Association of the State of Illinois refused to support the strike that was carried out by hundreds of physicians in the State for one day in protest at their problems in the field of professional liability insurance. The Medical Associations explained their opposition to the strike on the ground that the issue of insurance was admittedly important, but did not justify causing harm to patients.6
In France the Prime Minister, Alain Juppé, announced in 1995 a reform in the health system. The reform was intended to put restraints upon national spending for healthcare, mainly by restricting the professional autonomy of physicians by means of budgetary supervision. The Government’s intention was to allocate to each district in France a certain amount for healthcare services, which included payments for medical treatments and prescription drugs, which permitted no departure. A departure from the approved amount would lead to a ‘fine’ that would be imposed on physicians in the district. This far-reaching measure, which was regarded as a threat to the French healthcare system, met with fierce opposition from physicians, who began an extensive struggle in order to cancel it, or at least to moderate it. Within the framework of the struggle, which continued during the years 1995-1997, and which included strikes and other industrial action, the physicians repeatedly claimed that ‘the Government was compelling them to replace the stethoscope with the calculator,’ and thereby it harmed their ability to provide the best healthcare to the citizens of France. They saw it as a flagrant intervention of the sovereign in the relationship between a physician and his patient, which compelled the physician to introduce the economic criterion into the set of medical criteria that are taken into account during the treatment.7 Within the framework of the struggle, the hospitals were shut down for periods of time, elective treatments were postponed and demonstrations were held, with thousands of physicians participating in main cities.8
In May 1997, under the shadow of the mass demonstrations, general elections took place in France, in which the Government’s plan was put to the test. The incumbent Government was defeated and replaced by the socialist Government of Lionel Jospin. The new Government admittedly remained committed to its predecessor’s efforts to restrict health spending, but at the same time the implementation of one of the main and most problematic elements of the planned reform — the imposition on the physicians of a predetermined and limited budget, with a threat of economic sanctions if it was exceeded — was rejected.9 The main medical association (the Confederation of French Medical Unions — CSMF) had, over the years, remained steady in its refusal to recognize this clause, and therefore it had also not been subsequently implemented.10 Thus, the State’s attempt to impose a mechanism that made the writing of drug prescriptions subject to budgetary restrictions failed, and it was de facto abandoned by the French Government in 2000.11
In Luxembourg physicians and dentists stopped providing healthcare services during 2010 as a result of the Government plan to reduce the budgets of the hospitals. Following the struggle, the Government held negotiations with the physicians’ representatives, which led to a settlement that moderated the original reform.12
In Britain, the Government announced at the beginning of 2011 a wide-ranging plan to reform the National Health Service (NHS), whose purpose was a fundamental change of the structure of healthcare services in the country. The plans included far-reaching steps that were intended to advance the privatization of the National Health Service by creating competing markets between healthcare providers, including between private clinics and commercial companies. The physicians in Britain regard this plan as a serious threat to the healthcare system, and it announced that it would not accept these measures. The British Medical Association (BMA) announced in February that it was not impossible that it would declare a strike in order to stop the planned reform.13
In Greece, thousands of physicians and additional healthcare workers stopped the healthcare services in the country for several days beginning in March 2011 in protest at budgetary cuts and privatization measures that the Government tried to promote in the national health system.14 They also clashed with the police in stormy demonstrations that took place recently in Athens. The physicians’ struggle in Greece is a part of the public protest that is spreading in the country against the severe cuts in the public service that the Government is promoting in order to contend with the economic crisis.15
These examples illustrate that it is not really possible to separate the purposes of physicians from the welfare of patients, since they are united by the concern for a strong and functioning healthcare system. By exerting pressure on decision makers and employers, physicians in various countries are succeeding in increasing the resources devoted to the system, and thereby in improving the quality of treatment and service, and even preventing reforms that may undermine healthcare services for reasons of budgetary savings.
1 S.L. Thompson and J.W. Salmon, ‘Strikes by Physicians: A Historical Perspective toward an Ethical Evaluation,’ International Journal of Health Services 36, no. 2 (2006): 334-335.
2 Ibid.
3 Ibid., at pages 337-338.
4 Ibid.
5 The American College of Physician's Ethics and Human Rights Committee and the Center of Ethics and Professionalism, Physician work stoppages and political demonstrations – economic self-interest or patient advocacy? Where is the line? 2-3.
6 P. Maguire, Doctors struggle to balance professionalism with the pressures of everyday practice, 2003.
7 P.C. Sorum, ‘Letter from France: Striking Against Managed Care,’ Journal of American Medical Association, 280, no. 7 (1998): 662-663.
8 Inter alia, some of the strikers took part in exceptional action that went beyond the normal course of the struggle, such as throwing half a ton of fertilizer in front of the National Insurance Institute, breaking into the television studios in five different cities, while disturbing the broadcasting of the news program and covering the house of one of the union chiefs who opposed the struggle with false bills of money.
9 Sorum, at page 664.
10 The European Observatory on Health Systems and Policies, Health Care Systems in Transition: France, 2004, at pages 12, 17.
11 The European Observatory on Health Systems and Policies, Health Care Systems in Transition: France, 2010, at page 200.
12 352luxmag, ‘Doctors’ strike in Lux ends early,’ November 25, 2010. http://www.352luxmag.lu/?p=edito&a=external&id=90577 [accessed on June 16, 2011].
13 J. Laurance, ‘Doctors threaten to strike as anger grows over NHS reforms,’ The Independent, February 3, 2011.
14 EUbusiness, ‘Greek doctors strike against revamp,’ February 7, 2011. http://www.eubusiness.com/news-eu/greece-government.8ic [Accessed on June 16, 2011].
15 Desert News, ‘Greece: Police clash with striking doctors,’ May 6, 2011.