Analysis

What are the consequences when doctors strike?

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6231 (Published 25 November 2015) Cite this as: BMJ 2015;351:h6231
  1. David Metcalfe, research fellow,
  2. Ritam Chowdhury, research associate,
  3. Ali Salim, professor of surgery
  1. 1Center for Surgery and Public Health, Harvard Medical School, Boston, MA 02115, USA
  1. Correspondence to: D Metcalfe dmetcalfe{at}bwh.harvard.edu
  • Accepted 17 November 2015

Doctors considering strike action may worry about the effect on patients. David Metcalfe and colleagues examine the evidence

The right to strike is recognised as a fundamental human right by the United Nations, the Council of Europe, and the European Union.1 Most European countries enshrine the right to strike in their national constitutions.2 It has been argued that collective bargaining amounts to nothing more than “collective begging” for employees without the option to strike.3 This is because employees have no choice but to accept the final terms imposed by their employer. It has even been claimed that an individual’s right to withdraw his or her labour is a feature that distinguishes employment from slavery.4

Industrial action by doctors is, however, complicated by their professional values and ethical framework. Most strikes are effective because they harm a neutral third party, who is then motivated to pressure the employer to accede to strike demands. Unfortunately, when doctors strike, this third party is often their patients.5 For many people, such behaviour is inconsistent with the over-riding duty of doctors to advocate for their patients.6 Others have claimed that doctor strikes inevitably expose patients to risk of serious harm.7 The situation may be further complicated by doctors striking to oppose policies that are perceived to threaten the standard of care they are able to deliver.

Strikes by doctors highlight the conflict between doctors’ rights as employees and their duty to patients. They are, however, a global phenomenon, with strikes already reported this year in Australia, India, Ghana, Nigeria, the United States, and Venezuela. In a recent British Medical Association ballot, junior doctors in England voted overwhelmingly in favour of strike action over the government’s threat to impose a new contract next year.8 We examine data from …

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