Perspective piece calls for physician strike regulations

Author(s):

Austin Littrell

Key Takeaways

Physician strikes are increasing, driven by workload, compensation, and financial pressures, necessitating regulatory reforms to protect patient safety.
U.S. lacks comprehensive regulations for physician strikes; adopting international models could ensure essential services during labor disputes.
Current labor laws hinder physician unionization; modernizing them could empower physicians to advocate for better working conditions.
Punitive actions against striking physicians harm relations and trust; alignment with international guidelines is recommended.
Collaboration among stakeholders is crucial for developing policies that balance physician rights and patient protections.

New perspective calls for regulatory reforms to address the rising trend of physician strikes in the U.S. based on international examples.

On January 11, a perspective piece was published in The New England Journal of Medicine, calling for urgent regulatory reforms to address the rising trend of physician strikes in the United States. The paper, “Striking a Balance – Advancing Physician Collective-Bargaining Rights and Patient Protections,” comes from the Harvard Pilgrim Health Care Institute, co-authored by a collaborator from Harvard Law School. The piece highlights the increased frequency of physician strikes across the world, offering a framework for U.S. policymakers to learn from international examples of balancing collective bargaining rights with patient protections.

Over the past two years, practices worldwide have seen significant physician strikes, including three in the U.S. Concerns regarding increased workload, insufficient compensation and increased financial pressures have contributed to a rise in unionization of medical residents, fellows and attending physicians.

“Physician strikes are a growing reality that we can no longer ignore,” Tarun Ramesh, lead author of the paper and research fellow at the Harvard Pilgrim Health Care Institute said in a news release. “We examined the impacts of these strikes on health care delivery and patient outcomes with the goal of finding potential solutions that, if implemented, can support all sides during times of unrest.”

Address regulatory gaps

The authors of the piece point out that the U.S. lacks comprehensive regulations to manage physician strikes, putting patient safety at risk. As a solution, they advocate for the adoption of policies that mandate minimum staffing levels during strikes. Successful models from countries including France, Italy, Ireland and Spain demonstrate how these measures can ensure essential services remain operational, minimizing disruption to patient care during labor disputes. Implementing similar standards in the U.S. could provide a critical safeguard while allowing physicians to exercise their collective-bargaining rights.

“The statutory 10-day notice for strikes against health care institutions in the United States is intended to provide a ‘cooling off’ period and give the institution time to make arrangements to safeguard patient care,” the authors of the study explained. “Adding a legally required minimum level of service could further protect patients, address some physicians’ concerns that striking conflicts with their ethical duty to provide care and protect against potential allegations of patient abandonment by state medical boards.”

Reduce legal challenges

Current U.S. labor laws pose significant barriers for physician unionization and collective action. Notably, many physicians are left excluded from union protections, including those classified as independent contractors or supervisors. According to the paper, these definitions fail to account for the growing corporatization of health care, which has significantly reduced physicians’ autonomy. Antitrust laws further complicate organizing efforts by treating independent physicians as competitors, restricting their ability to unionize.

The authors of the paper recommend modernizing labor laws, including revising the National Labor Relations Act (NLRA) to make more physicians eligible for union protections. This change would better reflect the realities of the modern health care landscape, empowering physicians to collectively advocate for improved working conditions without compromising patient care.

Prevent punitive actions

Punitive measures against striking physicians, including license suspension or career-related retaliation, can harm employee-employer relations and public trust. The authors urge alignment with International Labor Organization (ILO) guidelines, which discourage punitive actions against workers engaged in lawful strikes. During South Korea’s 2024 physician strike, punitive actions by the government made tensions worse and were met with public outcry. Protecting physicians from similar repercussions in the U.S. could foster a more constructive approach to resolving labor disputes.

Engage stakeholders

Developing and implementing effective policies to manage physician strikes requires the involvement of key stakeholders. The authors of the paper emphasize the need for collaboration among these stakeholders, which include hospitals, health care systems, the American Medical Association (AMA) and state medical boards. These entities have the ability to play a pivotal role in creating regulations that balance physicians’ labor rights with patient protections, ensuring that the health care system remains resilient in times of unrest.

“Our findings underscore the urgent need for regulatory reforms to balance the rights of physicians with the imperative of patient safety,” said Hao Yu, senior author of the paper and Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. “By learning from international examples, we can develop policies that protect both health care providers and patients.”