Effects of doctors strikes

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Health effects

  • Generally strikes result in the maintaining of emergency services either by the striking doctors or by colleagues. If so there does appear to be the potential for a decrease in mortality, due it is believed to the reduction in elective work.
    • 20% decreased mortality (Israel 2000) [1]
    • 55 to 153 deaths did not occur because of the number of elective operations not performed secondary to the strike easily hid any impact from increased patient transfer to other facilities on emergency admission mortality(California 1973)[2].
    • Similar reductions were seen in California and UK decades earlier

The decrease in mortality does not affect routine perinatal statistics

  • No change in the perinatal mortality (Israel 1983) [3]

And does not appear at a macro level

  • No increase or decrease in population mortality (Croatia 2003)[4]
  • County mortality statistics not affected(California 1973)[5]

But it is possible some of the effects are long term

Some of the effects of a junior doctors strike may be superficially attractive in a management target driven culture:

  • Resident strike (Spain 2000)[7]
    • Fewer clinical tests
      • Pathology
      • X-rays
    • Shorter lengths of hospital stay
  • The argument that some of this effect of mortality is a result of removing from health care those felt most likely to have competency deficiencies is only partially supported by medical staff cohort turnover studies that tend to demonstrate fairly minimal or no impact on mortality.

Disruption

The disruption caused by a 2012 UK 24 hour strike of doctors with maintained emergency services has been described. This was locally patchy involving about 8% of the NHS doctor work force on the issue of pension reform. An analysis of the national impact was that emergency admissions fell by 2.4%, elective admissions decreased by 12.8%, outpatient activity dropped by 7.8% and A&E attendances dropped by 4.7%. In hospital mortality did not increase significantly[8]

Malta had a ten year doctor strike from 1977 when health care became a state responsibility and the government amended legislation governing medical licensing. This had major consequences, with the political decision not to employ striking doctors aggravating the doctor brain drain. This was partially reversed in 1987 when a change of government attracted many Maltese doctors with useful overseas experience back again. It is said Maltese politicians are now very cautious in their dealings with doctors, the scars run so deep, but, whatever the history, by 2000 the healthcare system was quite functional on international comparative measures.

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In 2016 due to continued and escalating industrial action by junior doctors the GMC issued guidance on some relevant issues:

References

  1. Siegel-Itzkovich J. Doctors' strike in Israel may be good for health. BMJ (Clinical research ed.). 2000 Jun 10; 320(7249):1561.
  2. James JJ. Impacts of the medical malpractice slowdown in Los Angeles County: January 1976. American journal of public health. 1979 May; 69(5):437-43.
  3. Bukovsky I, Herman A, Sherman D, Schreyer P, Arieli S, Caspi E. Perinatal outcome following physicians' strike of 1983. Israel journal of medical sciences. 1985 Oct; 21(10):804-7.
  4. Erceg M, Kujundzić-Tiljak M, Babić-Erceg A, Coric T, Lang S. Physicians' strike and general mortality: Croatia's experience of 2003. Collegium antropologicum. 2007 Sep; 31(3):891-5.
  5. James JJ. Impacts of the medical malpractice slowdown in Los Angeles County: January 1976. American journal of public health. 1979 May; 69(5):437-43.
  6. Marcovici OA, Slater PE, Ellencweig AY. Effects of the Israel doctors' strike on hypertension control in Ashdod. European journal of epidemiology. 1987 Mar; 3(1):30-4.
  7. Salazar A, Corbella X, Onaga H, Ramon R, Pallares R, Escarrabill J. Impact of a resident strike on emergency department quality indicators at an urban teaching hospital. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2001 Aug; 8(8):804-8.
  8. Ruiz M, Bottle A, Aylin P. A retrospective study of the impact of the doctors' strike in England on 21 June 2012. Journal of the Royal Society of Medicine. 2013 Sep; 106(9):362-9.(Link to article – subscription may be required.)