Can psychology explain our surprise at mortality decreases when doctors’ strike?
Doctors in the U.K. are considering whether to strike over proposed changes in their contracts and they are marching in London as part of the protest. What’s the likely impact of withdrawing medical care on the health of the nation? Physicians seem to be gambling that the government doesn’t want to alarm the electorate.
But when doctors strike, the scientific research shows that patients stop dying.
The most comprehensive review of the medical impact of doctors’ strikes is published in the prestigious academic journal Social Science and Medicine. A team lead by Solveig Cunningham and Salim Yusuf at Emory and Georgetown Universities in the U.S. and McMaster University in Canada, analyzed five physician strikes around the world, all between 1976 and 2003.
Doctors withdrew their labor, in the different strikes analyzed, from between nine days and 17 weeks.
Yet all the different studies report population mortality either stays the same, or even decreases, during medical strikes. Not a single study found death rates increased during the weeks of the strikes, compared to other times.
For example, in a strike in Los Angeles County, California in January 1976, doctors went on strike in protest over soaring medical malpractice insurance premiums. For five weeks, approximately 50% of doctors in the county reduced their practice and withheld care for anything but emergencies. One analysis, quoted by Cunningham and colleagues, found the strike may have actually prevented more deaths than it caused.
Strikes and Mortality
The study entitled, “Doctors’ strikes and mortality: A review,” suggests that it’s the fact that elective, or non-emergency surgery, tends to stop during a doctors’ strike, which seems to be the key factor.
It looks like a surprising amount of mortality occurs following this kind of procedure that disappears when elective surgery ceases because of doctors withdrawing their labor. Mortality declined steadily from week one (21 deaths/100,000 population) to weeks six (13) and seven (14), when mortality rates were lower than the averages of the previous five years.
However, as soon as elective surgery resumed, there was a rise in deaths. There were 90 more deaths associated with surgery for the two weeks following the strike in 1976 (ie when doctors went back to work) than there had been during the same period in 1975.
But, unlike Los Angeles, what about the impact of doctors’ industrial action where the majority of doctors participate, and the strike lasts several months?
Cunningham and colleagues report on a strike in Jerusalem from 2 March to 26 June 1983 because of a salary dispute between the government and the Israel Medical Association. Eight thousand of Jerusalem’s 11,000 physicians refused to treat patients inside hospitals, though many of them set up separate aid stations where they treated emergency cases for a fee.
One analysis examined death certificates from several months surrounding the strike period, 16 February-3 September 1983, and from a control period the previous year, 17 February-3 September 1982. Mortality did not increase during or after the strike, even when elective surgery resumed.
The pre-strike deaths for the control period and the strike period were identical at 89; there were six fewer deaths during the strike than during the control period, while in the 10 weeks following the strike, there were seven more deaths than there had been in 1982.
An Over-Supply of Doctors?
In an example of how a doctor’s strike can backfire, the authors of this particular mortality analysis argued this apparent lack of impact of the strike on mortality suggests that there was an over-supply of doctors in Jerusalem at the time. The problem with drawing conclusions remains that the strike did not involve the whole scale deprivation of medical services.