Why Do Patients Stop Dying When Doctors Go on Strike?

Cunningham and colleagues point out in their review paper that striking physicians opened aid stations, supplementing medical care and preventing people from mobbing the hospitals. While physicians were technically on strike during the four months of the dispute, most did not, in fact, adhere to the industrial action regulations.

In truth, most doctors in Jerusalem provided care in a private or partially private context, so, while participating in spirit, they did not actually withdraw services.

Another intriguing study analyzed changes in mortality by studying the Jerusalem Post’s newspaper reports of funerals during another Jerusalem doctors’ strike, this time between March and June of 2000. This one arose from the Israel Medical Association’s conflict with the government’s proposed wages. The hospitals in the area cancelled all elective admissions and surgeries, but kept emergency rooms and other vital departments, such as dialysis units and oncology departments, open.

Funeral Study

The funeral study found a decline in the number of funerals during the three months of the strike, compared with the same months of the previous three years. One burial society reported 93 funerals during one month of the strike (May 2000) compared with 153 in May 1999, 133 in May of 1998, and 139 in May 1997.

Cunningham and colleagues summarize their review of research assessing the effects of doctors’ strikes on mortality, finding that four of the seven studies report mortality dropped as a result of medical industrial action, and three observed no significant change in mortality during the strike or in the period following.

There are several possible interpretations for this surprising finding. One is that as its elective or non-emergency surgery which is usually most affected in a doctor’s strike, it could be the mortality findings reflect an impact of elective surgery.

The findings might be important because they perhaps illuminate the relatively high risks of elective surgeries, which may actually increase mortality. If it wasn’t for doctor’s strikes, this finding, ironically would never be properly highlighted.

Another sobering possible conclusion is that the public, and perhaps doctors themselves, overestimate the ability of medicine to stave off or have an impact on mortality.

Nurses’ Strikes

However, Jonathan Gruber and Samuel Kleiner analysed the effects of nurses’ strikes in hospitals on patient outcomes using nurses’ strikes over the 1984 to 2004 period in New York State. The paper entitled, “Do Strikes Kill? Evidence from New York State,” found nurses’ strikes increase in-hospital mortality by 19.4% and 30-day readmission by 6.5% for patients admitted during a strike.

The authors, from MIT and Carnegie Mellon University, conclude, in their paper published as National Bureau of Economic Research Working Paper No. 15855, that hospitals during nurses’ strikes are providing a lower quality of patient care.

It would seem the public should worry much more about nurses going on strike compared to doctors, yet the irony is, nurses seem to earn a lot less than doctors.

The problem with interpreting the data, on doctors’ strikes, as Cunningham and colleagues point out in their review paper, in all medical strikes studied so far, not all doctors down tools. In the 1976 Los Angeles strike only 50% of physicians were involved. So doctors’ strikes don’t necessarily drastically reduce access to health care.

Given the purpose of most strikes is to deprive management of the worker’s labor, and its benefits, this raises the sobering question of how effective a doctors’ strike can ever be in comparison to other occupations.

Why Do Patients Stop Dying When Doctors Go on Strike?