New perspective calls for regulatory reforms to address rising trend of US physician strikes

A new Perspective published in The New England Journal of Medicine led by researchers from the Harvard Pilgrim Health Care Institute calls for urgent regulatory reforms to address the rising trend of physician strikes in the United States. The piece provides a comprehensive analysis of the increasing frequency of physician strikes and offers a framework for U.S. policymakers to learn from international best practices.

The piece was led by the Harvard Pilgrim Health Care Institute and co-authored by a collaborator from Harvard Law School.

The paper, "Striking a Balance - Advancing Physician Collective-Bargaining Rights and Patient Protections," appears in the January 11 issue of The New England Journal of Medicine.

Over the past two years, there have been significant physician strikes around the globe, including three physician strikes in the U.S. in the last year, with potentially more strikes anticipated in the coming years. Concerns about higher workload, lower compensation, and increased financial pressures have contributed to the rise in unionization among medical residents, fellows, and attending physicians.

The Perspective documents the significant rise in physician strikes globally, citing notable examples from South Korea, France, and the U.K. "Physician strikes are a growing reality that we can no longer ignore," said lead author Tarun Ramesh, research fellow at the Harvard Pilgrim Health Care Institute. "We examined the impacts of these strikes on healthcare delivery and patient outcomes with the goal of finding potential solutions that, if implemented, can support all sides during times of unrest."

To address the challenges posed by physician strikes, the authors propose several actionable solutions:

• Address Regulatory Gaps: Despite the growing risk of strikes, the U.S. lacks comprehensive regulations to manage them. Policies mandating minimum staffing levels during strikes are critical to ensuring patient safety, as demonstrated by successful models from countries like France and Italy.
• Reduce Legal Challenges: Current U.S. labor laws exclude many physicians from unionizing. Modernizing these laws can empower more physicians to negotiate better working conditions without compromising patient care.
• Prevent Punitive Actions: Protecting striking physicians from punitive actions to align with International Labor Organization guidelines can protect employee–employer relations, public confidence in the medical system, and physicians' working conditions.
• Engage Stakeholders: Involve key stakeholders such as hospitals, healthcare systems, the American Medical Association, and State Medical Boards in developing and implementing these policies.

Our findings underscore the urgent need for regulatory reforms to balance the rights of physicians with the imperative of patient safety. By learning from international examples, we can develop policies that protect both healthcare providers and patients."

Hao Yu, senior author and Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute