Physician trainees' attitudes toward physicians striking

http://www.ncbi.nlm.nih.gov/pubmed/21436671

Acad Med. 2011 May;86(5):580-585.
Developing Personal Values: Trainees' Attitudes Toward Strikes by Health Care Providers.
Li ST, Srinivasan M, Der-Martirosian C, Kravitz RL, Wilkes MS.
Source
Dr. Li is assistant professor, vice chair of education, and pediatric program director, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California. Dr. Srinivasan is associate professor, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California. Dr. Der-Martirosian is senior statistician, University of California, Davis, School of Medicine, Sacramento, California. Dr. Kravitz is professor and co-vice chair, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California. Dr. Wilkes is professor, Office of the Dean and Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California.

Abstract
Worldwide, health care providers use strikes and job actions to influence policy. For health care providers, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to provide care and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the health care workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence health care providers' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of health care professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions.