Analysis of physicians’ strikes and their impact

Resident doctors often resort to strikes for reasons concerning safety at the workplace, better working conditions, better remuneration, and policy issues such as caste-based reservations and appointments to institute positions (1). Although many articles have discussed whether or not physicians should resort to strikes, few have analysed the prevalence of strikes, their direct impact on healthcare delivery, and beneficial outcomes, if any, for physicians (2, 5). We conducted a single centre retrospective study for analysing the same.

In March 2011, an application was filed, on behalf of Rahul Yadav, one of the authors, at the Office of Public Information of Guru Teg Bahadur Hospital, New Delhi, under the Right to Information (RTI) Act, 2005, asking for information on all strikes called by the Resident Doctors’ Association (RDA) of the hospital over the previous five years. Information was obtained on the frequency and duration of strikes and their consequences; demands of the residents and remedial measures taken by the authorities; any punitive measures imposed by the authorities; and the number of times the provisions of the Emergency Services Maintenance Act (ESMA) had been invoked. The impact of strikes on healthcare services in the hospital was assessed by analysing the number of patients seen during working days, averaged over a month, preceding the strike period, and the number of patients seen during strike days.

The reply to the application under the RTI Act revealed that during the preceding five years from April 1, 2006 to March 31, 2011, work was struck on five different occasions, amounting to a total 22 days (eight days in August 2007, two days in April 2008, six days in September 2008, three days in October 2008 and three days in February 2011) in five years, an average of 4.4 days per year. The common factor mentioned for all the strikes was “misbehaviour by attendants with residents”. The April 2008 strike concerned misbehaviour of attendants with nurses. The RDA’s demands were related to improvements in security. There were no incidents of violence. ESMA was invoked twice in October 2008, and in February 2011.

There was a significant decrease in the number of patients attended to in the outpatient department (OPD) during strike periods, compared to the number of patients seen preceding each strike. The number seen in OPDs each day, averaged over a month, preceding the five strike periods, were 4,866, 4,719, 4,920, 4,878 and 4,550 respectively, and the average number seen in OPDs during the corresponding strike periods were 1,680, 2,377, 3,668, 1,389 and 3,093 respectively. The cumulative average of the number of patients seen during the strike period is 2,441.4 which is only 51% of the cumulative average of 4,786.6 patients seen during the month preceding the strike period.

Information on remedial measures by the management revealed that during the August 2007 strike, the management promised that “the present security will be scrapped and a better agency will be employed” and “regular surveillance will be done in the security services and patient care facilities”. A written assurance was given in reply to our RTI application, for time-bound implementation of these measures and also that no action would be taken against striking doctors. During the April 2008 strike, the management issued directions for regular rounds by security officers. A file was moved for 95 extra security guards. During the September 2008 strike, the management deployed additional security, installed close circuit televisions at intensive care units. Also a “one patient-one attendant” norm and the display of a gate pass by one attendant at a time were made mandatory.

No record was available of whether any RDA member’s services were terminated or suspended, or whether there was a cut in the salary of any RDA member due to the strike.

Our analysis of the strikes revealed that there is a significant decrease in the average number of patients seen in OPDs during strikes. Though striking residents often start parallel OPDs during strikes, it is clear that the health services are seriously compromised during strikes (5). Some studies have shown that strikes have led to decreased mortality though the reasons suggested for this were scarcity of emergency services and lack of emergency surgeries (4).

Repeated strikes for the same demands suggest that despite announcing appropriate measures every time, the management has failed to address the grievances of the residents adequately.

Tight regulation of security personnel and a serious assessment of the quality of security services are needed. Inclusion of RDA members in the decision making team may help formulate effective policies for ensuring the safety of residents at the workplace.