With Congress’ continued failure to enact a solution to the Medicare SGR problem, more and more physicians may decide that it is time organize a strike or boycott to send a message to Congress. Or something akin to a strike, like a single day when doctors collectively close their offices except for emergency care.
Earlier this year, the ACP Internist published a letter from a member who argued exactly that. He wrote that “it is time for the ACP, AMA, AAFP, and other groups to call for and lead a Medicare strike, whereby physicians refuse to see Medicare patients, except for urgent/emergent problems, for a period of, say, three days. By the way, don’t call Grandma by phone and tell her that her appointment is cancelled. Let her struggle across town and up to the office with her walker, then tell her why she won’t be seen that day, then hand her a piece of paper with the office phone numbers of her senators and representative on it. Maybe then we will see real change. If that doesn’t work, strike for a week. Then two weeks. Then a month. It is obvious that only such action will get rid of the SGR.”
There is precedence for a physician strike to put pressure on legislators. In 2003, the New York Times reported that almost all of the 30,000 physicians in New Jersey “canceled routine checkups and rescheduled elective surgery during the week of Feb. 4 in one of the nation's largest walkouts ever by doctors” to protest the state legislature’s unwillingness to curb malpractice premiums.
It is refreshing, then, that the brand new version of ACP’s code of ethics, published in the current issue of the Annals of Internal Medicine, reaffirms the College's position that strikes, boycotts, and other collective actions to deny care to patients or to inconvenience them are flat out unethical:
“Changes in the practice environment sometimes adversely affect the ability of physicians to provide patients with high-quality care and can challenge the physician's autonomy to exercise independent clinical judgment and even the ability to sustain a practice. However, physician efforts to advocate for system change should not include participation in joint actions that adversely affect access to health care or that result in anticompetitive behavior. Physicians should not engage in strikes, work stoppages, slowdowns, boycotts, or other organized actions that are designed, implicitly or explicitly, to limit or deny services to patients that would otherwise be available. In general, physicians should individually and collectively find advocacy alternatives, such as lobbying lawmakers and working to educate the public, patient groups, and policymakers about their concerns. Protests and marches that constitute protected free speech and political activity can be a legitimate means to seek redress, provided that they do not involve joint decisions to engage in actions that may harm patients.”
Yes, it is frustrating that Congress hasn’t ended the endless cycle of scheduled Medicare payment cuts. Physicians have a right to be angry. Traditional lobbying—persuading our democratically elected lawmakers to do the right thing—is a slog, difficult, time-consuming, and doesn’t always deliver the desired results, especially in today’s broken political system. But professionalism says that “the physician's primary commitment must always be to the patient's welfare and best interests.” [ACP Ethics Manual]. Accordingly, Congress’ failure to do its job cannot be an excuse for physicians not to do theirs. Collective actions to deny care to patients, in order to make a political point, can never be justified.
Today’s question: Do you agree with ACP that physician strikes or boycotts can never be ethically justified?