3.5 Physicians and Job Action
Ross Langley, MD, FRCPC, MACP; and Charles Weijer, MD, PhD, FRCPC
Following review of this case , the learner should be able to:
- Define physician job action;
- Discuss the key ethical issues concerning job action; and
- Outline the regulatory issues with respect to physician job action.
You have recently become the president of your local branch of the provincial medical association. The agenda for your first meeting of the provincial association arrives, and among the many items listed, one especially piques your interest: a report from the negotiation committee that talks for the next contract are not going well.
At the meeting, you learn that negotiations for a new contract have been ongoing for nearly two years. The association is asking for a 12 per cent increase in fees over the life of a three-year contract, higher standby fees for physicians on call for intensive care units outside cities and incentives to encourage physicians to relocate to areas such as yours. The association objects to the removal of certain insured services from the reimbursement schedule. The government wants the association to accept reduced fees for some services, and saved costs will be used to increase fees for undervalued services. You observe considerable polarization among the members with respect to physician job actions and whether it is ethical to undertake them.
You must now report back to your local branch, and you expect that the same concerns about the ethics of job actions will surface there. Two senior colleagues advise you to develop a framework outlining the ethical issues that you can use for discussion at the meeting.
- What is physician job action?
- What sources can you consult to learn more about the ethics of physician job action?
- What sections of the "CMA Code of Ethics" produced by the Canadian Medical Association are relevant? Do they seem to permit physician job action or not?
- What positions have provincial medical colleges taken on the issue? Do these positions reflect agreement or disagreement on the ethics of physician job action?
- Ought physician job action to be permitted? Support your position with an argument.
Recognizing the right of our colleagues to disagree, we support the view on physician job action taken by the American College of Physicians. We conclude by quoting — and endorsing — their view:3
"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, physicians' efforts to advocate for system change should not include participation in joint actions that adversely affect access to healthcare or that result in anticompetitive behaviour. Physicians should not engage in strikes, work stoppages, slowdown, 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 legitimate means to seek redress, provided that they do not involve joint decisions to engage in actions that may harm patients."
- Canadian Medical Association. CMA code of ethics (update 2004). Ottawa: Canadian Medical Association; 2004. Available from: http://policybase.cma.ca/PolicyPDF/PD04-06.pdf
- Medical professionalism in the new millennium: a physician charter. Annals of Internal Medicine 2002; 136(3): 243–6. http://www.acponline.org/running_practice/ethics/physicians_charter/
- Snyder L, Leffler C; Ethics and Human Rights Committee, American College of Physicians. Ethics manual: fifth edition. Annals of Internal Medicine 2005; 142(7): 560–82. http://www.acponline.org/running_practice/ethics/manual/
- The College of Physicians and Surgeons of Ontario. Withdrawal of physician services during job actions. Policy #6-10. Available from: https://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/withdrawal_web.pdf and College of Physicians and Surgeons of Nova Scotia Policy on Withdrawal of Physician Services during Job Actions. Available from: https://www.cpsns.ns.ca/DesktopModules/Bring2mind/DMX/Download.aspx?PortalId=0&TabId=129&EntryId=31
- College of Physicians and Surgeons of Alberta: Physicians Withholding or Withdrawing Services http://www.cpsa.ab.ca/publicationsresources/attachments_policies/Physicians%20Withholding%20or%20Withdrawing%20Services.pdf
- Baer N CMAJ 1997 Despite some PR fallout proponents say MD walkouts increase awareness and may improve healthcare; Can. Med. Assoc. J. Nov 1, 1997:157 (9)
- American College of Physicians Ethics Manual (Online) http://www.acponline.org/running_practice/ethics/manual/