Conditions that justify strikes as perceived by housestaff at a public hospital

Although physicians' strikes provoke considerable controversy and are increasing in incidence, little information is available regarding house officers' attitudes towards the ethics of striking. To determine house officers' views of whether and when it is justified to strike, and to understand the factors affecting their judgments, in 1988 the authors surveyed 432 residents (including interns and fellows) at a large public hospital shortly following a four-day housestaff work action; 255 (59%) responded. In responding to 12 hypothetical scenarios, 218 residents (85%) thought striking was justified if vital equipment were in short supply and the strike was unlikely to cause lethal harm, but only 10 (4%) thought striking justified if the issue was low salaries and the risk to patients was high. Twenty-two residents (9%) thought striking unacceptable in all 12 cases. Training in obstetrics-gynecology or psychiatry, liberal politics, and low levels of job satisfaction were independent predictors of residents' believing that strikes were more often justified. Although the residents' responses to the hypothetical scenarios were related to their prior work action behaviors, the association was weakened by adjustment for contextual factors such as specialty and social norms. Implications for education in medical ethics are discussed.