Contract for UK consultants--round 2: medical profession KO'd, OK?
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The policy of the Dutch government (now enshrined in legislation) aims at the integration of medical specialists in hospitals and seeks to end the economic and organisational autonomy of the medical specialist. This article suggests that this policy has also acted as an incentive for medical specialists to develop local strategies that often diverge. Medical specialists are pursuing strategies that aim to strengthen their collective power within the hospital organisation while at the same time consolidating their entrepreneurial status. Medical staff governance has consequently become a key factor in hospital governance.
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Exploitation of resident physicians still occurs and can result in working conditions so unfavorable that patients are endangered. Because residents are vulnerable to exploitation, and because they are not fully accountable for patient care or for fully developed professionalism until they have completed their training, for just ends it is morally acceptable for residents to strike. Given that the ultimate responsibility for every patient rests not with the residents but with the attending and staff physicians, in the event of a resident strike the attending and staff physician supervisors should cover patient care, at least with respect to essential services. It is not morally acceptable for attending or staff physicians who are employees to strike. Attending and staff physicians should make every effort to resolve concerns about patient care without the use of confrontation. However, it may be necessary to consider collective actions to secure certain professional interests, including an interest in patient care. For such ends, patient endangerment is an unacceptable means and contrary to the professional virtue of altruism. The strategy for a just collective action is to identify the things that physicians normally do for their employer and collectively to withhold all of them, with the single exception of patient care.
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