Attendings give advice to early-career docs about managing ongoing physician strikes
Industry Buzz
Before making a decision about participation, be sure to read your contract and understand the legal structure in your jurisdiction, as well as what your responsibilities are.
—Sharon Heng, MBBS, PhD, FRCOphth
Respect your co-workers’ perspective but do not leave the decision based on peer pressure.
—Daniel Careaga, MD
Nearly 70% of US union petitions involving attending physicians between 2000 and May 2024 were filed after 2019.[]
The sharp rise means residents, fellows, and new attendings are increasingly likely to face a union campaign, strike vote, or workplace action early in their careers. So, what advice would senior clinicians give early-career docs encountering labor action for the first time?
Related: More doctors are organizing—and putting hospital contingency plans to the testKnow what action you are joining
Daniel Careaga, MD, a board-certified plastic surgeon from Miami and founder of Careaga Plastic Surgery, says, “Early-career physicians need to realize that professional obligations do not change. Be sure to review the institution for policies, contractual obligations, and patient care provisions before any decision is made.”
US labor protections vary by employment model and jurisdiction. Employed physicians generally have broader collective bargaining rights than independent contractors. Supervisors, military physicians, and doctors in some public institutions face separate restrictions.[]
Visa status, training obligations, malpractice coverage, and hospital policies also deserve review before participation.
A 2025 legal and ethical review argued that US policy should distinguish organized labor action conducted with patient safeguards from sudden withdrawal of care. The authors emphasized the importance of advance notice, emergency coverage, and transparent contingency planning.[]
Handoffs
Dr. Careaga says, “Clear communication and complete handoffs are essential to patient safety. Verify that the receiving doctor took over the patient before you leave.”
Sharon Heng, MBBS, PhD, FRCOphth, a Consultant Ophthalmic Surgeon at Moorfields Eye Hospital in London, and Clinical Lead for the Medical Retina Digital Clinics and for the Northwest London Diabetic Retinopathy Screening Programme, says, “Patient safety actually breaks down at handoffs during a strike.”
Sharing her experience, she adds, “I've seen this in other high-volume clinical settings where even a slight delay in communication between teams can cause a patient who can't wait to be delayed in treatment, and that is exactly what the NHS data shows.” “About 61,000 patient appointments were rearranged in a week during a single five-day strike in July 2023 across the NHS,” she stated.
Her advice: “Write everything down. The receiving clinician should be apprised with the current condition of the patient, the plan, and what to look for, and not a verbal summary simply passed in a corridor. When treating patients with long-term ailments, patients are in time-sensitive cycles of treatment, and a lost handoff note is no small matter.”
Patient abandonment generally refers to ending an established physician-patient relationship without adequate notice or an opportunity to obtain replacement care. Whether a specific strike creates legal exposure depends on local law, notice requirements, employment arrangements, and the continuity plan in place.[]
Need for safeguards
Doctors who continue working during a strike often face pressure to cover for absent colleagues or perform duties outside their usual workflow.
The British Medical Association (BMA) advised hospitals to reduce lower-priority activity when required to protect emergency care during resident doctor strikes. Tom Dolphin, MD, chair of the BMA council, warned against asking doctors to return because a hospital had “failed to properly plan the extra cover needed.”[]
Dr. Heng advises, “If you are thinking of joining or working through a strike, there's one thing you should know first. Professional registration is not suspended when industrial action starts. I have coached fellows and junior doctors through what I think are some really difficult times in the NHS, and those who have had the most difficulties are those who have thought someone else was looking after them and doing their jobs for them. Before making a decision about participation, be sure to read your contract and understand the legal structure in your jurisdiction, as well as what your responsibilities are.”
Expect ethical disagreement
Physicians remain divided over whether doctors should strike.
In a January 2026 r/medicine discussion, one commenter wrote, “No physician should ever strike, ever,” and proposed a billing strike instead.[] Another physician argued that cancelling cancer visits would harm patients and the academic center rather than the intended political target.[]
The BMA states that “both action and inaction have ethical costs.” Strikes risk short-term disruption. But continued inaction amid unsafe staffing and poor retention also affects future patients.[]
Its guidance asks physicians to consider emergency coverage, health inequalities, workplace risks, and the likely effectiveness of the action.
Related: How one hospital’s staff is maintaining patient care amid ongoing healthcare strikesManaging peer pressure
Dr. Careaga says, “Respect your co-workers’ perspective but do not leave the decision based on peer pressure.”
Dr. Heng further observes, “Peer pressure in a strike strikes the young doctors the most, but no one seems to mention it.”
Sharing from her own experience, she adds, “I recall coaching other staff members who were afraid to be perceived as a ‘troublemaker’ if they participated, and afraid to not participate and be perceived as ‘disloyal.’ Both sides are unable to make the decision for you. Before you make your decision, sit down with your educational supervisor, so you can get direction and support that you can't get from a conversation in the corridor with a fellow colleague. The only thing that should be in that decision is your judgment.”
Protect your record
Dr. Heng puts it bluntly, “It is your responsibility to safeguard your medical license. In 15 years of working in the NHS, I've seen careers damaged, not for the side that a doctor played but for picking a side when they shouldn't have, and in response to an emergency. When making decisions, put patient welfare first and professional responsibility second and you will be able to justify your actions in any eventuality. This is what helps to distinguish a doctor who has progressed through this experience from one who is still outlining it years later.”
Early-career physicians may retain their copies of formal union notices, hospital instructions, schedules, and written handoff requirements.
Dr. Carega concludes, “Labor disputes do eventually get resolved, but your reputation for professionalism, fair judgment, and honesty stays with you.”