Kravitz R L, Linn L, Tennant N, Adkins E, Zawacki B
Department of Medicine, University of California, School of Medicine, Los Angeles.
West J Med. 1990 Nov;153(5):515-9.
Work actions by house staff are an infrequent response to sometimes difficult working conditions, but they can have a notable effect on institutional cohesiveness and represent a challenge to traditional notions of medical ethics. To determine the extent of participation in a hospital-wide doctors' strike and factors associated with participation, we surveyed 432 house officers at a university-affiliated public hospital where a contract dispute had recently led to a 4-day work action. Of 257 respondents, 69% approved of the strike and 50% participated in it. Both strikers and nonstrikers agreed that quality of care and specific contract issues were important precipitants of the event. By logistic regression, factors independently associated with strike participation (P less than .05) included being unmarried, training in internal medicine or psychiatry, being in earlier stages of training, being assigned to an outpatient service at the time of the strike, holding a favorable view of physician activism, and perceiving nurses, faculty, peers, and the public to have favored the strike. These associations may provide a basis for understanding the individual and social determinants of house-staff strike activity.
住院医师采取的工作行动是对有时艰难的工作条件的一种罕见回应，但它们可能对机构凝聚力产生显著影响，并对传统医学伦理观念构成挑战。为了确定参与全院范围医生罢工的程度以及与参与相关的因素，我们对一所大学附属公立医院的432名住院医师进行了调查，该医院最近因合同纠纷导致了为期4天的工作行动。在257名受访者中，69%赞成罢工，50%参与了罢工。罢工者和非罢工者都认为医疗质量和具体合同问题是该事件的重要促成因素。通过逻辑回归分析，与参与罢工独立相关（P小于0.05）的因素包括未婚、在内科或精神病学专业培训、处于培训早期阶段、罢工发生时被分配到门诊服务、对医生激进主义持赞成态度，以及认为护士、教员、同行和公众支持罢工。这些关联可能为理解住院医师罢工活动的个体和社会决定因素提供基础。
