To Strike or Not to Strike at Kaiser Permanente in California


Have you ever gone on strike?


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Walking out on a white coat ceremony, as new medical students did and we covered on August 2nd, is one ethical choice, but walking out on patient care is quite another. Strikers have to have a good ethical case that the long-term patient, personal, and collegial goals trump the short-term needs. Perhaps this ethical dilemma is one significant reason why health care strikes are so rare in the United States.

Starting yesterday morning, Northern California Kaiser Permanent mental health workers began to go on strike. According to CBS News in Sacramento, the union representing the various mental health disciplines have apparently been working without a contract since last September. The issues are inadequate staffing, increased patient needs, not enough time for administrative tasks, and pay. In December 2019, they struck for 5 days over staffing shortages. As far as I know, psychiatrists and general physicians have not been included.

Actually, throughout medical history in the United States, physicians have rarely formed unions or carried out strikes. There is some presumed legal obstacle in the way, though I am not sure that has ever been tested.

Periodically, physician strikes have occurred in Canada and other countries. Usually, they have been short-lived, with the unexpected finding of lowered mortality during the strike time, presumably due to elective surgeries being delayed.1 However, none of the strikes studied focused on mental health care specifically.

The Kaiser strike seems to continue the struggle as to whether business ethics for profits or health care ethics of patient care take priority.2 Last year, Kaiser reported a $8.1 billion net profit. In 2014, it was fined $4 million for concerns about its mental health care services.

Personally, I retired from clinical care at the Medical College of Wisconsin in 2012 when the med check time was administratively reduced to 10 minutes in the scheduling. I guess that could be said to be a permanent strike!

Given the continuing concern in psychiatry about health maintenance organizations like Kaiser, managed care, and business control, the outcome of this isolated strike may well be important more generally. The bigger and more widespread question is: how do we improve mental health care in a cost-effective way when the need is increasing?

Do you think you would ever go out on strike? If so, for what reasons?

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.


1. Cunningham SA, Mitchell K, Narayan KM, Yusuf S. Doctors’ strikes and mortality: a review. Soc Sci Med. 2008;67(11):1784-1788.

2. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.

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