Does mortality fall when doctors go on strike?

Question

In a 2017 article arguing that inaction is sometimes better than action (the urge to do something often dominates the urge to do the right thing) Tim Harford makes the following comment (I've included the context as well as the key claim):

It is a little unfair on doctors to point out that when they go on strike, the death rate falls. Nevertheless it is true. It is also true that we often encourage doctors to act when they should not. In the US, doctors tend to be financially rewarded for hyperactivity; everywhere, pressure comes from anxious patients. Wiser doctors resist the temptation to intervene when there is little to be gained from doing so — but it would be better if the temptation was not there.

Is Harford's incidental claim a solid one?

Answer 1

If you are sick, keep the doctors away? _{(Variously attributed to Democritus and Leonardo da Vinci, no reliable source found)}

Doctors' strikes and mortality: a review (doi: 10.1016/j.socscimed.2008.09.044):

A paradoxical pattern has been suggested in the literature on doctors' strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctors' strikes. We identified 156 articles, seven of which met our search criteria. The articles analyzed five strikes around the world, all between 1976 and 2003. The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods. The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.

With the following reasoning:

In spite of the limitations of the studies, the fact that several studies using different methods in different setting found consistent results suggests that they may indeed be capturing a phenomenon. The findings raise important issues regarding the appropriate levels of health care. They highlight the risks of elective surgeries, which may actually increase mortality. They also highlight the possibility that an over-supply of doctors may not increase patient survival and may introduce inefficiencies into health care. In summary, the selective withdrawal of services by various health care workers for relatively short period of time does not appear to adversely influence mortality.

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Discussion

One objection that may be raised against the paper cited is the ratio of 156 studies found that matched the systematic search criteria terms vs apparently only 7 studies evaluated meeting the systematic search criteria qualities. Some studies were of too low quality and since doctors usually do not strike; when they do this it is a highly unusual event with potentially very interesting effects to observe (witness the OP's question) and therefore under immense scrutiny leading to several papers covering one and the same event.

A doctor's job is difficult and burdened with immense responsibility. For every treatment there are effects and side-effects to be considered, a cost benefit analysis to be performed. Ideally, routinely.

The main effects found are theorised to be split into several parts: There are systemic effects inherent to a profit oriented system leading to (wholly) unnecessary treatments (one part because of greed in the system, one part wrong incentives to those involved and too much stress piled onto the decision makers). This is despicable in nature and in principle, although it may just not be realised by most doctors in each individual case presented to them. This should be, and presumably is, the smallest contributing factor and at the same time the main driving point given as surrounding context for the claim.

Doctors very seldom do harm on purpose, as this statistic cited above might suggest. Critical health care, like countering a heart attack, was still provided in every case examined, as the Hippocratic Oath prescribes. ("a doctors’ strike involving the withdrawal of some non-emergency services does not necessarily lead to increased mortality.") Many doctors do not adhere to the strict strike definition that would be expected from a workers' trade union.

A systematic over-provisioning and resulting health care system inefficiencies as well as their associated negative outcomes are probable and likely reduced (e.g.: "during this strike, the residents were replaced with staff physicians, so the care provided may have actually been more experienced.").

The main death toll reduction was assumed to be caused in a short time frame from cessation of elective surgeries were risks are often immediately realised but benefits only potential and later to be observed. This was probably the biggest contributing factor in the cases surveyed.

tl;dr:

Apparently yes, in the short time frame of such a rare strike and shortly thereafter the overall mortality rate remains the same or declines. However, the actual circumstances seem to suggest that this is not so much evidence for more harming patients (on purpose) than doing good. It is more an indication of several inherent limits of the way the health-care systems are organised.