Commentary: professionalism, unionization, and physicians' strikes.

Professionalism is the basis of medicine's social contract with society. The details of that contract are influenced by the presence or absence of a national health plan. In countries with such a plan, unlike in the United States, negotiations are dictated by the nature of medicine's contract with society and take place between the medical profession and society directly. This system has required that medicine be represented at the negotiating table, and, in most instances, it has resulted in the unionization of physicians. To influence these negotiations, the medical profession has used various forms of collective action, including strikes. As the United States continues on the path toward health care reform, it seems likely that the American medical profession will also require an organization to represent it at the negotiating table and will be under the same pressures to strike as are physicians in other countries. Because both unionization and strikes pose potential threats to the professionalism of students, residents and practicing physicians, such issues should be a part of the medical education curriculum at both the undergraduate and postgraduate levels. The authors briefly review the literature on strikes and job actions and share personal experiences to support this discussion. Students and residents should have an opportunity to consider these issues in a safe environment, both to understand the potential impact of a strike on patients and the profession and to determine their own personal course of action should such a situation arise.