Doctor Strike

This crisis seems too persistent to me. I have managed to push health to the top of the chart, significantly reduced health care demand, somewhat raised state health service spending, and implemented health care vouchers to divert some of the remaining demand, yet the event persists. This seems a bit much.

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You have to max out state health care.
You can also reduce labor laws to 0.

I’m aware that I can deal with it my maxing out one very expensive program. However my nation’s doctors being on strike for anything less than full funding seems unbalanced. When was the last time you heard of any country’s doctors being on strike continuously for a decade?

I’d agree that it’s a bit absurdly difficult to fix.
An alternate solution, absurdly, is actually to literally entirely get rid of state healthcare. Make it a problem of the private sector.
Imo that should have rather sizeable consequences if not fixed via other policies. But as it stands it’s actually pretty strong.

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All strikes are also heavily influenced by the labor laws. if your labor laws are very pro-employee, that makes strikes much easier, or more legal and more likely.

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Thanks for the reply Cliffski! I still feel the need to press this point however, as there is a difference between what people are allowed to do and what they want to do. Professionals are people who have chosen a field of work that they want to be in, and have worked hard to earn their place in that field. Such people are not looking for excuses to not work just because it’s legal. If professionals are striking, it’s because they perceive an unsatisfactory condition so bad that they cannot tolerate it. Legislating people back to work is a tactic sometimes used by governments, and being soft or reluctant with such methods would result in a strike drawing out longer if it were already ongoing. But again, people aren’t striking just because it’s legal, they are striking because something is wrong. Comparatively, I don’t tend to have problems with teacher strikes in my games, I wouldn’t say I’m treating the education system significantly better than the medical system, and it’s just as legal for the teachers to strike as the doctors.

To wrap up, I’m not asking for the game to be easier, I’m asking for more options to solve the problem. In this case, to be able to solve the problem of the doctor strike by solving the problems the doctors are striking about.


Agreeing with Rabid here. Strikes aren’t “Oh today I’m not gonna work for the hell of it and all my same-career buddies will join me in this spontaneous no-work party”. Strikes happen for reasons. And the things people strike about need to be addressable. Even at 100% pro employee balance.
It’s entirely possible that the solutions would be costly or otherwise controversial. But without a clear goal, strikes just seem awfully arbitrary.

I agree this strike needs some balancing. It should likely be more influenced by stuff like working week and wages too (as should all strikes actually).


somewhat suspicious that having higher wages seems to increase doctors strike, and having better labour laws also increases it.

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One thing that is sorta gimmicky is that, by cancelling public healthcare/schools/railways entirely, the player immediately ends the doctor/teacher/railworker strikes. It ends up encouraging players to outright cancel public services instead of have them be somewhat underfunded.

Potential ways to work around this could be…

  1. Why Do Patients Stop Dying When Doctors Go on Strike? | Psychology Today Weirdly-enough, mortality rates decreased early on during doctors’ strikes, b/c lots of doctors started working privately & not doing elective operations.

  2. This graph from the WHO identified the causes of health worker strikes in general…

WHO | Health workers’ strikes in low-income countries: the available evidence BLT.18.225755-F1full.jpg (1000×512) (

That WHO study in its discussion section says…

“Although wage demands were central to most of the strike events reviewed, macroeconomic conditions, such as GDP growth, unemployment and absolute salary levels, did not appear to be key triggers. Relative pay gaps between junior and senior cadres or with other professions were mentioned as a more frequent source of recrimination. Our data were not sufficient to allow the identification of specific political economy factors for the strike episodes; however, our results do suggest that professional associations, government departments, health sector and labour market governance, all contribute in reaching positive resolutions. In physician’ cases, as senior doctors have traditionally been well-connected with the government, they have had more effective means of influencing governments and to protect their economic interests. Therefore, strikes may arise from the failure of the medical associations to represent more junior doctors or general practitioners.”

“We identified 62 reports containing information about stakeholder involvement, including professional trade unions (general and health sector specific), medical and clinical associations and government authorities in charge of negotiations (health ministry, finance ministry, President, Prime Minister or Cabinet). Striking parties were represented by professional associations, and by diverse government institutions, such as the health ministry, Presidency, Prime Minister Office and the finance ministry. Health professional councils and associations, rather than general trade unions, were involved in all the strikes identified.”

IE the only real factor appears to be wages of doctors vs. wages of others, and the strength of the healthcare association to actually bargain. Stronger healthcare associations appear to make strikes less likely - or when they do occur, finish more quickly. Source: WHO | Health workers’ strikes in low-income countries: the available evidence

tl;dr the WHO says that GDP, unemployment, and raw dollars earned weren’t factors in doctors’ strikes, BUT raw dollars compared to other workers, as well as wage disparity between Old Wizened Physician & Brand-New Doc, were major factors. Having weaker doctors’ associations made things worse according to the WHO.


I definitely agree this is an exploitable game mechanic I should look into at some point!

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oh NP, I’m simply a bored office worker who likes this game a lot (and politics) and reads way too many news articles at his desk, so throws ideas up on these forums between jobs at my desk :slight_smile:

I put in italics the important parts of the WHO study above btw, IE the parts relevant to game mechanics. They may or may not be feasible to implement from a game-balance perspective… and that WHO study was only about all types of health workers’ strikes in more developing economies.

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It makes sense to me that private healthcare gets rid of the doctors strike, since it is no longer incumbent on the player to resolve the doctor’s demands.

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It’s still going to be a big problem if the doctors are on strike. The player might not get blamed for it as much, and it could even trigger a dilemma with options to 1 let the free market run its course 2 order the doctors back to work or 3 regulate the industry. Doctors being on strike and therefore citizens not getting health care shouldn’t be a non issue just because it’s handled by the private sector.


I think the private sector should hold some sway but not at all to a point where it ends the strike by just existing.

Yes, but the point is that the private sector is assumed to actually do something in response or anticipation, where as that assumption can’t be made for the player.

I do think this game has set an incredible precedent for the private sector simply resolving stuff devastatingly painlessly, as with the baffling effectiveness of private pensions, but it definitely doesn’t work this way in the real world.

It was on the water industry to react to Flint afterall, and you can see how that went.

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The game has set an incredible (and, compared to this, ubiquitous) precedent for solving everything by throwing money at government programs, too. No need to explain why that’s unrealistic. This is just how the game works, for better or (much more likely) worse.