Unionization of General Surgery Residents Has Positive and Negative Aspects

Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences with Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 7, e2421676 (2024).

Editorial: Mikolajczyk AE, Goodman C. Resident Labor Unions—Learning as We Go. JAMA Netw Open/ 7, e2421634 (2024).

The unionization of physicians during postgraduate training has been in existence since the mid-1930’s. Growth of unionization has been irregular because of difficulties in clarifying the definition of postgraduate medical trainees as students or employees. Resident unions are increasing in number because of resident recognition that a unified voice is needed to deal with health system administration.

Unions are associated with improved time off and provision of housing stipends, but available data show that rates of burnout, job satisfaction, and impressions of the educational environment are similar in unionized and nonunionized programs.

Foote and coauthors used data from interviews obtained in a previous study of residency programs to clarify resident and faculty experiences with unionization. The data showed that unionization was associated with improved impressions of resident ability to control compensation and other benefits. Residents felt that they had a stronger position when negotiating with health system administrators following unionization.

Negative effects of unionization were impressions of increased adversarial relationships with faculty, loss of departmental benefits, and reduced opportunities for educators to remediate residents.

In the editorial that accompanied the article, Mikolajczyk and Goodman noted that the definition of a resident as a student or employee remains a problem and that best practices to enhance the work environment without inhibiting the learning environment are needed as the unionization movement progresses.