An uncertain job market. Wellness. Work–life balance. Salaries discordant with the cost of living. Medical school debt.

“These issues are only a few of the complex stressors faced by surgical residents, and now more than ever, in light of the COVID-19 pandemic, thousands of residents across the country are considering advocacy issues ranging from hazard pay to workplace safety to loan forgiveness,” said Julia Roberts-Coleman, MD, MPH, Chair of the Resident and Associate Society of the American College of Surgeons (RAS-ACS) Advocacy and Issues Committee.

These conditions have led many surgical trainees and leaders to ponder the best mechanisms for resident advocacy, including unionization, which will be the topic of the RAS-ACS Symposium at the virtual Clinical Congress. Resident Unionization: Future of Resident Advocacy or Deterioration of Our Profession? will start at 3:00 pm CDT Sunday, October 4, featuring a panel of residents and experienced surgeons.

Susan Adelman, MD, FACS, Southfield, MI, will present the pros of resident unionization, while John R. Potts, III, MD, FACS, Chicago, IL, will present the cons. They will be joined by resident speakers, selected through an essay competition on the topic. Brooke Bredbeck, MD, University of Michigan, Ann Arbor, will add to the pro argument, and Sriram Rangarajan, MD, Arrowhead Regional Medical Center, Colton, CA, to the con argument.

Dr. Roberts-Coleman will open the symposium with an overview of this controversial topic and the history of resident unionization in the U.S.

She said those who support resident unionization may cite the following benefits: development of professional identity, empowerment to advocate, creating a tool for collective bargaining, the effects on future generations of residents, and a decreased sense of loss of autonomy. On the other hand, she continued, those not in favor of resident unionization may say it damages ethical, practical, and public perception of residents; decreases the focus on patient-centeredness; fosters an adverse culture; and violates the trust between teachers and learners.

Dr. Adelman served as clinical associate professor of surgery, University of Michigan, and chief of pediatric surgery, Oakwood Hospital. She also served as president, Physicians for Responsible Negotiations; chair, Surgical Caucus of the American Medical Association; president, Organization of State Medical Association Presidents; and medical director of coordinated health care, Detroit Medical Center. She will share some of her own experiences with resident advocacy and unionization, starting with success in obtaining a pay increase for residents at Henry Ford Hospital, Detroit, MI, in the late 1960s.

Today, the coronavirus pandemic has been added to resident concerns and is a potential inflection point that inspires residents to unionize, but it is far from the only one, Dr. Adelman contends.

“Now the reasons might be related to the electronic medical record, the fallout from hospital mergers, issues of patient safety, a lack of PPE (personal protective equipment), protections for resident physicians who are pregnant, [and] inadequate sick leave for residents in the era of COVID-19,” she said.

Dr. Potts, on the other side of the debate, served as program director in surgery, University of Texas, Houston, as well as chair, Graduate Medical Education (GME) Committee, assistant dean for GME, and designated institutional official; past-president, Association of Program Directors in Surgery; past-chair, Organization of Program Director Organizations; past-director, American Board of Surgery; and senior vice-president for surgical accreditation, Council for Graduate Medical Education. He characterizes resident unions as unwanted, unnecessary, and unprofessional.

“The only real hammer that a union has is to strike,” he said. “Resident strikes disrupt patient care, and that is unprofessional.”

Even if the job action is not a total walkout—a slowdown or a refusal to complete medical records, for example—the normal flow of work in the hospital is disrupted and “bad things happen,” Dr. Potts warns. “When bad things happen in a hospital, bad things happen to patients. It is absolutely antithetical to the role of physicians to cause bad things to happen to patients.”