Residents debate unionization at RAS Symposium

Working conditions for resident physicians and surgeons in modern health care can create complicated workplace dynamics for residents, who want the best for patients as well as for their own careers and well-being. Is resident unionization a worthwhile tool to achieve these goals?  Participants in this year’s Resident and Associate Society of the American College of Surgeons (RAS-ACS) Symposium discussed this important topic from both pro-unionization and anti-unionization perspectives.

The symposium will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.

Remarks from Moderator Julia Roberts-Coleman, MD, MPH, Chair of the RAS-ACS Advocacy and Issues Committee, and Susan Adelman, MD, FACS, Southfield, MI, who highlighted the potential benefits of unionization, and John R. Potts, III, MD, FACS, Chicago, IL, who noted the challenges, were previously covered in Clinical Congress News. The resident contributors to this session, Brooke Bredbeck, MD, Ann Arbor, MI, and Sriram Rangarajan, MD, Colton, CA, added their thoughts to the “pro” and “con” sides, respectively.

Brooke Bredbeck, MD
Brooke Bredbeck, MD

The Case for Resident Unionization

Resident unions are becoming an increasingly necessary to tool in modern health care to guarantee that residents are not exploited. In discussing the need for unionizing in general, Dr. Bredbeck said, “If employees cannot engage in a competitive employment market, they are at a high risk for exploitation.” Further, she argues that the National Resident Matching Program (NRMP) is a monopoly within the resident employment space.

By limiting total residency positions available per year in the U.S., the Accreditation Council for Graduate Medical Education, informally requiring NRMP participation for continuing institution accreditation among other elements, creates a monopoly that significantly limits residents’ ability to advocate for themselves. In these conditions, “a union can serve as a powerful advocate when the dynamic is so unbalanced, as it is in residency,” Dr. Bredbeck said.

Sriram Rangarajan, MD
Sriram Rangarajan, MD

The Case Against

However, while labor unions are designed to offer protection, “surgeons and surgery residents are not laborers,” according to Dr. Rangarajan. Residents do not work a typical 9-to-5 job, they are not compensated for overtime hours, and they do not meet other common definitions for laborers.

Dr. Rangarajan argues, rather, “Surgeons are leaders within the hospital infrastructure. They are called upon to care for sickest patients, perform lifesaving operations, and are expected to go above and beyond to care for their patients.” Therefore, they should avoid unionization.

Further, he noted that unionizing could detract from residents’ education by changing relationships with hospital leaders, complicating relationships with faculty, and undermining public trust in resident surgeons who might appear to be mainly concerned with their personal needs.

Drs. Adelman and Potts offered rebuttals to the other respective side’s arguments, and the Symposium concluded with panel discussion.