BACKGROUND AND PURPOSE: 

• Brajcich et al. (JAMA Network Open, 2021) evaluated the association of resident unions with well-being, educational environment, salary, and benefits among surgical residents in the US 

METHODS: 

• National cross-sectional survey study 
• Population 
  • Clinically active residents  
  • All nonmilitary US general surgery residency programs (ACGME) | Armed services can not unionize  
  • Completed 2019 American Board of Surgery In-Training Examination (ABSITE) 
• Study protocol  
  • Survey administered following ABSITE using exam software  
  • Data de-identified and not shared with residency administration 
  • Burnout assessed using abbreviated Maslach Burnout Inventory 
  • Rates of unionization in non-healthcare personnel were used to adjust for potential confounding  
• Primary outcome 
  • Burnout: Experiencing any symptom of depersonalization or emotional exhaustion at least weekly 
• Secondary outcomes 
  • Suicidality 
  • Measures of job satisfaction 
  • Duty hour violations, mistreatment 
  • Educational environment 
  • Salary 
  • Benefits 

RESULTS: 

• 5701 residents from 285 programs 
  • Response rate: 85.6% 
  • 56.5% male | 66.3% White | 7.9% Hispanic | 74.4% married or in a relationship | 22.9% had or were expecting children 
• Union coverage 
  • 690 residents from 30 programs | 10.5% of programs 
• There was no difference in burnout for residents at unionized vs nonunionized program 
  • Unionized: 43.0% 
  • Non-unionized: 43.4% 
  • Odds ratio (OR) 0.92 (95% CI, 0.75 to 1.13) 
• Benefits: Unionized programs more frequently offered 
  • 4 weeks instead of 2 to 3 weeks of vacation 
    • Unionized: 93.1% 
    • Non-unionized: 30.6% 
    • OR 19.18 (95% CI, 3.92 to 93.81) 
  • Housing stipends 
    • Unionized: 38.5% 
    • Non-unionized: 16.1% 
    • OR 2.15 (95% CI, 0.58 to 7.95) 
• No differences noted in other secondary outcomes 
  • Suicidality | Job satisfaction | Duty hour violations | Mistreatment | Educational environment | Salary 

CONCLUSION: 

• Unionized residency programs were associated with increased vacation and housing stipends but did not impact burnout, educational satisfaction, or other quality of life factors  
• The authors conclude 

…unions do not appear to improve burnout, suicidality, job satisfaction, duty hour violations, mistreatment, or program educational environment 

These findings should be noted as residents and residency programs discuss resident well-being and contemplate unionization 

Learn More – Primary Sources: 

National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being 

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