Unionized surgical resident programs are more likely to offer additional vacation time and housing stipends, but unions had no impact on burnout, mistreatment or other benefits, according to a recent study published in JAMA Network Open.
These findings suggest that while helpful in some ways, resident unionization is not a cure-all, according to Karl Bilimoria, MD, the John Benjamin Murphy Professor of Surgery, director of the Surgical Outcomes and Quality Improvement Center (SOQIC) and senior author of the study.
“This is a high-stakes, highly regulated industry already,” said Bilimoria, who is also vice president for quality at Northwestern Memorial Healthcare, vice chair for quality in the Department of Surgery, professor of Medical Social Sciences and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “It appears that having a unionized residency program does not do much for burnout.”
This study is part of the Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial, a national prospective trial to measure resident well-being and offer tools to programs in need of improvement.
The current study was borne of a recent focus on unionization as a possible solution to burnout, according to Brian Brajcich, MD, resident in general surgery, research fellow at the SOQIC and lead author of the study.
“There’s been discussion about resident unionization as a remedy to some of the issues of well-being and mistreatment, particularly at the height of the pandemic, but there are pretty minimal data or actual studies that evaluate this unique population of employees,” Brajcich said.
Brajcich, Bilimoria and their collaborators extended questions about unionization to residents participating in the SECOND trial, including queries about how long they’ve been unionized and affiliations with national unions. Some labor contracts were available for review, as well.
About 10 percent of the 5,701 residents who completed the survey were from 30 unionized programs. Measuring associations between unionization and burnout, the investigators found no difference in burnout when comparing unionized programs versus non-unionized programs.
Unionized programs did more frequently offer four weeks of vacation rather than two or three weeks, and more frequently offered housing stipends. However, these benefits appeared to have no impact on burnout, job satisfaction or feelings of mistreatment.
“There are so many things that go into burnout — how satisfied are you, are you overworked, do you have people who support you — and things such as a week of vacation may not be enough to move the needle overall,” Brajcich said.
Further, the presence of the Accreditation Council for Graduate Medical Education (ACGME) means the industry is already tightly regulated, reducing the space and need for unions to negotiate work hours or environment, according to Bilimoria.
Instead, improving resident wellness or reducing burnout needs to happen on a program-by-program basis, Bilimoria said.
“With the SECOND trial, we are providing programs with highly granular data on how they’re doing, and we’re giving them the tools to improve in those specific areas,” Bilimoria said. “The whole community is trying to improve resident well-being, and we think our wellness toolkits are a good way to do just that.”
Co-authors of the study include Yue-Yung Hu, MD, MPH, assistant professor of Surgery in the Division of Pediatric Surgery; Ryan Ellis, MD, resident in general surgery; and Jeanette Chung, PhD, research associate professor of Surgery in the Division of Surgical Oncology.
Funding for this work was provided by the Accreditation Council for Graduate Medical Education, the American College of Surgeons and training grant T32CA247801 from the National Cancer Institute.
