The Future of Resident Unionization

Summary: Burnout is a recognized phenomenon among residents and attending surgeons in the United States, resulting in physical and mental exhaustion. Residents see a reduction in working hours as being essential to deal with this issue. Consequently, residents have unionized to improve collective bargaining power and advocacy with employers to achieve their aims. Unionization has proved controversial and spawned generational conflict within the profession. Older attending surgeons suggest that such unionization demeans the profession, as it is at odds with their sense of vocation and “nostalgic” professionalism. Residents and younger attending surgeons are not prepared to make the same commitments as their predecessors given the increased work–life balance they crave, reflecting the new societal norm. The United States must heed the lessons from those who have traveled this road previously. In the United Kingdom, working hours have significantly reduced in recent decades, requiring moves away from apprentice-style resident training towards a more remote shift pattern style of working. This has resulted in unintended consequences: (1) disruption of the “hidden” curriculum through which professionalism was previously taught and (2) an isolated and demoralized resident workforce. This tension reflects a breakdown in the social contract among medicine, society, and government that, if not addressed in the United States, may result in continued discord, as recently manifested by resident strikes in the United Kingdom. Looking forward, United States training programs should ensure that any changes in working hours must maintain teamwork between residents and attending surgeons, not only for their own well-being but also for that of their patients.