Abstract
IMPORTANCE: Resident physicians provide frontline care to approximately 70% of hospitalized patients. After decades of relative stability with a small minority of resident physicians unionized, unionization movements have succeeded in recent years at multiple major academic medical centers. OBJECTIVE: To evaluate resident physicians' unionization intention and the factors informing their unionization consideration at their institution. DESIGN, SETTING, AND PARTICIPANTS: This nationwide survey study was conducted in May 2023 among a cohort of resident physicians, which was established over the course of 3 academic years (2020-2023). Resident physicians were invited to participate in an end-of-study survey on contemporary topics, which included questions on unionization. EXPOSURE: Consideration of unionization by resident physicians. MAIN OUTCOMES AND MEASURES: The main outcomes were the presence of a union at the institution for physicians in training, the presence of a movement to unionize, whether the resident physician would vote to unionize, and the factors most important in considering unionization. All measures were self-reported. RESULTS: A total of 1235 participants (mean [SD] age, 28.8 [3.6] years; 737 of 1224 females [60%]; 791 of 1086 (73%) in their first postgraduate year) responded to survey questions regarding unionization. Twenty percent of participants (n = 249) reported that physicians in training belonged to a union at their institution. Among the 986 nonunionized resident physicians, 63% (625) reported they would vote to unionize, whereas less than 10% (96) would not vote to unionize. Pay and work hours were the most commonly cited factors in considering unionization (88% [1081 of 1235 participants] and 76% [941 of 1235 participants], respectively). CONCLUSIONS AND RELEVANCE: In this survey study, most resident physicians (>70%) reported either being in a union or supporting unionization at their institution, citing pay and financial security as critical factors in their consideration of unionization. Future research should investigate other factors and whether unionization achieves its goals of increased pay and benefits, work hours, and well-being.