Most radiology residents support unionizing the profession, survey finds
Most radiology residents are supportive of unionizing the profession, according to new survey data published Monday in the Journal of the American College of Radiology.
Residents have shown growing interest in unionization in recent years, with the Committee of Interns and Residents reporting 32,000 members as of last May. That represents a doubling of membership since 2019 for the largest house staff union in the U.S.
Academic imaging experts sought to better understand sentiments about this shift, surveying 229 radiology residents about their perceptions. The majority said they were either “very” (55%) or “somewhat” (21%) supportive of unionization, believing it could positively impact everything from time off to benefits and wellness.
“The recent surge in house staff unionization may be partly driven by an increased prevalence of burnout, extended work hours, accrued debt, and suboptimal working conditions currently experienced by house staff,” Erica Kinne, MD, program director of diagnostic radiology residency at the Loma Linda University School of Medicine in California, and co-authors advised. “Our results suggest that radiology residents may see unionization as protection against these changes in their work environment. Residents may feel that membership in house staff unions could improve their experience, but our results revealed no significant difference in program satisfaction between unionized and nonunionized residents.”
Researchers sent the survey to all 50 members of the Radiology Residency Education Research Alliance, who subsequently forwarded it to 756 residents across 24 programs. The final tally of 229 residents (including 52 in unions at the time of the survey) represents a 30% response rate, with 20 tossed due to incomplete data. Most of those surveyed said they believe unionization has had a positive impact on residents’ wellness (60%), duty hours (64%), time off (66%), ability to have their voices heard (68%), salaries (80%), and benefits (83%).
Unionized residents also reported having more vacation time, with about 90% saying they get 20 or more days versus 70% among other respondents. Same for subsidized housing (54% vs. 6%) and technology/education stipends (90% vs. 82%) compared to their counterparts. Nonunionized residents were “significantly” more likely to report that unionization positively impacts duty hours (71% vs. 54%). However, they also were more likely to view disciplinary action as a drawback of union membership (at 15% vs. 2% among those in unions). Respondents outside of unions also tended to believe that organized labor could impact resident-faculty relationships either positively (22% vs. 10% for those in unions) or negatively (34% vs. 19%).
“This may be due to nonunionized residents having a wider range of perspectives, as they have not been directly influenced by a union, whereas unionized residents are more accustomed to and familiar with the unionized environment,” the authors wrote.
Kinne and co-authors cautioned that their small sample size may have influenced the results. The survey did not explore the impact of trainee unionization on the educational environment or patient care—two possible areas for follow-up investigations.
“Resident unions can also advocate for adequate staffing to ensure that hospitals rely less on overworked residents and offload menial tasks, freeing up more time for patient care, although this was not directly addressed in our study,” the authors added. “Potential negative outcomes of resident unionization include the financial implications of altering the hospital budget to increase resident salary and benefits, which could shift funding away from other programs that support patients and may even result in increased patient fees. In the event of failed union negotiations, a workforce strike could also delay care or cause patients to seek out-of-network care, resulting in an ethical dilemma between self-advocacy and the physician’s oath to ‘do no harm.’”
The authors also expressed concern about how unionization could possibly create a competitive advantage against other programs without organized labor. About one-third of survey respondents said that program unionization positively impacted their rank-order list for the annual Match.
“Based on these results, there is the potential that recent unionization of a program could increase a program’s competitiveness in the matching process. However, the long-term effects of unionization on residency match outcomes [are] less clear,” the authors wrote. “As programs unionize and higher financial costs related to negotiated salaries and benefits are realized, unionized programs could struggle to keep pace with peer programs. The increased costs of unionized resident salaries, benefits, and institutional expenses will affect a healthcare system’s finances. Hospitals could be forced to reduce hiring or diminish its ability to retain faculty and staff, purchase new equipment, or expand a training program. These downstream effects could ultimately lead to diminished resident satisfaction and, ultimately, negatively impact recruitment.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.