Neurosurgical faculty and resident perspectives on collective bargaining efforts by resident physicians in the United States.

Objective: Collective bargaining unions frequently represent employees across industries, including healthcare workers such as nurses. In recent years, resident physicians have been increasingly unionizing to improve working conditions and benefits. However, whether resident unionization will benefit or harm neurosurgery training is unclear. This study aimed to ascertain the perspectives of neurosurgical faculty and trainees on collective bargaining efforts by resident physicians in the United States.

Methods: A 17-question survey (14 multiple choice, 3 open ended) evaluating respondents' opinions on resident unionization was emailed to lists of 551 faculty members and 1728 neurosurgical trainees (residents and fellows) in the United States. Both lists were extracted from a database maintained by the Society of Neurological Surgeons (SNS). The faculty list consisted of department chairs, residency program directors, and members of the SNS. Categorical variables were analyzed using chi-square tests. All p values < 0.05 were considered significant.

Results: There were 405 respondents (17.8% response rate): 182 faculty (33.0%) and 223 trainees (12.9%). Among faculty respondents, 70% opposed or strongly opposed unions, 54% thought they negatively impact patient care, 80% thought they could lead to strikes, and 85% thought alternate channels for voicing resident concerns were adequate. In contrast, among trainees, only 16% opposed or strongly opposed unions, 9% thought they negatively impacted patient care, 27% thought they could lead to strikes, and 38% thought alternate channels for voicing resident concerns were adequate (all p < 0.001). Among institutions with resident unions, 34.2% of faculty and 12.1% of trainees indicated witnessing a negative consequence of unionization, frequently mentioning an inability to make departmental-level changes without applying changes to all resident specialties. Among unionized residents, 84.8% reported a positive result of unionization, including improved pay, protected working hours, parental leave, parking, and educational stipends.

Conclusions: The findings revealed a divide between the opinions of trainees and faculty about trainee unionization. Trainees favored resident unionization, while faculty opposed it, highlighting the need for further dialogue to understand the impact of unions on residency training and promote optimal training environments in both unionized and nonunionized environments.