Participation in collective bargaining units appears to be widely supported by resident physicians, who often cite pay and work hours as key reasons they would vote to unionize if able, according to a recent nationwide survey of physicians in training.
The poll, published late last week, was conducted in 2023 and reached 1,235 resident physicians, of whom about three-quarters were in their first postgraduate year. Of these, about a fifth said they were already part of a union at their institution.
However, among the remaining 986 respondents who were not unionized, 63% said they would vote in favor of a union at their institution while just under 10% said they would vote against.
Taken together, more than 70% of the respondents are in or would support a union at their institution. These responses, researchers wrote in JAMA Network Open, “substantiate the increasing prevalence of unionization among resident physicians, who traditionally work long hours with low hourly compensation.”
While female residents were more likely than male residents to say they would vote for a union, there were no significant differences by respondents’ race, ethnicity or the type of program they were in.
On the other hand, respondents were more likely to say they would vote in favor if their institution did not provide childcare facilities or need-based stipends, or if their institution did not provide coverage for when their children were sick. Respondents who self-reported greater financial insecurity were also more likely to say they would vote in favor.
When asked which factors played into a voting decision, 88% pointed to pay and 76% their work hours. Less commonly outlined (30% to 50%) were housing benefits, support for mitigating fatigue, retirement benefits and childcare benefits.
Thirty-six percent said they were aware of a movement to consider unionization at their institution at the time of the survey, while an equivalent percentage said there was no such movement.
The researchers said their findings on union interest and participation are in line with prior published research data and national union reports from 2023, though their work appears to be the first nationally representative survey outlining the factors behind those decisions published in a peer-reviewed journal.
“Future research should investigate other factors, such as workload, electronic health records, and patient portals, in unionization considerations; whether unionization leads to increased financial stability, reduced work hours, and provision of other benefits; and whether such changes are associated with improved work-life balance and decreased rates of burnout,” the researchers wrote.
Though labor organizations for resident physicians at public hospitals have been around for several decades, it wasn’t until 1999 that the National Labor Relations Board began recognizing residents at private hospitals as employees rather than students. Union representation remained low in subsequent years, with about 10% of all trainees (16,000) belonging to a union by 2019. That changed during and immediately after the COVID-19 pandemic, per news reports, association surveys and the unions.
The largest of these, the Committee of Interns and Residents (CIR), which is part of the Service Employees International Union, says it doubled in size during the pandemic and currently represents more than 37,000 resident physicians and fellows—more than a fifth of the 159,010 active residents reported by the Association of American Medical Colleges in 2024.
In January alone, there were six National Labor Relations Board elections in which early physicians working at six hospitals—Thomas Jefferson University Hospital, the Beth Israel Deaconess Medical Center, Rhode Island Hospital, Temple University Hospital, the Albert Einstein Healthcare Network and Christiana Care Health Services—voted in favor of CIR representation. And, just a few weeks back, the CIR announced a “supermajority” of the almost 1,000 resident physician and fellows at the University of Minnesota voted in favor of joining.