A.J. Hughes1, M.L. Hunt1, B. Ruedinger1, A.L. Holmstrom1, J.S. Eng1, Y. Hu1,2, T.J. Nasca3, K.Y. Bilimoria1 1Surgical Outcomes And Quality Improvement Center (SOQIC), Department Of Surgery, Indiana University School Of Medicine, Indianapolis, IN, USA 2Feinberg School Of Medicine – Northwestern University, Division Of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA 3The Accreditation Council for Graduate Medical Education, Chicago, IL, USA
Introduction:
Resident unionization has increased over the past decade, with numerous programs unionizing after the pandemic. An initial cross-sectional study using pre-pandemic data showed no association between unionization and resident well-being. The pandemic offers an opportunity to assess whether unionized programs fared better than non-unionized programs. The objective of this longitudinal study was to examine the association of unionization on general surgery resident wellbeing, mistreatment, and duty-hour violations before and after the pandemic.
Methods:
A cross-sectional survey of general surgery residents was administered following the 2020 (pre-COVID), 2021, 2022, and 2023 (post-COVID) American Board of Surgery In-Training Examination (ABSITE). The survey assessed well-being (burnout, thoughts of attrition), mistreatment (bullying, racial and gender discrimination, sexual harassment) and duty-hour violations. Residents who unionized after 2020 were considered non-unionized. A multivariable logistic regression difference-in-differences (DiD) model compared unionized vs. non-unionized programs pre and post pandemic, adjusting for resident and program characteristics, and county-level COVID-19 cases.
Results:
In 2020 and 2023, 13,318 responses (75.2% response rate) were collected from all 356 general surgery residency programs. 10% of residents were in 31 unionized programs. There were no significant differences in burnout, thoughts of attrition, or racial discrimination at unionized vs. non-unionized programs before vs. after the pandemic. Compared to pre pandemic, there was significant worsening in rates of gender discrimination (DiD coefficient 0.59, p=0.02), sexual harassment (DiD coefficient 0.67, p=0.03), and duty-hour violations (DiD coefficient 0.38, p=0.04) post-pandemic in unionized vs. non-unionized programs, but these were not significant after adjustment for multiple comparisons (Table 1). Results were similar when using 2021 or 2022 as the “post” comparison. There were no significant associations between program unionization status and agreement with: ‘My program came together during the pandemic’ (union 76.3 %, non-union 78%, p=0.19), and ‘My program prioritized my health and safety during the pandemic’ (union 79.8%, non-union 80.5%, p=0.70).
Conclusion:
In this first longitudinal study evaluating the impact of unionization on resident well-being and mistreatment, there were no significant differences between unionized and non-unionized programs before vs. after the pandemic in burnout, thoughts of attrition, gender or racial discrimination, sexual harassment, or duty-hour violations. Thus, unionization does not appear to improve resident well-being or mistreatment.