I read a recent JAMA Viewpoint on medical trainee unions not just with disappointment, but with a deep sense of recognition. It presents a narrow and skewed interpretation of unionization, framing it not as a response to systemic dysfunction but as a threat to medical education and hospital finances.
We do not unionize for marginal gains or lighter schedules. We are responding to an embedded educational hierarchy that excludes us from decisions directly affecting our professional training and well-being, but demands our everything: our time, our health, our silence.
A narrow interpretation
The article cites a study showing no difference in burnout or satisfaction between unionized and non-unionized surgical residents, presenting this as a metric of union failure. This is a misinterpretation. Correlation does not imply causation. A more plausible reading is that burnout persists because the system remains unchanged, with unsustainable workloads, insufficient support, and rigid training models. Expecting unions to fix these deep-rooted issues alone is strategically misleading.
The article perpetuates a harmful dichotomy: that having a family or being older legitimizes the motivation for unionization, while implying that younger trainees should embody silent endurance. This misses the heart of a generational shift. The generational gap mentioned by the authors is not evidence of entitlement. It reflects an evolving understanding of work-life balance, equity, and psychological safety that deserves attention, not dismissal. Our advocacy is not a negotiation for perks; it is a non-negotiable foundation for a sustainable medical profession. We are not rejecting hard work; we are rejecting exploitation.
Solidarity, not inefficiency
The evidence cited to suggest unions breed conflict between faculty and residents is revealing. A qualitative study of 22 individuals, including only four faculty members, is used to dismiss a national movement. Yet, within that same limited sample, the authors noted that active engagement with union processes improved communication. The selective interpretation reveals a bias: seeing conflict where there is, in fact, the difficult but necessary noise of reform.
The critique that union benefits do not serve every resident misunderstands solidarity entirely. Collective bargaining builds a floor of dignity for all. I may never need the parental leave we fight for, but I will fight for it relentlessly because my colleague does. This is not inefficiency; it is the bedrock of a professional community.
The root of the problem
Most concerning is the implication that our advocacy makes us financial liabilities, potentially to be replaced. This argument weaponizes economic anxiety against the very trainees whose labor keeps teaching hospitals running, while failing to address the root causes of financial strain: government policy, insurance structures, and corporate interests.
We inherited this system. We did not build its unsustainable workloads, its rigid hierarchies, or its culture of silent endurance. Yet, we are told that organizing to change it “could be problematic.” Our union is not a grievance; it is a testament. It is proof that our commitment to medicine is so profound that we must fight for a system worthy of that commitment.
Resident unions are not the problem. They are a symptom of a system in urgent need of reform. The conversation should not center on whether residents deserve a voice, it should ask why it took unionization for them to be heard.
This essay is cited in the KevinMD record on residency.
Paz De la Torre is a surgery resident.
