Views of Radiology Program Leadership on the Impact of Resident Unionization

In recent years, medical residents across the United States have been seeking to unionize with the goal of increasing compensation and improving work conditions. The impact on resident education and the administration of such programs is not well understood. We undertook this study to investigate radiology program directors' views about resident unionization.

A 24-item IRB-approved survey was disseminated by email to members of the Association for Program Directors in Radiology (APDR) in August 2023. Members were asked questions about individual demographics, program characteristics, and Likert-scale questions about unionization and its potential impact on resident education. Subgroup analysis was conducted using ordinal regression.

63 of 247 active members completed the survey, yielding a 26% response rate. Of the respondents, 31 (49%) identified as female, 37 (59%) as White, and 48 (76%) as non-Hispanic. 49 respondents (78%) identified themselves as program directors. The mean reported program size was 29 residents. 52 (83%) respondents identified their training site as an academic program, and 49 (78%) stated their program is located in an urban setting. 45 (71%) reported that trainees in their program were not unionized. Large majorities reported agreement that unions make their job more difficult (79%), that unions interfere with their ability to remediate a struggling resident (71%), and that unions change how they perform their roles (71%). Additionally, most respondents believed that unions have a positive impact on the ability of residents to make their voices heard (65%), and on resident benefits (65%). Slight majorities believed unions have a positive impact on resident salaries (57%), but negative impacts on the ability to foster resident-faculty relationships (59%) and residents' willingness to accept constructive feedback (59%).

This survey study suggests that most radiology program directors view resident unionization as problematic, with concerns including the ability of trainees to be accepting of constructive feedback, the ability to remediate an underperforming resident, and the ability to foster trainee and faculty relationships. They believe that resident well-being and educational quality are not affected by unionization, but that resident compensation, benefits, and potential for advocacy do improve when unions exist.