Resident Unions Are Growing in Popularity in Otolaryngology

In Dr. Harris’s view, unionization efforts represent a larger collaboration among peers having a voice in spaces where historically they did not. “As otolaryngology residents who are frequently outnumbered by residents from other programs, it’s important for us to be participants because oftentimes our opinions and perspectives are unique,” she said.

In addition to salary increases, higher meal allowances, and parking reimbursement, the resident union at UCSF has bargained for longer parental leave and fertility coverage as part of resident healthcare insurance. 

“Unionization continues to challenge the traditional residency model to ensure that residents are cared for holistically—spiritually, emotionally, physically, and mentally,” Dr. Harris said. “It serves to remind the institutions that we are employees and more than just the backbone of the workforce of the hospital. In the future, the union will continue to fight for higher wages in consideration of inflation and rising costs of living, plus resources to enhance our education along the way.”

Dr. Pletcher believes that there’s probably an evolution of unionization. “Even though we’re five plus years in, I don’t know that we really know the long-term impacts, but my experience so far is that it really hasn’t changed the traditional resident model,” he said. “It has just made our residents’ transition to San Francisco a little bit easier by decreasing some of the financial stress.”

Unionization Drawbacks

While some residency directors like Dr. Pletcher haven’t experienced downsides to having residents who are unionized, even after several years, there are some who have. Mark Wax, MD, program director for the otolaryngology residency program and microvascular reconstructive surgery fellowship at Oregon Health and Science University (OHSU) in Portland, does believe unions serve a vital role in society and the economy. In a healthcare setting, however, he believes that unions often represent the interests of a broader group of residents and isn’t so sure that smaller departments, like otolaryngology, and the residents in them necessarily benefit.

“Sometimes the interests of the broad group may adversely affect certain constituencies,” Dr. Wax said. “The union may be negotiating for something that benefits a majority of their members but that’s detrimental to a select group of their other members, which are in a minority.”

Dr. Wax described having had a great system for recording and monitoring duty hours for otolaryngology residents, one that was individualized with a login and logout system that was pre-populated and easy to use. This system also enabled the department to take into account variability with on-call differences in shifts and proactively look ahead, predicting potential problems with duty hours in upcoming weeks or months. This system, however, didn’t fit the overall institution’s view.