In a survey study Agarwal et al. from the UPMC, Pittsburgh (Agarwal et al.); U Michigan, Ann Arbor (Zaki et al.) published in the *Journal of Neurosurgery* to evaluate neurosurgical faculty and trainee opinions on resident physician unionization via a 17‑question national survey. Survey sent to 551 faculty (chairs, PDs, SNS members) and 1,728 trainees (residents/fellows). Response rate was 17.8% (182 faculty, 223 trainees). Categorical responses analyzed with chi-square; significance at p < 0.05.
* Key Findings:
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Faculty: 70% opposed unions; 54% felt unions negatively affect patient care; 80% feared strikes; 85% believed current channels were sufficient.
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Trainees: Only 16% opposed unions; 9% thought unions impact patient care negatively; 27% feared strikes; 47% believed existing channels adequate (all p < 0.001).
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Among those at programs with existing unions, 34.2% of faculty and 12.1% of trainees reported negative consequences—most commonly inability to enact discipline‑specific departmental changes.
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Conversely, 84.8% of unionized residents cited benefits: enhanced pay, duty hours protection, parental leave, parking, and educational allowances
Critical Analysis
* Strengths:
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National reach and representation of both faculty and trainees.
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Direct comparison reveals stark divergence in perspectives.
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Mix of quantitative and qualitative feedback on union effects.
* Limitations:
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Modest response rate (17.8%) poses risk of non-response and selection biases.
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Trainee respondents underrepresented (12.9%); faculty slightly higher (33%), potentially skewing views.
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Cross-sectional study can’t determine causality or long-term impacts of union activity.
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Definition and context of “negative consequences” lack granularity; specifics not clearly delineated.
* Bias Considerations: Both faculty and trainees may hold entrenched positions shaped by institutional culture—responses may reflect these preconceptions more than objective outcomes.
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Verdict: 6 / 10
⚠️ A timely and well‑structured survey shedding light on the pronounced gap between faculty and resident views on unionization. However, limited by low response rate and cross‑sectional design. Useful as a starting point for dialogue, but insufficient to guide policy or systemic change without further empirical investigation.
Takeaway for Neurosurgeons
* Understand that resident support for unionization is strong, driven by concerns like compensation, work hours, and work–life balance * Faculty skepticism is primarily driven by fears about patient safety, training alterations, and institutional rigidity. * Any conversation or policy around resident unions must proactively address both faculty concerns and trainee needs—dialogue, transparency, and empirical follow‑up are key.
Bottom Line
This survey highlights a significant faculty–trainee divide on unionization in neurosurgical training, with trainees reporting clear benefits while faculty express concerns. The topic calls for nuanced, data‑driven discussions before implementing any changes to training structures.
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Publication date: July 11, 2025 Corresponding author: Prateek Agarwal, MD, MBA