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Medicine is a calling. But far too often, trainees — residents and fellows — at hospitals don’t receive the support necessary to deliver the best clinical care. Overworked, underpaid, and under-appreciated in an era of skyrocketing paperwork requirements and historic inflation, trainees sometimes struggle to make ends meet, care for themselves and loved ones, and even find joy in the day-to-day grind of learning to be an independent physician.

In response, many trainees are calling for unions, including at Mass General Brigham, where I’m currently a third-year orthopedic surgery resident. But while many consider unionizing to be a “yes” or “no” proposition, at this moment, I suggest a third option: a pause.


A one-year pause and reassessment would allow us to sift through the fearmongering on both sides of the unionization debate, consider what has already been done by Mass General Brigham in good faith, and permit all voices to be better heard.

On the pro-unionization front, trainee colleagues argue that the concessions recently made by Mass General Brigham — including a 10% wage increase, $10,000 per year additional stipend, no-cost health insurance, and 2% annual base pay retirement contribution — are “just the beginning” to the benefits a union would guarantee. While enticing, this is false. There is no language in the law that requires any negotiated union contract to be better, or provide more benefits, than the baseline “starting point.” In fact, it could even be worse, and trade-offs are a natural outcome of union negotiations. While trainees at other institutions that have unionized have “won” some key benefits, none compare with the significant increase in benefits that Mass General Brigham trainees were provided that will make us the highest-paid residents in the country starting next year.

On the anti-unionization side, Mass General Brigham leadership have suggested that unionizing may negatively impact mentorship between trainees and faculty. While the process of unionizing can be viewed as adversarial, the expectation that day-to-day relationships between trainees and attending physicians will be negatively impacted may be an extreme view; I have not been able to locate any health care literature to support this position. Further, this argument assumes physicians who elected to lead a career in academic medicine will change their approach to trainee education in response to unionization efforts. I find that hard to believe.


There are numerous other statements — frankly assumptions — made by camps in support of or against unionization. People who desire more flexibility in and specialty-specific changes to their educational programming and time-off requests lean towards not unionizing. Those who prioritize a guaranteed seat at the table lean toward unionizing. And the list goes on. I hear the arguments made by my trainee colleagues, and by my Mass General Brigham leadership colleagues. I respect and value both sides, and I would urge all involved to really assess just the facts, not the hyperbole.

It is undeniable that trainees deserve better and have for a long time. We arrive to the clinic or hospital early and stay late. We make personal sacrifices, often going the “extra mile” to deliver the very best care even when it may be suboptimal for us and our families.

But no one knows what a union at Mass General Brigham will or will not accomplish. The only scientific literature on the topic, which was published in JAMA Network Open, demonstrates no improvement in education environment, salary, duty hour violations, mistreatment, burnout, suicidality, or job satisfaction.

What we all want is action and solutions that will make a difference in our lives and the lives of our patients. But whatever the motive behind the recent benefits announcement by Mass General Brigham, we have already accomplished so much without unionization. So, while many pro-union trainees believe —though there is no clear evidence of this — that the recent benefits changes were motivated by the desire of Mass General Brigham for us not to unionize, does that even matter? Even if it may sit poorly with some trainees, the most important question becomes: Can we truly do better with a union? Perhaps, but any gains will involve trade-offs.

I am not trying to persuade anyone to vote for or against the union, and at the end of the day, I think it is critical for all parties to make their voice heard and vote. But at the moment, I simply want everyone to do what we do every day in medicine — take a deep breath, review all the facts, make the best decision possible, and only then take action. In my mind, this requires a pause from the current high-speed push for and equally adamant opposition to unionization grounded in a mix of emotion and assumption with a “sprinkle” of facts. We must see how the new promise of teamwork and benefits from Mass General Brigham leadership actually positively impact our lives and our patients lives over the next year — or not. Without doing so, I fear trainees come across as vengeful rather than focused on what we can actually achieve for ourselves and our patients and no olive branch — regardless of the benefits — from Mass General Brigham would have been enough to appease us.

If I have to vote now, I’m a “no” on unionization because, in part, trainees have already won — we are now set to be the most highly compensated residents in the United States and will continue to be educated by some of the best and brightest attending physicians worldwide.

However, I urge the pause and remind my trainee colleagues that even if the recent changes were an attempt to halt unionization efforts, it is then clear that whatever power we wield stems from the legitimate option to unionize and the engrained benefit to strike in a “worst case” scenario. But I must admit that does not sit well with me even if it would be an extraordinarily rare instance. I cannot imagine ever striking and putting patients at risk.

The best way to think of unionization is that it — and the trainees’ ability to re-start the process should our voices be silenced or our progress be reversed — is the ace up our sleeve to protect us and our patients.

At least for now, this isn’t the time to play it.

David N. Bernstein, M.D., MBA is a resident physician in the Harvard Combined Orthopaedic Residency Program, which is based out of Mass General Brigham.

Read a counterpoint by another third-year resident at Mass General Brigham who is voting for the union.

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