Table 2. Association Between Program Unionization Status and Resident Outcomesa.
| Outcome | Resident group, No./total No. (%) | Logistic regression, OR (95% CI)b | IV analysis, difference in probability (95% CI)c | |
|---|---|---|---|---|
| Unionized | Nonunionized | |||
| Burnout | 297/690 (43.0) | 2175/5011 (43.4) | 0.92 (0.75 to 1.13) | 0.15 (−0.11 to 0.42) |
| Suicidal ideation | 26/690 (3.8) | 234/5011 (4.7) | 0.69 (0.44 to 1.08) | −0.08 (−0.17 to 0.01) |
| Job satisfaction | ||||
| Thoughts of attrition | 89/689 (12.9) | 578/4996 (11.6) | 1.00 (0.76 to 1.31) | 0.08 (−0.09 to 0.24) |
| Dissatisfied with decision to become a surgeon | 37/685 (5.4) | 253/5004 (5.1) | 1.02 (0.66 to 1.56) | 0.11 (0.00 to 0.23) |
| Dissatisfied with time for rest | 152/688 (22.1) | 897/5004 (17.9) | 1.01 (0.74 to 1.38) | −0.07 (−0.28 to 0.13) |
| Duty hour violations | 299/672 (44.5) | 2079/4911 (42.3) | 0.88 (0.65 to 1.18) | −0.30 (−0.65 to 0.05) |
| Mistreatment | ||||
| Any discriminationd | 344/630 (54.6) | 2490/4657 (53.5) | 0.88 (0.70 to 1.09) | −0.05 (−0.23 to 0.13) |
| Bullying | 441/668 (66.0) | 3294/4906 (67.1) | 0.85 (0.70 to 1.05) | 0.05 (−0.23 to 0.33) |
| Sexual harassment | 170/668 (25.5) | 1525/4868 (31.3) | 0.70 (0.56 to 0.87)e | −0.07 (−0.27 to 0.12) |
| Educational environment | ||||
| Dissatisfied with educational quality | 105/688 (15.3) | 456/5003 (9.1) | 1.49 (1.03 to 2.17) | 0.05 (−0.14 to 0.24) |
| Inadequate time for patient care | 99/686 (14.4) | 458/4982 (9.2) | 1.38 (1.01 to 1.90) | −0.02 (−0.17 to 0.12) |
| Lack of protected educational time | 124/678 (18.3) | 610/4959 (12.3) | 1.47 (0.95 to 2.29) | 0.00 (−0.23 to 0.23) |
| Inadequate time in operating room | 93/681 (13.7) | 363/4957 (7.3) | 1.55 (0.97 to 2.49) | 0.00 (−0.15 to 0.16) |
| Inadequate autonomy in operating room | 83/682 (12.2) | 427/4955 (8.6) | 1.14 (0.72 to 1.82) | 0.00 (−0.20 to 0.20) |
| Inadequate autonomy in clinical decisions | 37/682 (5.4) | 207/4972 (4.2) | 1.22 (0.68 to 2.21) | −0.03 (−0.14 to 0.09) |
| Lack of effective support staff | 183/683 (26.8) | 786/4984 (15.8) | 1.70 (1.13 to 2.57) | −0.01 (−0.22 to 0.21) |
| Program not responsive to resident concerns | 68/685 (9.9) | 360/4965 (7.3) | 1.21 (0.78 to 1.87) | 0.03 (−0.11 to 0.16) |
| Program did not take wellness seriously | 82/686 (12.0) | 378/4978 (7.6) | 1.53 (1.02 to 2.28) | 0.01 (−0.13 to 0.15) |
Abbreviations: IV, instrumental variable; OR, odds ratio.
Each row represents a separate model assessing the association of union status with each outcome. Residents with missing responses for the following outcomes were excluded from the model for that outcome: thoughts of attrition (n = 16), dissatisfaction with decision to become a surgeon (n = 12), dissatisfaction with time for rest (n = 9), duty hour violations (n = 118), discrimination (n = 414), bullying (n = 127), sexual harassment (n = 165), dissatisfaction with educational quality (n = 10), inadequate time for patient care (n = 33), lack of protected educational time (n = 64), inadequate time in operating room (n = 63), inadequate autonomy in operating room (n = 64), inadequate autonomy in clinical decisions (n = 47), lack of effective support staff (n = 34), program nonresponsiveness to resident concerns (n = 51), and program did not take wellness seriously (n = 37).
Logistic regression models estimated the OR for each outcome among residents at unionized programs with nonunionized programs as the reference group. Covariates included sex, race, Hispanic ethnicity, relationship status, parental status, census region, urban-rural classification, and program size. Odds ratios greater than 1.00 indicate worse outcome at unionized programs.
Instrumental variable regression models were estimated as linear probability models using regional rates of public sector employees who report being covered by labor unions as an IV for presence of a resident union. The same covariates used in logistic regression models were included. Coefficients represent the difference in probability of experiencing the outcome; values greater than 0 indicate worse outcomes at unionized programs.
Includes discrimination based on sex, gender identity, sexual orientation, race, ethnicity, and religion.
Remains significant after Bonferroni adjustment for multiple comparisons.