To unionize, or not to unionize? A comparison of integrated plastic surgery residency program benefits.

[BACKGROUND] Residency unionization provides increased leverage for trainees to negotiate compensation and benefits. However, no study to date has compared the benefits offered between unionized versus non-unionized hospital systems with integrated plastic surgery residencies.

[METHODS] Data was collected on unionization status and residency benefits (including salary, health insurance, and stipends) for the 2023-2024 post-graduate training year from all ACGME-accredited integrated plastic surgery residency programs via program websites, the American Medical Association (AMA) FREIDA Residency and Fellowship Database, and direct contact with the Accreditation Council for Graduate Medical Education (ACGME) office or plastic surgery residency coordinators. Statistical analysis for continuous and discrete variables was performed via Wilcoxon Two-Sample and Fischer exact tests, respectively.

[RESULTS] A total of 23% (20/85) of the integrated plastic surgery programs included in the study were unionized. There were no differences between unionized versus non-unionized programs for number of residents per year (2.75 versus 2.3, p = 0.08), city population (median 595,386, IQR 1,305,930; median 241,952, IQR 521,660; p = 0.09), or top 40 Doximity Program Reputation (50% vs. 46.2%, p = 0.76). Unionized programs had a higher base salary for PGY-1 (mean $72,809, SD $7,988 versus mean $65,008, SD $5,792; p = 0.0001). However, this trend reversed once salary was standardized for cost of living, with non-unionized residents having significantly higher salaries (mean $59,357, SD $7,407 versus mean $49,464, SD $8,045; p < 0.0001). Unionized residents had more vacation days per year (mean 20.4, SD 6 versus 17.9, SD 3.8; p = 0.039), more days of parental leave (mean 38.5, SD 15.3 versus mean 30.3, SD 9.7, p = 0.04), and a higher proportion of on-site child-care (12/16, 75% versus 20/49, 40.8%; p = 0.018), housing (8/14, 57.1% versus 4/47, 8.5%; p = 0.0003), and cell phone stipends (11/12, 91.7% versus 19/41, 46.3%; p = 0.0053). In comparison, non-unionized programs offered a higher proportion of parking stipends (38/49, 77.6% versus 6/16, 35.3%; p = 0.0014).

[CONCLUSION] While non-unionized residents have higher standardized salaries, unionized residents have a higher proportion of competitive benefits including housing stipends, number of vacation days, and in-house childcare. This information may aid medical students in selecting future residency programs with benefit packages that would best fit their lifestyle.

[CLINICAL TRIAL NUMBER] Not applicable.