Attitudes Regarding Unionization Among US Graduate Medical Trainees and Practicing Physicians.

Abstract

Unionization among US physicians remains controversial, but interest in unionizing has increased in recent years. How attitudes regarding unionization differ between trainees and practicing physicians and across demographics is not well understood. To explore attitudes regarding unionization across individual characteristics, including career stage, gender, specialty, practice setting, and current union membership status. Cross-sectional surveys of US residents, fellows, and practicing physicians conducted between November 30, 2023, and March 3, 2024. Data analysis was performed in August 2025. Attitudes regarding unionization and associated professional, health system, and patient care outcomes as well as alignment with professional values were assessed on 5-point Likert scales using items adapted from the Pew Research Center and published literature. Surveys also included items on standard demographics, specialty, and current union membership status. Among respondents, trainees were more likely than practicing physicians to hold a favorable attitude regarding union membership (1767/2468, 71.6% vs. 1499/3011, 49.8%; P < 0.001). In the multivariable model adjusted for demographic differences in age, gender, relationship status, work hours, and specialty, trainees remained more likely to report a more favorable attitude regarding physician union membership (OR 1.33, 95% CI 1.12-1.58, P = 0.001). In addition, trainees and practicing physicians who were current members of a union or similar labor organization were more likely to report a more favorable attitude regarding physician union membership (OR 2.26, 95% CI 1.87-2.73, P < 0.001). Younger physicians held more favorable attitudes regarding union membership, unionization outcomes, and alignment of unionization with professional values. In this cross-sectional study of 5479 US trainees and practicing physicians, a majority of trainees and approximately half of practicing physicians reported favorable attitudes regarding unionization.