Standing-Room-Only Crowd Discusses Unionization, Professional Autonomy

A standing-room-only crowd gathered yesterday for the special session, “How to Gain Control of Our Professional Lives and Reclaim Our Autonomy” (SL01), which examined surgeon unionization, workplace standards, and new ACS efforts to support professional autonomy.

The session began with ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS, offering insights into the origins of the College’s work on these topics. She noted that ACS leaders began receiving questions about unionization at speaking engagements, including requests for the ACS itself to become a union. As a result, ACS leaders formed a task force focused on “becoming a trusted source of information” and “really looking into whether the ACS can be a union.”

“I won’t bury the lede,” she said. “The answer is no.”

Despite logistical and legal constraints, Dr. Turner said, “We can support you.”

Philip Wolinsky, MD, FACS, an orthopaedic surgeon in Lebanon, New Hampshire, ACS Regent, and Chair of the ACS Optimal Working Environment for Surgeons Task Force, addressed surgeon unionization.

“I cannot claim to be an expert on unions, but I learned quite a bit about them,” he said.

He noted that as recently as in 2012, 60% of practices were owned by physicians, but that 78% of physicians are now employed, a shift that has affected professional autonomy and made more physicians eligible to unionize. He noted that approximately 8% of surgeons are in unions, a percentage that is rapidly rising.

He defined a union as a collective of employees whose employers are legally required to bargain and outlined potential benefits and limitations. Potential benefits include greater input into workplace conditions and the potential to reduce burnout, even in areas dominated by a local healthcare system. Limitations include issues outside a union’s bargaining authority.

For example, unions cannot negotiate with the Centers for Medicare & Medicaid Services or insurance companies. Unionization also can create friction among specialties, and unions typically operate locally or are “regional at best,” Dr. Wolinsky said.

Noting that “strikes are kind of a bad word in the medical world,” he briefly described legal requirements for healthcare strikes, such as mandatory 10-day advance notice, intended to protect continuity of patient care.

Recognizing that not all surgeons are eligible for or interested in union membership, the ACS Task Force also developed a framework for specialty-specific workplace standards, published in the Journal of the American College of Surgeons in March 2026. Douglas Wood, MD, FACS, FRCSEd, a cardiothoracic surgeon in Seattle, Washington, Vice-Chair of the ACS Board of Regents, and a task force member, discussed the framework.

He remarked that unlike unions, which must be organized locally across the country, workplace standards documents “plug into machinery that hospitals have for licensing, regulations, and ACGME requirements,” possibly permitting rapid dissemination.

Rapid adoption is a realistic possibility, he said, because the standards may improve surgeons’ lives, patient outcomes, and institutional stability: “It is meant to be a win-win-win.”

Dr. Wood then described the eight domains of workplace standards, including call coverage; OR, clinical, and resource access; inpatient census; clinical support; fatigue mitigation; and compliance burden. He emphasized that surgeons should read the entire document before highlighting several key points, including: “If you have a work RVU expectation, then there ought to be a way you can meet the RVUs that are being asked of you.”

The session also included presentations by leaders from two of the 14 surgical societies developing workplace standards pertinent to their own disciplines.

Kirsten Wilkins, MD, FACS, FASCRS, president of the American Society of Colon and Rectal Surgeons (ASCRS), said, “We have a task force, and we’ve gone to our membership to make sure we are right on track with what they want.”

She presented results from an ASCRS member survey showing support for greater flexibility and adaptability, then walked through specifics of call expectations, including measures to address post-call fatigue and promote patient safety. She echoed Dr. Wood by saying, “We need 1.5 to 2 OR days per week, and OR access needs to be reliable and predictable and aligned with the demands placed upon us.”

Milan Sen, MD, MBA, MS, FRCSC, FAAOS, FACS, an orthopaedic surgeon in New York, New York, and chair of the Health Policy and Planning Committee of the Orthopaedic Trauma Association, focused on the workplace needs of his discipline. He explained that orthopaedic traumatology can be poorly reflected in Current Procedural Terminology codes. “The longer and more complex the codes get, the lower the RVUs get,” he said, giving detailed examples.

He noted that other RVU policies, such as payment reductions for multiple procedures, may not accurately reflect orthopaedic trauma care, where surgeons may operate on several body parts in a single OR visit to improve patient outcomes and shorten length of stay. Dr. Sen then listed possible solutions, including changing how RVUs are credited, supplementing compensation, setting a guaranteed base compensation, or crediting surgeons for education, administration, and research.

The discussion drew questions and comments from the audience. Presenters and audience members acknowledged that neither unionization nor workplace standards offer a single solution to the challenges facing surgeons, while underscoring continued interest in approaches that could strengthen professional autonomy and improve the surgical workplace.