In my February column, I mentioned two new and exciting ACS projects: one on workplace standards and another focused on sharing accurate information on surgeon unionization. This month, I am pleased to explain more about the vital resources we have developed. As always, our aim is to serve surgeons in every specialty—in this case, by providing information that may help improve working conditions across our profession.
Why We Need Workplace Standards
All of us value hard work. Indeed, we cannot deliver optimal results for our patients unless we sustain a strong work ethic throughout our careers. Historically, this has meant we must be constantly and individually responsible for patient care.
Over the past few decades, however, practice configurations have changed for some. While most surgeons were once self-employed, the majority now are employees of hospitals, systems, or other healthcare entities. That change has involved a reduction in autonomy, with little corresponding effort by employers, legislators, and/or regulators to offset the resulting dissatisfaction.
Articulating and Promoting Workplace Standards
The Board of Regents created the Optimal Working Environment for Surgeons Task Force in early 2025. One result of the task force’s efforts is an article by a team of ACS leaders, “Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers,” which was published in the Journal of the American College of Surgeons on March 3.
Its purpose is to help ensure surgeons receive the benefits of standards on issues related to workload, fatigue, coverage, and resources that physicians in some other specialties (such as emergency medicine, anesthesiology, and some acute care surgery practices) already enjoy. We have articulated standards in multiple domains based on reviews of the benchmarks available in those specialties; insights from practicing surgeons and healthcare leaders; and the literature on physician workload, burnout, fatigue, and resource allocation.
These standards include several highly specific quantitative recommendations, including formulas for calculating appropriate workload and compensation for overnight call, nuanced proposals for minimum levels for OR and clinic access, and a proposed maximum inpatient census level sensitive to patient acuity. Additionally, the framework includes qualitative recommendations on resource access, clinical support and team composition, fatigue mitigation and wellness support, and administrative burden.
Because The House of Surgery® includes numerous surgical disciplines with widely varying needs, the ACS is also collaborating closely with other surgical societies. To date, the ACS has held meetings with more than a dozen organizations. Many have expressed interest in adapting the recommendations for the groups they support and will be drafting manuscripts that reflect their nuanced requirements.
Understanding Surgeon Unionization
In December 2024, the ACS Bulletin published “Is It Time for Surgeons to Unionize?” by Jeremy Lewin, JD. The article discussed the feasibility of surgeons creating or joining a labor union, as well as possible scenarios for related activity in the surgical workplace. Regarding the value of labor organizing, Mr. Lewin wrote, “There is no right or wrong answer, but…it is important to gather as much information as possible to help make an informed decision.”
Many surgeons found that idea compelling. In direct response to ACS members’ repeated requests for more information, the Optimal Working Environment for Surgeons Task Force has worked to create resources to help ACS members understand the facts about physician unionization. These are now available via a new website hub, Understanding Surgeon Unionization, at facs.org/unionization.
The work began with the knowledge that organized labor is not currently widespread among US surgeons. At present, just under 10% of all physicians in the US are unionized (a percentage on par with union membership among all US workers). As a result, the resources include an FAQ on physician unionization that begins with basic definitions and extends to surgeon-specific information not readily available elsewhere.
We have also included a bibliography offering numerous peer-reviewed academic articles examining labor organization efforts among physicians and the impact of union activities on healthcare workplace standards and patient care. Finally, the website includes details on relevant organizations, including engaged healthcare associations, unions that currently welcome physicians, and the federal agency that oversees unions, the National Labor Relations Board.
The intention of this project is not to convince any individual or institution to embrace or resist unions. Rather, we hope to provide evidence-based, objective content that helps each member of The House of Surgery understand this topic. As with all ACS efforts, the key purpose is to empower all surgeons to thoughtfully develop their own perspectives and take actions that most benefit their lives and careers.
I encourage you to read this information and the workplace standards article. Please communicate the information to your colleagues where appropriate. As always, I welcome your feedback.
Submit Your Abstract to QSCC
The ACS Quality, Safety & Cancer Conference is accepting abstract submissions until March 9. Learn more and submit at facs.org/qscc—and mark your calendars for the conference, which will be in Orlando, Florida, July 30–August 2.
Apply to an ACS Committee
The ACS thrives on input from our members, and the most vital contributions come from those on our committees. The ACS has many committees, spanning focus areas from cancer and trauma to ethics, education, advocacy, practice management, and artificial intelligence. This year’s application for all committees will be open April 1–June 15. I strongly encourage all interested members to apply on facs.org/committees. We want you to engage with us.
