This commentary discusses the forces behind the formation of a resident union at the University of New Mexico School of Medicine and the union's evolution over its first three years. Because unions exist primarily to provide an avenue for advocacy to their members, they could have a negative impact on resident professionalism and on the faculty-resident mentor relationship. Resident unionization could also adversely impact the perceived balance between education and clinical service, to the detriment of the professional identity development of resident physicians. Despite this concern, the authors express their initial, cautious optimism that the union is instead currently promoting resident professionalism. The resident union has provided a forum for a unified resident voice, the engagement of the residents in safety and quality improvement activities, and advocacy for, and direction of, additional patient care funds, all of which has encouraged resident professionalism. Residents who have been active in the union also seem to have maintained altruistic professional attitudes as well as engagement in their educational activities. However, as the environment changes from one of increasing resources to one of stagnant or decreasing institutional resources, inevitable conflicts will arise between advocacy for resident salaries and benefits and patient care needs, and the manner in which the resident union will balance these conflicting needs and what impact it will have on the residents' professional identity development is unclear.
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