In their insightful and provocative analysis in this issue, Drs. Lypson, Hamstra, and Colletti propose that the Accreditation Council for Graduate Medical Education (ACGME), with some modifications in process, might assume the role of unions or other collective bargaining units for residents. They make valid observations about aspects of the ACGME Institutional Requirements that pertain to resident safety and well-being and the environment in which residents learn and participate in care. To understand the nature of these requirements, the authors reiterate the ACGME's role as an educational accreditor and the philosophical basis for its accreditation function. The authors conclude that the ACGME cannot and will not replace resident unions, associations, or other groups where residents perceive the need arising for the presence of these organizations.