EARLY-CAREER DOCTORS ARE JOINING UNIONS NOW
They work gruelling 80 hours a week for low pay
In some California hospitals, early-career doctors make as little as $16 per hour working 80-hour weeks. It's training, known as residency, that every board-certified doctor must complete.
The grueling schedules for little pay have been contentious in medicine for decades, and they're increasingly driving medical residents to form unions. The national accrediting agency for residency programs limits the average work week to 80 hours.
Last week, hundreds of resident physicians and fellows at Kaiser Permanente's Northern California facilities became the latest to join the wave of medical trainees demanding better pay and working conditions. Their petition filed with the National Labor Relations Board comes after Kaiser Permanente refused to voluntarily recognize the union.
Union membership at medical training programs in California has more than doubled since 2020, according to data from the Committee of Interns and Residents, the union which represents most unionized trainee doctors nationally. Residents at Stanford Health Care, Keck Medicine of USC and all six of the University of California academic medical centers have organized labor unions in recent years.
Northern California Kaiser staff now must hold a formal vote to finalize unionization. If the vote succeeds, residents would join most other Kaiser workers — including pharmacists, nurses and housekeepers — in gaining union representation at the largest health provider and private employer in the state. More than 9 million Californians get health care through Kaiser.
Dr. Brandon Andreson, a second-year internal medicine resident at Kaiser San Francisco Medical Center, said the move to organize was spurred in part by other hospital residents unionizing across the state and country. In an informal vote more than 70% of trainee doctors across Northern California Kaiser facilities supported unionizing, Andreson said.
“There is a huge national movement to recognize residents as decent workers,” Andreson said. “We've become pawns in this giant game of making money for a hospital at the expense of your frontline workers.”
Nationally, union membership among medical residents has expanded from 17,000 to more than 32,000 in a little over three years. There are more than 144,000 doctors in residency programs nationally, according to the Association of American Medical Colleges. In California, the number of unionized medical residents has grown by 62% since 2020, said Annie Della Fera, a spokesperson for the Committee of Interns and Residents.
In a statement, a spokesperson for Kaiser Permanente said the organization is committed to providing a good learning and working environment.
“We respect our longstanding relationships with labor unions and the rights of our employees to make decisions about whether they want to be represented by a union,” the statement said.
At stake is increased pay, overtime compensation, housing stipends and more manageable schedules. Unions representing residents have bargained for fertility benefits to support delayed family planning. Dr. Berneen Bal, a third-year psychiatry resident at Kaiser's Oakland Medical Center, said some colleagues have even traveled out of state where it's cheaper to freeze eggs.
“As more residencies have unionized, it's put greater criticism on this training structure that we've all just accepted for so long,” Bal said.
Pay for medical residents in California
At Kaiser's eight Northern California hospitals, residents make around $80,000 per year and typically work between 60 to 80 hours a week, getting one day off per week, Andreson said. The pay range for residents at other non-unionized health systems in California is similar or lower. In contrast, starting salaries for full-fledged physicians are nearly $300,000 depending on specialty.
Unions represent few certified doctors in California because many employment structures make them business partners and prohibit them from joining a labor organization. Many doctors participate in the politically powerful California Medical Association, which represents their interests in the Capitol.
Doctors-in-training have long bemoaned grueling work weeks and little pay, but the pandemic fueled unionization, said Ken Jacobs, co-chair of the UC Berkeley Labor Center.
“In health care specifically, COVID and the aftermath of COVID have pushed a lot of people into seeing the need for a union and going out and doing the work necessary to win a union election,” Jacobs said.
Hospitals relied on residents for surge staff during COVID-19 peaks but didn't pay them overtime or offer other worker protections, several doctors interviewed for this story said.
Stanford Health Care initially excluded residents from eligibility for the first round of COVID-19 vaccines in 2020, a breaking point for trainee doctors there who unionized in 2022.
“It showed us that they view us as an expendable workforce,” said Dr. Philip Sossenheimer, a hospice and palliative medicine fellow at Stanford Medicine. “It was so stark the differences of how we're treated compared to our colleagues who are doing similar work.”
Sossenheimer said doctors-in-training are especially vulnerable to exploitative employer practices because it is nearly impossible to leave a residency and find another position. They are contractually obligated to complete their residency training if they want to practice medicine. Residencies last between three and seven years with additional time for specialty training known as fellowships.
Last year, residents at Stanford Health Care won additional benefits and a 21% across-the-board pay increase in their first contract.