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In some California hospitals, early-career doctors make as little as $16 per hour working . It鈥檚 training, known as residency, that every board-certified doctor must complete.

The grueling schedules for little pay have been , and they鈥檙e increasingly driving medical residents to form unions. The limits the average work week to 80 hours.

Last week, hundreds of resident physicians and fellows at Kaiser Permanente鈥檚 Northern California facilities became the latest to join the wave of medical trainees demanding better pay and working conditions. Their petition 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 鈥� including pharmacists, nurses and housekeepers 鈥� 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.

鈥淭here is a huge national movement to recognize residents as decent workers,鈥� Andreson said. 鈥淲e鈥檝e become pawns in this giant game of making money for a hospital at the expense of your frontline workers.鈥�

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 , 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.

鈥淲e respect our long-standing relationships with labor unions and the rights of our employees to make decisions about whether they want to be represented by a union,鈥� 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鈥檚 Oakland Medical Center, said some colleagues have even traveled out of state where it鈥檚 cheaper to freeze eggs.

鈥淎s more residencies have unionized, it鈥檚 put greater criticism on this training structure that we鈥檝e all just accepted for so long,鈥� Bal said.

Pay for medical residents in California

At Kaiser鈥檚 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.

鈥� 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,鈥� Jacobs said.

Hospitals relied on residents for surge staff during COVID-19 peaks but didn鈥檛 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 in 2020, a breaking point for trainee doctors there who unionized in 2022.

鈥淚t showed us that they view us as an expendable workforce,鈥� said Dr. Philip Sossenheimer, a hospice and palliative medicine fellow at Stanford Medicine. 鈥淚t was so stark the differences of how we鈥檙e treated compared to our colleagues who are doing similar work.鈥�

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. with additional time for specialty training known as fellowships.

Last year, residents at and a 21% across-the-board pay increase in their first contract.

Kaiser union could set precedent

Hospitals began adhering to an 80-hour workweek for medical residents 20 years ago. A 2009 Rand Corp. study found that to meet that standard and to prevent fatigue would cost major teaching hospitals more that $4 million a year, expenses driven by hiring substitute providers and additional residents.

Hospital executives across the country have been outspoken about for consumers, something which puts pressure on . Research shows that . compared to other countries, but spending on administration and prescription drugs are bigger drivers.

Despite the growing appetite for collective action among resident physicians, not every institution has accepted unionization efforts. Residents and fellows at over bargaining. The 80-member unit won union representation last June under the Union of American Physicians and Dentists, but the hospital is refusing to bargain citing religious exemptions, according to case documents filed with the National Labor Relations Board

Loma Linda University Health is affiliated with the Seventh-day Adventist Church.

Dr. Jessica Mu帽oz, an emergency medicine resident who led unionization efforts at Loma Linda, said seeing other residents win contracts and move to organize offers hope to her and her colleagues.

鈥淣o matter what happens here, I鈥檓 excited for all of these residents and fellows that are unionizing around California and the country,鈥� Mu帽oz said.

Jacobs with the Berkeley Labor Center said establishing a union among Kaiser residents could have far-reaching impacts given the size of the health care behemoth, which is often looked at as a leader for worker pay and benefits.

鈥淚t鈥檚 a big deal to take on something the size of Kaiser,鈥� Jacobs said. 鈥淲hat happens here will have an impact and is likely to ripple out.鈥�

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit  to learn more.

 is a nonprofit, nonpartisan media venture explaining California policies and politics.