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.”

“It was so stark the differences of how we’re treated compared to our colleagues who are doing similar work.”
— Dr. Philip Sossenheimer, hospice and palliative medicine fellow at Stanford Medicine

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 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,” 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.

“It’s a big deal to take on something the size of Kaiser. What happens here will have an impact and is likely to ripple out.”
— Ken Jacobs, co-chair of the UC Berkeley Labor Center

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.

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 reducing residents’ workloads 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 increasing labor costs leading to higher prices for consumers, something which puts pressure on California’s attempts to tamp down medical costs. Research shows that wages contribute to higher health care costs in the U.S. 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 Loma Linda University Health are locked in a legal battle 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 Muñoz, 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.

“No matter what happens here, I’m excited for all of these residents and fellows that are unionizing around California and the country,” Muñoz 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.

“It’s a big deal to take on something the size of Kaiser,” Jacobs said. “What happens here will have an impact and is likely to ripple out.”

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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 www.chcf.org to learn more.

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

Victoria Lee Onstine passed away April 3, 2024, at the age of 73. She was born January 31, 1951 to Bonnie Jean Fricker and Leon Jay Duste in San Francisco. Victoria spent her early years in East Palo Alto before relocating to Eureka, where she graduated from Eureka High School in 1969.

She received her bachelor’s degree in nursing from Humboldt State University in 1973 and began a 46-year career in Humboldt County as a registered nurse and public health nurse, primarily in the home health sector. Victoria was an active member of the community and a dedicated social servant. During her life, she served on the board of directors for General Hospital, the Area 1 Agency on Aging, and Redwood Concert Ballet. She organized and taught caregiver courses in Humboldt and Del Norte counties and was instrumental in developing the Area 1 Agency on Aging’s caregiver registry. Victoria was a member of the Rotary Club of Old Town Eureka, where she held the role of secretary for over 15 years, in addition to being a business owner for several years in downtown Eureka, along with her partner, Jayne. She participated in the Nutcracker in the role of grandmother for many years and held the position of costume mistress with the Redwood Concert Ballet, spending her evenings mending and altering tutus for the ballet dancers.

In Victoria’s private life, she was an avid gardener, showcasing her own garden in the Eureka Garden Tour in 2014. She was also known as a cook, crafter, and lover of science fiction and fantasy; however, she will be most remembered by her unconditional love and care for others. Victoria was steadfast in her devotion to family and friends, placing the needs of others before self, and a role-model of compassion and acceptance. Her quiet patience, positivity and eccentricities will be missed. At her request, Victoria was laid to rest at the Ferndale Cemetery following the guidelines of the Bahá’í Faith.

Victoria was preceded in death by her parents; brother, Billy Charles; sister-in-law, Jennifer Duste; and nephew, Patrick Fabian. She is survived by her partner, Jayne McNeilly; daughter, Molly Onstine; son, Justin Onstine and wife, Erin; brothers, David Duste and Christopher Charles; sisters Marta Charles, Nicki Charles, Zina Keeran, and Margaret Duste; grandson, Harrison Onstine; and nieces and nephews David, Casey, Trish, Matt, Jackie, and Madison.

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The obituary above was submitted on behalf of Victoria Onstine’s loved ones. The Lost Coast Outpost runs obituaries of Humboldt County residents at no charge. See guidelines here.

It is with great sadness that we announce the passing of Cleone Rae (Conner) Monson.

In January of 2023, Cleone was diagnosed with leukemia and she passed away at home in Eureka, on March 26, 2024 with her husband Tom Monson at her side, just two days after their 23rd anniversary.

Cleone was born on June 26, 1947 at the old hospital in Scotia. She was raised in Rio Dell, attended Rio Dell Grammar School and graduated from Fortuna High School in 1965. After high school, she worked at Daly’s department store in Fortuna for a few years, eventually moving to Eureka and working as a sales clerk for Value Giant.

Cleone is probably best remembered for her years as a Frito-Lay driver. In 1978, she was hired as the only female route driver/delivery person for Frito-Lay in Northern California. It was a job she truly enjoyed, meeting so many different people over the course of her career, and fit her outgoing personality to perfection. She created long lasting friends and relationships with other drivers, her customers, store employees, and the general public. It seemed that everyone knew “Cleone the Frito driver.” This included a friendly meat cutter named Tom Monson, from the Eureka Safeway. The saying “she never met a stranger” certainly applied to her. While Cleone retired from Frito-Lay in 2002, after 24 years of service, she continued to work various jobs in order to stay busy, meet new people and make new friends. Far and away her favorite, was working with her kitchen crew at Pacific Union Elementary School, and getting to be with Makenzi each day.

In 2000, some 20 years after first meeting, a chance run in with Tom, the friendly meat cutter from Safeway proved to be a turning point in Cleone’s life, and she and Tom began dating. They were quick to realize they had something special, and in March 2001, Cleone and Tom Monson were married in Reno. From that point, until she passed, were the happiest times of her life. Tom and Cleone were an inseparable team, doing everything together, and enjoying every minute. Both retiring early, they went camping, fishing, golfing and traveled the western U.S. for 17 years together; always laughing, joking and teasing one another. Tom eventually taught her the basic and finer points of golf. She admitted she wasn’t very good at the game, but they had a great time playing. Cleone and Tom were always having fun and smiling together — a sight that will be sorely missed.

Cleone was predeceased by her father, Kenneth (Bill) Conner, her mother and stepfather, Marguerite and Orlando Micheli, her brother Angelo Micheli, and her step-daughter Heidi Monson. She is survived by her husband Tom Monson, stepson Cameron (Nichole) Monson and family, and beloved granddaughter Makenzi Watkins; her brother Andrew Conner and family; sisters Neferti Kinser, Charmaine LaPrelle, Bettina Chittenden and their families; as well as her favorite aunt, Mary Rovai, and her family. In lieu of flowers, please consider making a donation to Hospice of Humboldt in Cleone’s name. A Celebration of Life will be held at a later date, details to be determined. So for now, please enjoy a beverage of your choosing with a friend or loved one, share some laughs, and give a toast to Cleone. She was certainly one of a kind, and loved immensely. Goodbye, Cleoney Baloney - we all love you and miss you more than you know. I will leave you with these final words from her husband Tom.

“She was my best friend and the love of my life. I will miss her forever.”

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The obituary above was submitted on behalf of Cleone Monson’s loved ones. The Lost Coast Outpost runs obituaries of Humboldt County residents at no charge. See guidelines here.

Bonnie Marie Butcher
June 11, 1948 – April 1, 2024

It is with heavy hearts that we announce that our mother, Bonnie Marie Butcher, passed away peacefully in her home on April 1, 2024. Bonnie was born on June 11, 1948, in Eureka, to Ernest and Nadine Bailey. She was the youngest of three daughters. Bonnie lived most of her life in Humboldt and graduated from Arcata High School in 1966. She retired as an optician from The Vision Center in Eureka in 2014. She loved spending time with her family, and was an avid gardener and a spontaneous traveler. Bonnie was also a beloved member of the Faith Center Foursquare Church in Eureka. Bonnie was loved by all who knew her.

She is survived by her oldest sister Roxanne Youell of Ukiah; her three children, Alicia Jones (Frank Mancinelli), Angie Esskew (Paul Esskew), and Byron Butcher of Eureka; her three grandchildren Scott Jones of Ashland, Sabrina Jones and Gregory Esskew of Eureka, and her great-grandchild Aryanna Leal of Eureka; her nephews Ernest Silva (Deborah), Lee Fleming (Vicki), Darren Fleming (Shannon), James Silva, David Silva; her nieces Sheila Silva and Tonya Fleming (Sarah); and her many great nieces and nephews and great-great nieces and nephews, as well as numerous cousins.

She was preceded in death by her grandparents Edward and Elva Bailey and Theodore and Kate Creason, her parents Ernest and Nadine Bailey (Creason), her older sister Sheryl Fleming, her aunts Enna Helm and Irene Knight, and her cousin Fran Mellon. Memorial services will be announced at a later date. Contributions may be made to the Paralyzed Veterans of America or to the donor’s favorite charity. We would like to thank Hospice of Humboldt for their loving care of our mother in her final days.

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The obituary above was submitted on behalf of Bonnie Butcher’s loved ones. The Lost Coast Outpost runs obituaries of Humboldt County residents at no charge. See guidelines here.

“Why is euthanasia almost always considered the appropriate end point for our animal companions, but not for our human loved ones?”

— Jessica Pierce in Psychology Today

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Neil Gaiman’s “Death of the Endless,” drawn by Chris Bachalo in Death: The Time of Your Life #1, DC Comics. (Lo-res version qualifies as fair use under United States copyright law.)

The March issue of our local Senior News (published by the Humboldt Senior Resource Center) was dedicated to what the editor called “a difficult topic” which “may sound grim.” I was heartened that he took on this topic, one of universal relevance, although I’ve never been comfortable with the idea of death being difficult or grim, as in The Grim Reaper. Neil Gaiman’s “Death” character in his Sandman series — a kind, ankh-wearing goth girl — is more to my taste. In fact, the wealth of contributions in that issue of Senior News belie pessimism around the topic, many of which I found inspiring and compassionate.

I guess, at least at this point in my life, I’m in Kant’s kamp, so to speak: “The meaning of life is that it ends,” he wrote. Not just the meaning, either. Isn’t the certainty of death the whole justification for getting up in the morning and doing anything—writing a weekly rant, for instance? The only thing worse than dying, imho, is not dying—an awful eternity, day after day, century after century, whether on Earth or in some monotonous Barbieland, aka Heaven. Shudder.

(Practically speaking, we are virtually immortal, in a sense. Our “germ plasm,” as the late biologist George Wald called it, represents an unbroken line stretching over three billion years, all the way back to the first primitive organism to appear on our planet. The other part of us, what Wald called the “soma,” is merely the vehicle for the germ plasm to get from one generation to the next. He writes, “Death is the casting aside of the body, of the soma, after it has done its work. That work is to carry the germ plasm, to feed it, to protect it, to warm it in a warmblooded organism, and finally to mingle it with the germ plasm of the opposite sex. With that, it has completed its function and can be discarded.”)

Philosophy aside, in my dotage I follow legislation relating to MAID, Medical Assistance in Dying, which currently, in California and a handful of other states, glosses over the problem of dementia. As the law now stands, MAID permits assisted death if two physicians confirm that death is likely to occur within six months, and that, absent intervention, the period between now and then is likely to be painful — not just for the dying person, but for their caregivers.

However, dementia, including Alzheimer’s, is rarely fatal in the short term (i.e. six months), typically taking years from onset of the disease to death. I dread the possibility that I might live a life in which I’m no longer conscious, behaving in ways that I wouldn’t want my wife Louisa, my family or friends to deal with. I believe that if someone with dementia meets the criteria for MAID — mental capacity for informed consent, intolerable suffering, and a foreseeable death, even if not within six months — they should be eligible.

Louisa and I already have advance directives, but we wish we could add that if, for instance, we became verbally or physically abusive, required physical restraint/locked door facility, or couldn’t feed ourselves — we’d want MAID. Unfortunately that’s not an option under California law, nor in any of the other nine states with MAID laws. We would like to see the legislation liberalized so that dementia, as defined under clear guidelines, would be a permissible reason for allowing a medically assisted death with dignity.

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Press release from Humboldt Bay Fire:

On 4/05/2024 at 19:25 hrs. Humboldt Bay Fire responded to a reported Structure Fire at 1404 14th St. in Eureka. Humboldt Bay Fire responded with 1 Chief Officer, 3 Engines and 1 Truck for a total of 13 fire service personnel. Additionally, 2 volunteer Fire Support personnel responded and provided traffic control.

The first Engine arrived on scene in 4 minutes and reported a working fire in a residential structure and began to attack the fire. Due to the size of the fire in the residence another Humboldt Bay Fire Engine was requested to respond bringing an additional 3 fire service personnel to the scene. The second arriving unit was assigned to search the interior of the residence for any potential victims and the third arriving unit was assigned to vertically ventilate the smoke and fire from the residence. The fourth arriving unit was assigned to assist the first arriving unit with extinguishing the fire. The fire was controlled in 25 minutes and all occupants had escaped the residence prior to the arrival the first fire Engine.

Humboldt Bay Fire remained on scene for an additional 2 hours to completely extinguish the fire and conduct a cause and origin investigation of the fire. The cause of the fire is still under investigation and PG&E arrived on scene and disconnected the electrical and gas service to the residence. There were no civilian or Firefighter injuries and the value of the property is estimated at $450,000 and damage from the fire is estimated at $75,000.

Smoke Alarms Save Lives. Humboldt Bay Fire would like to thank City Ambulance, PG&E, Samoa-Peninsula Fire and Arcata Fire for their assistance on scene and providing coverage to other emergency calls during this incident.

Humboldt Bay Fire would like to remind everyone to immediately call 911 and get outside in the event of a fire in your home and to please have a designated meeting place outside your home in case of a fire so all occupants of the home can be accounted for by arriving fire service personnel.

“One of the penalties of an ecological education is that one lives alone in a world of wounds.”

— Aldo Leopold

Do you also have a gnawing, seemingly ever-present hum in the back of your head — an intrusive thought about the immensity of the climate crisis and your own minuscule ability to do anything about it? If so, you are not alone. Some 83% of the United States thinks that climate change poses a “serious and imminent threat to the planet” and “59% of youth and young adults said they were very or extremely worried about climate change.”

Doomerism is not the only option. Would you like to reduce your own eco-anxiety? This show is for you. Join Chelsea Pulliam, EcoSomatic Coach at Somatic Earth, for a discussion about how you can cultivate resilience.

Want to hear more? Check our interview with Sarah Jaquette Ray, author of A Field Guide to Climate Anxiety.