Full opinion text
Opinion BIRD, C. J. The Regents of the University of California (University) petitions for review of a decision by the Public Employment Relations Board (PERB or the Board). The Board found that housestaif, who are paid by the University while participating in residency programs at clinics, institutes or hospitals owned or operated by the University, are “employees” within the meaning of Government Code section 3562, subdivision (f) of the Higher Education Employer-Employee Relations Act (HEERA or the Act) (§ 3560 et seq.). Therefore, they are entitled to collective bargaining rights. This court must review the propriety of that ruling. I. Prior to July 1, 1979, Physicians National Housestaif Association (PNHA) chapters representing housestaif at the Irvine, San Francisco and Davis campuses participated in meet-and-confer sessions with representatives of diiferent hospital administrations. During this period, PNHA also received payroll dues deductions from its members’ paychecks. In 1978, the California Legislature enacted HEERA, which extended collective bargaining rights to employees of the University of California, Hastings College of the Law and the California State University. (§ 3560, subd. (b).) Shortly after HEERA became effective (July 1, 1979), the University notified PNHA that it did not consider housestaff to be “employees” within the meaning of the Act. It then ceased making payroll deductions from housestaff salaries to pay PNHA dues. On July 20, 1979, PNHA responded by filing an unfair labor practice charge against the University, alleging that the University had violated section 3571, subdivisions (a) and (b) and section 3585, by refusing to make such deductions. A hearing before a PERB hearing officer ensued. The evidence consisted of the following: The University operates medical schools at five of its campuses: Los Angeles (UCLA), San Diego (UCSD), San Francisco (UCSF), Irvine (UCI) and Davis (UCD). Through its medical schools, the University provides residency training programs in most medical specialty and subspecialty areas and operates hospitals at which housestaff gain clinical experience. Other hospitals, both public and private, are also affiliated with these medical schools. Many housestaff rotate through these hospitals during the course of their training. In the spring of 1979, approximately 4,500 housestaff were participating in University residency programs. Approximately 2,000 of them were on the University payroll. The others were paid by the affiliated institutions at which they served. In order to participate in a University residency program, an individual must have graduated from medical school with a doctor of medicine (M.D.) degree. To qualify to practice medicine in California and in most other states, such an individual must complete at least one year in an approved residency program. In California, he or she must also obtain a “physician’s and surgeon’s certificate” from the Board of Medical Quality Assurance. Until receipt of such a certificate, housestaff may practice medicine only under an approved residency program. (Bus. & Prof. Code, § 2065.) Most residency programs take between two and six years to complete, depending upon the specialty. The programs are structured so that housestaff rotate through different hospital services relevant to their specialty. Upon successful completion of a residency, an individual receives a certificate entitling him or her to take a specialty board examination leading to board certification in a particular specialty. Board certification is not a requirement for specialty practice, but attests to the physician’s competence in that field. Board certification requires participation in a training program approved by the Liaison Committee on Graduate Medical Education (LCGME). LCGME sets standards for residency programs, reviews programs for compliance and grants accreditation to programs which meet those standards. In order for University residency programs to acquire LCGME approval, they must comply with the general requirements contained in an LCGME document entitled “Essentials of Accredited Residencies.” On April 9, 1980, the PERB hearing officer concluded that housestaff are not employees under HEERA and recommended that PNHA’s unfair labor practice charge be dismissed. PNHA filed exceptions to the proposed decision. On February 14, 1983, PERB rendered a written decision adopting the hearing officer’s findings of facts and making additional factual findings. The Board found that the educational objectives were subordinate to the services housestaff perform and coverage of housestaff under HEERA would further the purposes of the Act. Based on these findings, the Board concluded that housestaff are “employees.” It further held that the University had violated HEERA by refusing to make payroll deductions. The Board issued a cease and desist order and directed the University to reimburse PNHA for the dues lost during the period for which the University made no payroll deductions. This matter is before the court on the University’s petition for a writ of review. II. The first question to be resolved is whether HEERA precludes housestaff from being considered employees under the Act. “‘The fundamental rule of statutory construction is that the court should ascertain the intent of the Legislature so as to effectuate the purpose of the law. [Citations.]’” (T. M. Cobb Co. v. Superior Court (1984) 36 Cal.3d 273, 277 [204 Cal.Rptr. 143, 682 P.2d 338].) In determining such intent, the court turns first to the words of the statute. (Ibid.) “[W]here . . . the language is clear, there can be no room for interpretation.” (Caminetti v. Pac. Mutual L. Ins. Co. (1943) 22 Cal.2d 344, 353-354 [139 P.2d 908].) The statute provides in relevant part that “[t]he board may find student employees whose employment is contingent on their status as students are employees only if the services they provide are unrelated to their educational objectives, or, that those educational objectives are subordinate to the services they perform and that coverage under this chapter would further the purposes of this chapter.” (§ 3562, subd. (f).) Although the statute is silent on the subject of housestaff, it clearly leaves open the possibility that such persons may come within it. As the words of the statute make clear, the Legislature intended that PERB determine whether a particular student qualifies as an employee under the Act. The legislative history which accompanied the passage of HEERA supports this conclusion. HEERA was enacted by Assembly Bill No. 1091 during the 1977-1978 session. When that bill was first introduced, subdivision (f) contained no reference to students. That provision simply defined “employees” as “any employee” except managerial and confidential employees. (Assem. Bill No. 1091 (1977-1978 Reg. Sess.) Mar. 24, 1977.) This section was subsequently amended to exclude “managerial, and confidential employees, and employees who are students on the same campus where they are employed and who work less than 10 hours per week.” (Assem. Amend, to Assem. Bill No. 1091 (1977-1978 Reg. Sess.) May 23, 1977. ) However, the bill was not passed in this form. On the Senate side, an amendment was passed which eliminated the distinction between student employees based on the number of hours worked. That amendment, which was enacted into law, prescribed a case-by-case assessment of the degree to which a student’s employment is related to his or her educational objectives. The determination of student employee status was expressly left to PERB. (Sen. Amend, to Assem. Bill No. 1091 (1977-1978 Reg. Sess.) Aug. 7, 1978. ) Although this amendment arguably made the status of housestaff more uncertain, it is clear that they were not eliminated from coverage under the Act. When this statutory history is considered in conjunction with a Legislative Counsel’s opinion prepared while the bill was pending, the conclusion is inescapable that the Legislature did not intend to exclude housestaff from coverage under the Act. The Legislative Counsel’s opinion was prepared at a time when subdivision (f) contained the exclusion for students employed less than 10 hours per week. The opinion concluded that “[wjhile this [exclusion] indicates an intention to cover students who are employees under some circumstances, it does not resolve the essential issue imposed by the [NLRB] as determining the coverage of student employees.” (Ops. Cal.Legis. Counsel, No. 7522 (May 28, 1978) Housestaff Physicians, p. 3.) The opinion also noted that “[generally speaking, the provisions of A.B. 1091 parallel those of the National Labor Relations Act [NLRA], as amended (Sec. 151 et seq., Title 29, U.S.C.). The [NLRB] ... has concluded that interns and residents are ‘primarily students’ rather than ‘employees’ and thus are not covered by the National Labor Relations Act (St. Clare’s Hospital [(1977) 229 NLRB 1000 [95 LRRM 1180]]; and Cedars-Sinai Medical Center [(1976) 223 NLRB 251 [91 LRRM 1398]]). ... [1] We think that in the absence of any more definitive statements in A.B. 1091, the courts would conclude that a similar construction is intended under A.B. 1091 to that given the provisions of the National Labor Relations Act . . . .” (Ops.Cal.Legis. Counsel, No. 7522, supra, at p. 2, italics added.) The Legislature responded to this opinion by amending subdivision (f) to include a “more definitive statement” as to the status of student employees. That action strongly suggests that the Legislature intended to promulgate a new standard for determining this issue rather than to follow NLRB precedent and deny housestaff employee status. That action also indicates that the Legislature did not intend to foreclose the issue of housestaff organizational rights. Instead, its creation of a statutory standard distinct from NLRB precedent was intended to permit PERB to make an independent determination of the status of housestaff. The dissent contends that the Legislature’s amendment was intended to incorporate NLRB precedent into the Act and deny housestaff employee status. This argument requires a comparison of the NLRB precedent with the statutory language ultimately adopted. The NLRB first addressed the issue of housestaff status in Cedars-Sinai Medical Center (1976) 223 NLRB 251 [91 LRRM 1398]. Over a strong dissent, the NLRB held that housestaff were not employees under the NLRA, since they “are primarily engaged in graduate educational training” and thus are in “an educational rather than an employment relationship [with the hospital].” (Id., at p. 1400 [223 NLRB at p. 253].) In arriving at that determination, the NLRB focused primarily on the purpose of housestaff participation in such programs. The Board paid little attention to the actual services performed by them. It found that housestaff participate in such programs to gain an education, not to earn a living, and that their selection of programs is primarily motivated by the quality of the training they will receive, rather than the amount of compensation. Further, it noted that while housestaff do perform much unsupervised patient care, this is merely a part of the training they must receive to develop practical skills. (Id., at p. 1400 [223 NLRB at p. 253],) Member Fanning vigorously dissented from the majority’s approach. He argued that the fact that “hospitals are instructed to view the primary purpose of housestaff programs as educational has no bearing on whether the housestaff ultimately performs a service for compensation . . . (Cedars-Sinai, supra, 91 LRRM at p. 1403 [223 NLRB at p. 256].) Nor did Fanning find any relevance in “the fact that an individual desirous of becoming an orthopedic surgeon chooses a residency program based on its quality and the opportunity for extensive training.” (Id., at p. 1404 [223 NLRB at p. 257].) “That is,” Fanning observed, “not a unique approach in any field of endeavor, particularly professional ones.” {Ibid.) Instead, Fanning thought the Board’s inquiry should focus on the services actually performed by housestaff. Member Fanning was not alone in his criticism of his colleagues’ ruling. (See, e.g., Drake, Labor Problems of Interns and Residents: The Aftermath of Cedars-Sinai (1977) 11 U.S.F. L.Rev. 694; Maute, Student-Workers or Working Students? A Fatal Question for Collective Bargaining of Hospital House Staff (1977) 38 U.Pitt. L.Rev. 762, 767, 772, 786 [hereafter Student-Workers or Working Students]; see generally Scholars or Working Stiffs, supra, 12 Pacific L.J. 1127.) Other jurisdictions chose not to follow the Cedars-Sinai majority. (See, e.g., House Officers, etc. v. U. of Neb. Med. Ctr. (1977) 198 Neb. 697 [255 N.W.2d 258, 261-262]; City of Cambridge and Cambridge Hospital House Officers Association (1976) 2 MLC 1450, 1458-1459 (Mass. Labor Cases).) One year after Cedars-Sinai was decided, the NLRB addressed the issue again in St. Clare’s (1977) 229 NLRB 1000 [95 LRRM 1180], noting that it “may not have been as precise as [it] might have been in articulating [its] views” in Cedars-Sinai. (95 LRRM at p. 1181 [229 NLRB at p. 1000], fn. omitted.) In these decisions the Board basically adopted a “primary purpose” test, which gave paramount consideration to the students’ subjective intent in participating in housestaff programs. “Our conclusion that housestaff are ‘primarily students ’ rather than employees connotes nothing more than the simple fact that when an individual is providing services at the educational institution itself as part and parcel of his or her educational development the individual’s interest in rendering such services is more academic than economic." (St. Clare’s, supra, 95 LRRM, at p. 1184 [229 NLRB at p. 1003], italics added.) In St. Clare’s, the NLRB also observed that Cedars-Sinai fit within its prior decisions which had classified students into four general categories. (95 LRRM at p. 1181 [229 NLRB at p. 1000].) Two of these categories concern commercial employers and are inapplicable here. The other two categories involved students employed by their own educational institutions either (1) in a capacity unrelated to their course of study (id., at p. 1182 [229 NLRB at p. 1001]), or (2) in a capacity directly related to their educational program (id., at p. 1183 [229 NLRB at p. 1002]). Both of these categories of students are denied collective bargaining rights. (Id., at pp. 1182-1183 [229 NLRB at p. 1002].) After reviewing the various categories of students and noting that house-staff fall within the latter category, the NLRB reaffirmed its conclusion that housestaff are not entitled to collective bargaining rights under the NLRA. “Since the individuals are rendering services which are directly related to— and indeed constitute an integral part of—their educational program, they are serving primarily as students and not primarily as employees.” (St. Clare’s, supra, 95 LRRM at p. 1183 [229 NLRB at p. 1002], fn. omitted.) It is true, as the University notes, that subdivision (f) uses the “related/ unrelated” classification scheme that St. Clare’s created. However, that is where any similarity between St. Clare’s and the present statute ends. While St. Clare’s held that both categories of students were per se, not entitled to collective bargaining rights under the NLRA, HEERA expressly permits PERB to find students in both categories entitled to collective bargaining rights in appropriate circumstances. Under HEERA, the Board may find students who are employed in a capacity unrelated to their course of study to be “employees” within the meaning of the Act and therefore entitled to collective bargaining rights. Further, PERB may find students who are employed in a capacity related to their educational program entitled to such rights depending on a case-by-case evaluation of (1) whether their educational objectives are subordinate to the services they perform, and (2) whether coverage under HEERA would further the purposes of the Act. Thus, in defining “employees” under HEERA, the Legislature specifically rejected the NLRB rulings. Under the NLRB precedent, the relevant inquiry is whether the student’s objectives are primarily academic. Under HEERA, even if PERB finds that housestaff are motivated by “educational objectives,” it may nevertheless classify them as “employees” if their objectives are “subordinate to the services they perform” and if granting collective bargaining rights would further the purposes of the Act. It is, therefore, clear that instead of denying collective bargaining rights to student employees of public educational institutions, the Legislature intended to permit PERB to grant such rights in situations not permitted under NLRB precedent. If, as the dissent suggests, the Legislature had intended to retain NLRB precedent, it could have easily done so by adopting the language of the NLRA verbatim. The dissent attempts to recast the language of subdivision (f) in order to read it as incorporating the NLRB decisions. With all due respect, this attempt fails. The crux of the dissent’s position focuses on “10 rather colorless words” of subdivision (f) (dis. opn., post, at p. 641), which comprise the standard which PERB must apply in determining whether housestaff may be granted collective bargaining rights. Those 10 words declare that students may be classified as “employees” if “those educational objectives are subordinate to the services they perform . . . .” The dissent argues that those 10 words can be reduced to 2—“primary purpose.” (Dis. opn., post, at p. 641.) The dissent is correct in noting that when the statute refers to “those educational objectives” it means the student’s educational objectives. This meaning becomes clear when the phrase is read in context with the passage immediately preceding it, which states that PERB may find that “student employees . . . are employees ... if the services they provide are unrelated to their educational objectives . . . .” (Italics added.) However, the dissent’s analysis of the phrase immediately following this one is severely flawed. The dissent argues that the clause “are subordinate to the services they perform” means the student’s interest in performing those services must be greater than his or her interest in obtaining an education. (Dis. opn., post, at p. 640.) Under this view, in order to qualify as an “employee” under HEERA, a student’s “interest” in performing services must outweigh his or her interest in obtaining an education. Such an interpretation is improper because it attempts to judicially redraft the Legislature’s language. Surely, this court is not free to rewrite a statute merely because the Legislature has used what some members of the court think are “10 rather colorless words.” (Cf. People v. Weidert (1985) 39 Cal.3d 836, 847 [218 Cal.Rptr. 57, 705 P.2d 380].) This interpretation, moreover, is not what the Legislature intended. Subdivision (f) makes clear that PERB should determine in each case whether “[the student’s] educational objectives are subordinate to the services they perform.” The dissent argues that this language cannot be applied as written because it would require PERB to “ ‘balance’ apples and oranges.” (Dis. opn., post, at p. 639.) That is to say, a student’s “subjective” educational objectives cannot be “balanced” against the “objective” “services they perform.” From this premise, the dissent takes a gargantuan leap and concludes that PERB may look only to the students’ subjective balancing as to which aspect of the students’ job they believe is more important. (Dis. opn., post, at p. 640.) The dissent then takes another leap and states that the University’s subjective balancing of these factors is also a determinative factor. {Ibid.) The dissent cites absolutely no authority for this latter proposition. While applying the Legislature’s command may be difficult, that is no excuse for disregarding it altogether. The Legislature has clearly not instructed PERB to confine its inquiry to the students’ state of mind. Moreover, nothing in the language of subdivision (f) even hints that the University’s subjective perceptions of the functions of housestaff duties should be taken into consideration. The Legislature has instructed PERB to look not only at the students’ goals, but also at the services they actually perform, to see if the students’ educational objectives, however personally important, are nonetheless subordinate to the services they are required to perform. Thus, even if PERB finds that the students’ motivation for accepting employment was primarily educational, the inquiry does not end here. PERB must look further—to the services actually performed—to determine whether the students’ educational objectives take a back seat to their service obligations. This interpretation is the only one which remains true to the statutory language. Moreover, it makes sense in light of the events surrounding the passage of HEERA. As noted above, the housestaff issue was clearly on the mind of the Legislature when it enacted this provision. The NLRB had just rendered two controversial decisions on the issue. In those decisions a majority of the Board concentrated primarily on the students’ motivation for entering into housestaff programs. The NLRB dissenter thought the focus should be confined to the services they actually perform, disregarding as irrelevant their motive for taking such jobs. (See ante, at pp. 609-611.) Subdivision (f), as enacted, represents a compromise between the majority and dissenting opinions expressed in the NLRB decisions. HEERA took a middle road, requiring both factors to be considered. It is not the prerogative of this court to act as a super-legislature and alter that legislative choice merely because it may be unwise. (People v. Dillon (1983) 34 Cal.3d 441, 463 [194 Cal.Rptr. 390, 668 P.2d 697].) Another provision of HEERA corroborates the conclusion that housestaff were not excluded, per se, from the benefits of collective bargaining. Section 3562, subdivision (o)(l) defines a “professional employee” as a person engaged in work (i) predominantly intellectual and varied in character, (ii) involving the consistent exercise of discretion, (iii) impossible to standardize with respect to output, and (iv) requiring knowledge of an advanced type acquired through a course of specialized intellectual instruction and study in an institution of higher learning or a hospital. A professional employee is also defined as an individual who has completed the courses of specialized intellectual instruction and study described in clause (iv) above and is performing related work under the supervision of a professional person to qualify to become a professional employee. (§ 3562, subd. (o)(2).) Housestaff fit precisely within this definition. The fact that housestaff so clearly fall within the definition of professional employee reinforces the view that the Legislature did not intend housestaff to be excluded under the Act. It is noteworthy that at the time HEERA was enacted the vast majority of decisions from other jurisdictions had concluded that housestaff are employees within the meaning of their respective collective bargaining statutes. (See, e.g., House Officers, etc. v. U. of Neb. Med. Ctr., supra, 255 N.W.2d 258; Regents of Univ. of Mich. v. Michigan Emp. Rel. Com’n (1973) 389 Mich. 96 [204 N.W.2d 218, 224] (hereafter Regents-Michigan); City of Cambridge and Cambridge Hospital House Officers Association, supra, 2 MLC 1450, 1463; Wyckoff Heights Hospital (1971) 34 SLRB 625, 631 (New York State Labor Relations Board); Bronx Eye Infirmary, Inc. (1970) 33 SLRB 245, 250; The Long Island College Hospital (1970) 33 SLRB 161, 172-173; Brooklyn Eye and Ear Hospital (1969) 32 SLRB 65, 74; see also Albert Einstein College, Etc. (1970) 33 SLRB 465, 467; but see Pa. Ass’n of Int. & Res. v. Albert Einstein Med. Ctr. (1977) 470 Pa. 562 [369 A.2d 711, 714].) Although these collective bargaining statutes did not contain a provision like subdivision (f), many of the factors which led to the conclusion that housestaff are employees are similar to those which are appropriately considered under a subdivision (f) analysis. In view of the foregoing, it is clear that the Legislature did not intend to preclude housestaff from coverage under the Act. Rather, it left that determination to PERB. Under subdivision (f), the Board determines whether students are employees under the Act by assessing whether the educational objectives are subordinate to the services students perform and whether according them collective bargaining rights would further the purposes of the Act. Since PERB made such a finding here, the only remaining issue is whether there is substantial evidence to support it. III. “[T]he relationship of a reviewing court to an agency such as PERB ... is generally one of deference.” (Oakland Unified School Dist. v. Public Employment Relations Bd. (1981) 120 Cal.App.3d 1007, 1012 [175 Cal.Rptr. 105], citing Ford Motor Co. v. NLRB (1979) 441 U.S. 488, 495 [60 L.Ed.2d 420, 426, 99 S.Ct. 1842]; accord Moreno Valley Unified School Dist. v. Public Employment Relations Bd. (1983) 142 Cal.App.3d 191, 196 [191 Cal.Rptr. 60].) Such deference is mandated by HEERA itself. “The findings of the board with respect to questions of fact, including ultimate facts, if supported by substantial evidence on the record considered as a whole, are conclusive.” (§ 3564, subd. (c).) This court recently reaffirmed the limited nature of judicial review of a labor board’s determinations under the substantial evidence standard. “Of course, we do not reweigh the evidence. If there is a plausible basis for the Board’s factual decisions, we are not concerned that contrary findings may seem to us equally reasonable, or even more so. [Citations.] We will uphold the Board’s decision if it is supported by substantial evidence on the whole record. [Citations.]” (Rivcom Corp. v. Agricultural Labor Relations Bd. (1983) 34 Cal.3d 743, 756-757 [195 Cal.Rptr. 651, 670 P.2d 305], cert, den. (1984) 466 U.S. 972 [80 L.Ed.2d 819, 104 S.Ct. 2345]; see also San Diego Teachers Assn. v. Superior Court (1979) 24 Cal.3d 1, 12 [154 Cal.Rptr. 893, 593 P.2d 838]; Moreno Valley Unified School Dist. v. Public Employment Relations Bd., supra, 142 Cal.App.3d at p. 196.) Under the substantial evidence standard, when a labor board chooses between two conflicting views, a reviewing court may not substitute its judgment for that of the Board. As the United States Supreme Court has observed, “To be sure, the requirement for canvassing ‘the whole record’ in order to ascertain substantiality does not furnish a calculus of value by which a reviewing court can assess the evidence. Nor was it intended to negative the function of the Labor Board as one of those agencies presumably equipped or informed by experience to deal with a specialized field of knowledge, whose findings within that field carry the authority of an expertness which courts do not possess and therefore must respect. Nor does it mean that even as to matters not requiring expertise a court may displace the Board’s choice between two fairly conflicting views, even though the court would justifiably have made a different choice had the matter been before it de novo. ” (Universal Camera Corp. v. Labor Bd. (1951) 340 U.S. 474, 488 [95 L.Ed. 456, 467-468, 71 S.Ct. 456].) PERB’s review of the evidence revealed that the patient care services performed by housestaff were an important part of the hospital’s overall service delivery. The Board also found that although housestaff did receive educational benefits in the course of their programs, this aspect was subordinate to the services they performed. The Board made this determination based on (1) the substantial quantity of time housestaff spend on clinical activities and direct patient care, (2) the nature of the procedures housestaff perform with little or no supervision, (3) the professional guidance they provide for interns, medical students and other hospital employees such as nurses and technicians, (4) the extensive indicia of employment that characterize housestaff as employees rather than students, and (5) the extent of the educational benefit and training received by housestaff. A review of the record demonstrates that the Board’s finding was supported by substantial evidence. There was abundant testimony that housestaff provide valuable patient-care services. From their first year of residency, housestaff are immersed in all aspects of direct patient care. They perform physical examinations, obtain patients’ medical histories, develop treatment plans, prescribe drugs, administer dangerous drugs which nurses are not permitted to administer, and perform various operations and procedures. First-year residents normally write all orders for patient treatment and prescriptions. Housestaff are also required to supervise other hospital personnel such as nurses and technicians. Some of the procedures performed by housestaff—in most cases with no attending physician present—include bone marrow biopsies, intubation, running of respirators, drawing blood, cardiopulmonary resuscitation, administering barium enemas, upper GI’s (evaluations of the intestinal tract), IVP’s (evaluations of the urinary tract), bone marrow aspirations, and placement of catheters. Also, housestaff perform procedures in life-threatening situations without the presence of attending physicians, including open chest massage and placement of pacemakers and chest tubes. Housestaff also deliver babies. They are often called upon to perform Caesarean sections, forcep deliveries and emergency D and C’s (dilation and curettage). In many instances, these procedures are performed in the absence of an attending physician. Residents are also assigned to outpatient clinics where they treat patients with minor problems and admit patients who require more extensive treatment to the hospital. Attending physicians are rarely consulted in these matters. In the course of providing direct patient care, entry-level residents are supervised by more senior housestaff who generally operate with little or no supervision. In general, a resident is given as much independent patient-care responsibility as he or she is able to handle. In some cases, a patient may be admitted and discharged from the hospital without ever seeing an attending physician. Housestaff are generally the sole physicians providing nighttime care when many emergency medical situations arise since attending physicians are rarely in the hospital at night. Housestaff also work very long hours. An 80- or 100-hour week is not uncommon. More than 75 percent of that time is usually spent in direct patient care. The remaining time is spent in didactic, or instructional, activities. These activities consist of lectures, weekly “grand rounds” during which cases are discussed with faculty, and “attending rounds” during which housestaff visit patients with an attending physician or the chief resident. In some specialties, a portion of the resident’s time is set aside for intensive classroom, instructional or research activity. Since patient care is their primary responsibility, it is not uncommon for housestaff to be absent from didactic activities. The extensive indicia of employment status also weigh in favor of the Board’s findings. Housestaff are paid with monthly payroll checks from which federal and state income taxes are withheld. In 1979, annual salaries ranged from $15,100 to $21,800. Housestaif receive annual step and cost of living increases. They complete personnel forms, signing as “employees.” Housestaif receive several fringe benefits including paid vacations and medical coverage. Their medical malpractice and workers’ compensation insurance is paid for by the University. On the other hand, housestaif are not included in the University’s retirement system and do not receive life insurance or state unemployment insurance benefits. However, these facts do not detract from other evidence which strongly indicates employee status. In addition, most indicia of student status are lacking, an omission which provides further support for PERB’s conclusion. Although housestaif are eligible for financial aid, they pay no tuition or student fees. They do not take University examinations. They receive no grades. They do not complete registration forms processed by the registrar’s oifice. They receive no degrees after they have completed their residencies. The “Essentials of Accredited Residencies” (hereafter Essentials), which set forth general requirements with which the University residency programs must comply (see ante, at p. 606), also support the Board’s finding. Hospitals in which approved residency programs operate must be conducted “primarily for the welfare of the patient. . . . ¡T]he educational program is supplementary to the primary purpose of the hospital, i. e., the care and management of patients . . . .” (Italics added.) The Essentials encourage hospitals to enter into contracts with residents for the purpose of determining salary, hours, working conditions and fringe benefits. “It is inappropriate that house officers be expected to assume increasing responsibility for patient care, while not at the same time participating effectively in communications which contribute ultimately to policy-making decisions. The intern and resident must be integrated into the medical staff as true colleagues in order that effective programs of medical education and patient care be carried out.” Since the University must comply with the Essentials to retain accreditation, these statements cannot be ignored. The University argues that residency programs are primarily of an educational nature. It contends that (1) housestaff participate in the residency programs in order to further their educational development, (2) residency programs are developed by the various departments of the different medical schools to ensure that educational objectives predominate, (3) clinical service and the various tasks and duties required of housestaff are of an educational value, (4) the programs include participation in various didactics such as grand rounds, lectures and efforts to keep informed of the latest medical literature, and (5) clinic service is required by the Essentials. The fact that housestaff obtain an educational benefit from providing direct patient-care services does not mean services are subordinate to educational objectives. Such services are undertaken for a patient’s welfare. Obviously, patient demands are such that services must be performed without regard to whether they will provide any educational benefit. Many services housestaff perform become routine and do not have a continuing educational value. That housestaff must continue to perform them supports PERB’s conclusion that the “educational” side of the scale is subordinate to the “services” side. Also, housestaff do not administer procedures on patients simply to “polish their skills.” Rather, their day-to-day routine, like that of regular physicians, is dictated almost entirely by the exigencies of injury and disease. In short, although housestaff obviously receive intensive professional training through their work, there is substantial evidence to support the Board’s finding that educational objectives are subordinate to the services they perform. In light of that substantial evidence, this court must defer to PERB. The next step in determining whether housestaff are employees under subdivision (f) is to assess the Board’s finding that granting collective bargaining rights to housestaff would further the purposes of HEERA. This determination necessarily involves questions of fact and policy. It is also necessary to bear in mind PERB’s expertise in this area. In enacting HEERA, the Legislature found that the people of this state “have a fundamental interest in the development of harmonious and cooperative labor relations between the public institutions of higher education and their employees.” (§ 3560, subd. (a).) The Legislature also found that it would be “advantageous and desirable” to grant collective bargaining rights to higher education employees. (See id,., subd. (b).) As the Legislature declared, “[i]t is the purpose of this chapter to provide the means by which relations between each higher education employer and its employees may assure that the responsibilities and authorities granted to the separate institutions ... are carried out in an atmosphere which permits the fullest participation by employees in the determination of conditions of employment which affect them.” (Id., subd. (e).) “It is the further purpose of this chapter to provide orderly and clearly defined procedures for meeting and conferring and the resolution of impasses, and to define and prohibit certain practices which are inimical to the public interest.” (§ 3561, subd. (a).) The Board found and the record demonstrates that there are substantial employment concerns which affect housestaff, particularly in the area of wages, hours and working conditions. Salaries, vacation time, fringe benefits and hours are manifestly amenable to collective negotiations and have a direct and primary impact on the employment relationship of housestaff with the University. The Board concluded that according housestaff collective bargaining rights would further the purposes of the Act because it would enable them to participate fully in the determination of employment conditions which affect them. Further, the interest of developing “harmonious and cooperative labor relations” would be advanced since a viable mechanism for resolving their differences would be available. PERB also suggested that denying housestaff collective bargaining rights would have serious ramifications in the public health care field. In addition, PERB found that according collective bargaining rights to housestaff would provide a viable mechanism for resolving disputes and minimize the potential for strikes. Lastly, PERB recognized that the quality of patient care is no doubt affected by the conditions under which housestaff are required to render services, and that bargaining over such matters as hours and working conditions may result in higher quality health care. Given PERB’s expertise in this area and the reasonableness of its conclusions, deference to PERB’s finding is warranted. The University asserts that if collective bargaining rights were given to housestaff the University’s educational mission would be undermined by requiring bargaining on subjects which are intrinsically tied to the educational aspects of the residency programs. This “doomsday cry” seems somewhat exaggerated in light of the fact that the University engaged in meet-and-confer sessions with employee organizations representing house-staff prior to the effective date of HEERA. Moreover, the University’s argument is premature. The argument basically concerns the appropriate scope of representation under the Act. (See § 3562, subd. (q).) Such issues will undoubtedly arise in specific factual contexts in which one side wishes to bargain over a certain subject and the other side does not. These scope-of-representation issues may be resolved by the Board when they arise, since it alone has the responsibility “[t]o determine in disputed cases whether a particular item is within or without the scope of representation.” (§ 3563, subd. (b).) The University also argues that permitting collective bargaining for housestaff may lead to strikes. However, it is widely recognized that collective bargaining is an alternative dispute resolution mechanism which diminishes the probability that vital services will be interrupted. (See San Diego Teachers Assn. v. Superior Court, supra, 24 Cal.3d at pp. 8-9, 13.) Finally, the University argues that the brief tenure of housestaff’s relationship with the University undermines the conclusion that coverage would further the purposes of the Act. The University acknowledges that many other individuals whose relationship with the University is of short duration have been accorded employee status with full bargaining rights. Housestaff should not be treated differently. As the record demonstrates, housestaff in certain residency programs may be employed by the University for up to six years. Since there is substantial evidence to support the Board’s finding that educational objectives are subordinate to the services performed by house-staff and granting collective bargaining rights to them will further the purposes of the Act, the Board’s conclusion that housestaff are employees must be affirmed. IV. The HEERA does not preclude housestaff from being considered employees. The Legislature specifically intended that PERB determine whether students are employees under the Act by assessing whether the educational objectives are subordinate to the services students perform and whether according them collective bargaining rights would further the purposes of the Act. Here, the Board’s determination to that effect is supported by substantial evidence. Therefore, the Board properly concluded that housestaff are employees under HEERA. The Board’s decision is affirmed. The matter is remanded to the Board for reconsideration of its remedy in light of the defunct status of PNHA. (See ante, fn. 4.) Mosk, J., Broussard, J., and Reynoso, J., concurred. LUCAS, (Campbell), J. I respectfully but emphatically dissent. My review of the record convinces me that respondent Public Employment Relations Board (PERB) abused its discretion in this case, by failing to follow the governing statute, Government Code section 3562, subdivision (f) (hereafter subdivision (f)). The majority opinion compounds this error by mischaracterizing the legislative history and plain meaning of subdivision (f), thereby improvidently converting this into a “substantial evidence” case when the basic issue actually is whether PERB even understood the Legislature’s directive concerning the factual inquiry PERB was to pursue. In effect, the majority and PERB have concluded that, rather than conducting a bona fide residency program, the University has established its program as a device for procuring a cheap source of skilled medical labor to work in its hospitals. That conclusion, of course, stands the whole idea of university teaching hospitals and residency programs on its head. In the following portions of this opinion, I shall trace the origins of subdivision (f) and discuss what it really means, on its face. I shall show that the Legislature reacted to the problem of how to define “employees” for purposes of HEERA by adopting, in subdivision (f), a definitional provision that parallels that contained in the National Labor Relations Act but more fully specifies how PERB is to determine whether student employees of the University are entitled to collective bargaining. More particularly, I shall explain that when the Legislature confronted this issue in 1978, it faced, with respect to housestaif, two approaches to the problem, respectively reflected by the majority and dissenting opinions in the NLRB’s Cedars-Sinai decision. The majority approach was to focus upon the undisputed primary purposes of housestaif in pursuing a residency program; the dissenting approach was to draw upon the undisputed responsibilities and indicia of employment that housestaif bear. The Legislature chose the NLRB majority approach, and fashioned subdivision (f) so as to well-nigh compel PERB to find housestaif not to be employees. Somehow, PERB did not get the message. It pursued the same approach as the dissent in the Cedars-Sinai case, and focused upon indicia of employment, deeming it irrelevant that this case involved housestaif at University hospitals, maintained and operated for teaching purposes. The result is a decision that not only ignores the statutory language but also presents a picture of the University’s housestaif program as untrue to its and its students’ purposes. While my opinion chiefly treats the fundamental statutory question, it concludes with an explanation of what I perceive to be the proper disposition of this case. That disposition is to issue a writ of mandate directing PERB to vacate its decision and issue a new decision applying the statute as the Legislature intended it. I The National Background Students or Employees? Undisputed Facts, Flexible Law An initial review of events outside of California is necessary to provide perspective for understanding the majority opinion’s misperception of this case. The question whether housestaff are entitled to collective bargaining rights was hotly contested in several jurisdictions before the enactment of HEERA in 1978. The battle, however, involved primarily questions of statutory interpretation and semantics, because the congeries of facts considered by various courts and labor boards were generally consistent if not fungible with each other and, for that matter, with the record in this case. For example, in the two leading decisions holding housestaff “students” rather than “employees” and thereby denying them collective bargaining (Cedars-Sinai Medical Center (1976) 223 NLRB 251 [91 LRRM 1398] (hereafter Cedars) and Pa. Ass’n of Int. & Res. v. Albert Einstein Med. Ctr. (1976) 470 Pa. 562 [369 A.2d 711] (hereafter Pennsylvania)), the undisputed record disclosed that housestaff shared the same attributes and conditions that PERB here found dispositive—extensive time spent in clinical activities and direct patient care; performance of medical procedures with little or no “attending” supervision; guidance given to other housestaff, medical students, and hospital personnel; and “indicia of employment” such as stipends paid, workers’ compensation insurance provided, and federal income tax withheld. (Compare Cedars, 223 NLRB at p. 252 (maj. opn.), and pp. 255-256 (dis. opn.), and Pennsylvania, 369 A.2d at p. 714, with maj. opn., ante, pp. 617-619.) Conversely, in the two leading decisions granting housestaff the right to bargain (Regents of Univ. of Mich. v. Michigan Emp. Rel. Com’n (1973) 389 Mich. 96 [204 N.W.2d 218] (hereafter Michigan) and House Officers, etc. v. U. of Neb. Med. Ctr. (1977) 198 Neb. 697 [255 N.W.2d 258] (hereafter Nebraska), the record included not only similar facts but also undisputed evidence of many of the elements upon which the University relies in the present case—most significantly, that housestaff’s purpose in pursuing a residency program was educational and that the extensive and demanding patient care activities that dominated the program subserved an educational function. (Compare Michigan, 204 N.W.2d at pp. 225-226 and Nebraska, 255 N.W.2d at pp. 260-261 with maj. opn., ante, p. 621.) The dispositive factor in these conflicting decisions thus was not the factual record developed concerning “the facts of housestaff life.” These are essentially universal, and all of the aforementioned cases concurred that housestaff, as a practical matter, are both students and employees. The cases holding in favor of collective bargaining expressly so stated, and those holding to the contrary were forced to concede effectively as much. Where the cases ultimately divided was in the emphasis the determining tribunal placed upon the “student” and “employee” factors in construing and applying the relevant statute. Here too, the prior cases discussed above had something in common. In each jurisdiction, the determination whether collective bargaining would appertain revolved around application of a statute that granted such rights to “employees” without further defining what that term meant except in very broad and inclusive terms. The upshot of this statutory situation was that in Michigan and Nebraska, courts holding in favor of housestaff and against the universities had a relatively easy task in justifying their decisions as to employee status under the governing statutes. The majority opinion here has quoted the Michigan court’s expression on the subject (ante, p. 614, fn. 13); the Nebraska court’s reasoning was very similar. On the other hand, the Pennsylvania court, when faced with applying a statute that defined “public employee” as “any individual employed by a public employer” (see 369 A.2d at p. 714), divided four to three in favor of Temple University when it held that housestaff were not such employees. Like the NLRB in Cedars, the Pennsylvania majority conceded that house-staff possessed numerous “employee” attributes but focused upon house-staff’s own purpose in serving as such, and concluded that since the young physicians and medical school graduates (interns) “at Temple University [were] at Temple not for the primary purpose of obtaining monetary remuneration, but rather to fulfill educational requirements,” they should not be considered employees under the enabling act. (369 A.2d at pp. 714-715.) This holding evoked vociferous dissents, not to the court’s characterization of housestaff’s purposes but rather to its reliance on them in interpreting and applying the statute. While conceding, at least arguendo, that house-staff’s personal and professional purposes were educational, the dissenters deemed this irrelevant. In their view, the extensive indicia of employment to which the majority also had alluded should have been dispositive. The dissenting position in Pennsylvania paralleled that of dissenting NLRB Member Fanning in Cedars. (See maj. opn., ante, p. 610; see also post, pp. 641-642.) And the Cedars majority likewise employed a mode of analysis quite similar to that of the Pennsylvania court, which followed it. Cedars, however, deserves further discussion, for reasons that will soon become apparent. The governing statute in Cedars was section 2(3) of the National Labor Relations Act (hereafter the NLRA or the Act), 29 United States Code section 152(3), which provides in relevant part that “The term ‘employee’ shall include any employee . . . unless this [Act] explicitly states otherwise . . .,” and then proceeds to list some of the Act’s few explicit exceptions. In short, as the Supreme Court has noted, “The Act provides broadly that ‘employees’ have organizational and other rights. 29 U.S.C. § 157. Section 2(3) defines ‘employee’ in general terms, 29 U.S.C. § 152(3) . . . .” (NLRB v. Yeshiva University (1980) 444 U.S. 672, 681, fn. 12 [63 L.Ed.2d 115, 125, 100 S.Ct. 856].) The exceptions listed in section 2(3) do not, on their face, include house-staff. In Cedars, the NLRB nonetheless found and held that housestaff were not employees in the legal sense of the Act—principally because of the purpose of the residency program and the purpose of housestaff in participating in it. Those factors led the NLRB, in its own words, to “find that interns, residents and clinical fellows are primarily engaged in graduate educational training at Cedars-Sinai and that their status is therefore that of students rather than of employees.” (223 NLRB at p. 253.) The NLRB’s specific findings concerning the nature and purpose of the residency programs, and the purposes of housestaff in pursuing them, merit quotation here at length for purposes of further allusion later: “The record shows that the medical education and training of a physician involves a progression from classroom and laboratory education in the basic and clinical sciences, through an internship, and usually then to a period of more advanced training in a specialty or subspecialty of medicine. It is the purpose of internship and residency programs to put into practice the principles of preventive medicine, diagnosis, therapy, and management of patients that the medical school graduate learned in medical school. “From the foregoing and the entire record, we find that interns, residents, and clinical fellows are primarily engaged in graduate educational training at Cedars-Sinai and that their status is therefore that of students rather than of employees. They participate in these programs not for the purpose of earning a living; instead they are there to pursue the graduate medical education that is a requirement for the practice of medicine. An internship is a requirement for the examination for licensing. And residency and fellowship programs are necessary to qualify for certification in specialties and subspecialties. While the housestaff spends a great percentage of their time in direct patient care, this is simply the means by which the learning process is carried out. It is only through this direct involvement with patients that the graduate medical student is able to acquire the necessary diagnostic skills and experience to practice his profession. The number of hours worked or the quality of the care rendered to the patients does not result in any change in monetary compensation paid to the housestaff members. The stipend remains fixed and it seems clear that the payments are more in the nature of a living allowance than compensation for services rendered. Nor does it appear that those applying for such programs attached any great significance to the amount of the stipend. Rather their choice was based on the quality of the educational program and the opportunity for an extensive training experience. The programs themselves were designed not for the purpose of meeting the hospital’s staffing requirements, but rather to allow the [housestaff] to develop, in a hospital setting, the clinical judgment and the proficiency in clinical skills necessary to the practice of medicine in the area of [their] choice. . . . The ‘Essentials,’ which describe the standards for approved internships and residencies, indicate that the primary function is educational. . . . “In sum, we believe that interns, residents, and clinical fellows are primarily students. We conclude, therefore, that they are not employees within the meaning of Section 2(3) of the Act. Accordingly, no question affecting commerce exists concerning the representation of ‘employees’ of the Employer within the meaning of Section 9(c) of the Act, and we shall dismiss the petition herein.” (Id., at pp. 251, 253.) Within six months after filing its Cedars decision, the NLRB further explained its rationale. In Kansas City General Hospital and Medical Center (1976) 225 NLRB 108 [92 LRRM 1379] (hereafter Kansas City General Hospital)), the board had dismissed another housestaff representation petition, relying on Cedars, but had included language to the effect that the hospital employer was not an “employer” as defined in the Act, because its housestaff were not “employees” under section 2(3). A New York trial court picked up this reference and held that since the NLRB was now saying that private hospitals were not “employers”—defined in the Act in an interlocking way with other terms so as to establish, inter alia, the NLRB’s federally preemptive range of jurisdiction over labor representation decisions—then the states could regulate that subject with respect to housestaff in private hospitals. The NLRB closed this “loophole” by filing a “Revised Decision and Order” in Kansas City General Hospital, nunc pro tunc, in which it deleted the language about “employers” and reiterated Cedars’ finding that house-staff’s nonemployee status was dispositive. In addition, the NLRB’s revised, four-to-one opinion (the earlier decision had been rendered by a three-member panel) further recharacterized Cedars as having held that to extend collective bargaining to housestaff would be antithetical to the policies and purposes of the NLRA (which Cedars actually had never explicitly held). I quote the concluding paragraph of the NLRB’s revised opinion: “Turning to the preemption question, we believe that it has now become necessary for us to state explicitly that which is, in our view, implicit in the Board’s Decision in Cedars-Sinai; that is, at the risk of being somewhat repetitious, that the majority of this Board intended by its decision therein to find Federal preemption of the health care field to preclude States from exercising their power to regulate in this area. It is our judgment that the Congress, in passing the 1974 health care amendments, simply made a determination that residents, interns, and fellows, inter alia, were not supervisors within the meaning of the Act, but left the question as to whether they were ‘employees’ entitled to collective-bargaining rights for resolution by the Board in the exercise of its discretion. Having exercised its discretion in Cedars-Sinai, by finding residents, interns, and fellows to be primarily students and not ‘employees’ within the meaning of the Act, the Board confirmed, in our view, that it has not put hospital residents and interns beyond the reach of national labor policy, but has rather held that to extend them collective-bargaining rights would be contrary to that very policy.” (225 NLRB at p. 109 (fn. omitted).) From the standpoint of administrative functions and effects, this recharacterization of Cedars was accurate. In Board v. Hearst Publications (1944) 322 U.S. 111 [88 L.Ed. 1170, 64 S.Ct. 851], the Supreme Court explained that by defining employees only generally in the Act the Congress had entrusted to the NLRB resolution of whether particular employees fell within that statutory definition, and that in performing this function the NLRB was not limited by state law concepts but rather was supposed to apply and vitalize “federal legislation, administered by a national agency [and] intended to solve a national problem on a national scale.” (Id., at p. 123 [88 L.Ed. at p. 1180]; see id., at pp. 120-124, 130-132 [88 L.Ed. at pp. 1178-1181, 1184-1185].) On the other hand, Member Fanning—again the sole dissenter—was also correct in noting that the NLRB had gone about its business in an awkward way. (See Kansas City General Hospital, supra, 225 NLRB at p. 109 (dis. opn.).) I pause at this point to make two general comments about the significance of the Cedars decision to the national housestaff-university contest over collective bargaining and about Cedars’ relationship to the NLRB’s subsequent decision in St. Clare’s Hospital & Health Center (1977) 229 NLRB 1000 [95 LRRM 1180] (St. Clare’s). The majority opinion has seriously underestimated Cedars’ importance in both contexts. First, the majority opinion notes that Cedars was not an enthusiastically received decision in all quarters. (Ante, p. 610.) That is true, and Cedars’ interpretation and application of the NLRA is certainly an interesting topic for academic debate. However, that holding is now final: not only was Cedars repeatedly reaffirmed by the NLRB (e.g., in Kansas City General Hospital), it later was judicially upheld as not clearly erroneous and therefore unreviewable under the NLRA, in Physicians Nat. House Staff Ass’n v. Fanning (D.C. Cir. 1980) 642 F.2d 492 [57 A.L.R. Fed. 577] (en banc), cert. den. (1981) 450 U.S. 917 [67 L.Ed.2d 342, 101 S.Ct. 1360], The result of this condition of federal law is that, according to one of our informed amici, 64 percent of the 1,554 hospitals which today sponsor residency programs in the United States are controlled by that decision, and their housestaff accordingly are denied collective bargaining unless the hospitals agree to engage in it voluntarily. Second, a proper understanding of the NLRB’s position concerning housestaff’s status as “employees” vel non under the NLRA requires that Cedars and its rationale not be disregarded in favor of the St. Clare’s decision. Cedars was and is the seminal and dispositive interpretation of the Act concerning housestaff. It also was the case in which the NLRB rendered its findings of fact concerning housestaff’s predominantly educational objectives and the educational purposes o