Doctors, nurse practitioners, physician assistants and others picketed outside of the LifeLong William Jenkins Health Center in Richmond Wednesday to advocate for better working conditions.
The picketing, which was also scheduled to happen at other LifeLong locations in San Pablo, Berkeley and Oakland, is over contract negotiations between LifeLong Medical Care and its 165 providers who are represented by the Union of American Physicians & Dentists. Providers are seeking better working conditions, manageable patient panels and higher pay in their contracts.
If the employees and management can’t come to an agreement, the union will vote on whether to go on strike Monday.
“There’s a lot of pressure being put on providers and all of the staff to just churn through [patients] and increase revenue. But at the same time, the infrastructure doesn’t really exist to even support that level of productivity because we are constantly understaffed and not well paid,” said Dr. Adrianne Khanolkar, a family medicine doctor at LifeLong’s East Oakland Health Center. Khanolkar told Richmondside that most LifeLong doctors are passionate about caring for underserved communities. However, they say the work itself is becoming unmanageable.
“We are constantly understaffed and not well paid.”
— Dr. Adrianne Khanolkar, a family medicine doctor at LifeLong’s East Oakland Health Center. (Image courtesy of LifeLong)
“The workload is incredibly heavy, because it’s not just providing care, it’s unfortunately often picking up a lot of the slack…because we’re so understaffed for doing things like triaging or processing referrals or making sure that the insurance is working properly,” she said.
LifeLong Medical Care has more than 13 health centers, three urgent care locations, and four dental clinics across Alameda and Contra Costa counties. In 2024, LifeLong served 53,082 patients.
Currently, 852 patients across the provider network are scheduled for appointments on Monday, said John Jenkins, LifeLong’s CEO. “Their lives may be disrupted as a result of this work stoppage. That’s serious,” Jenkins said. “I don’t take that lightly.”
It wouldn’t be the first strike for the medical provider. In June 2023 Some 140 doctors, nurse practitioners, psychiatrists, and other LifeLong Medical Care providers went on strike over conditions and pay at the organization’s clinics across the Bay Area.
Jenkins said that the management’s bargaining team and the providers represented by the union are “close” to reaching an agreement. He pointed to the last 15 bargaining sessions in which management agreed to implement 29 improvements. He said that the main outstanding item is pay.
The union is proposing a one-time 1.5% pay increase across the entire three-year contract, accompanied by a bonus program.
“LifeLong is navigating significant uncertainty in the health care landscape and must protect patient access, support our broader workforce, and ensure we can continue serving our communities for the long term,” a LifeLong representative said in a statement.
The financial concerns facing LifeLong are real. With fewer patients covered by MediCal due to Trump’s One Big Beautiful Bill, LifeLong is expecting significantly less reimbursement this year.
It’s not just about pay. Doctors describe signing death certificates for people they haven’t treated
However, pay is not the biggest issue, said Dr. Julia Marino. She was previously a patient at LifeLong and is now a family medicine doctor at the West Berkeley site. She told Richmondside that her patient panel is miscounted by LifeLong. The number of her “active” patients, or patients seen in the last year, is 752. But the number of patients assigned to her is dramatically different – 1,682.
That means Marino receives lab results, patient messages and disability paperwork for those 1,682 people. She is expected to complete all of this paperwork and communication in a timely manner, which is difficult to do in the one afternoon a week allotted to her for this purpose.
“I just get them put in front of me.”
— Dr. Julia Marino describing having to sign the death certificates of patients she has never seen. (Image courtesy of Julia Marino)
She illustrates this with a particularly gripping example – death certificates.
Marino and other providers at LifeLong are routinely asked to sign death certificates for patients they have never seen or treated. Given the importance of doing this in a timely manner, Marino is often asked to determine the cause of death for these unknown people between her busy clinic schedule and teaching commitments.
“I just get them put in front of me,” Marino said.
Death certificates are often signed in the hospital where a patient dies. But if a patient dies at home, or the funeral home does not have a signed certificate, the request goes to the patient’s listed primary care doctor. And then Marino is asked to look through the patient’s chart and see what they could have died from.
Khanolkar has had the same experience. Both providers said this problem isn’t unique to LifeLong and many community clinics grapple with the same issue. However, it is a significant time and professional liability strain, they said.
Khanolkar recalled being in a bargaining session with management while getting messages to complete a death certificate. This particular patient had died in a hospital, but Khanolkar did not know which hospital, did not have the medical records from that hospital, and did not know why the hospital did not fill out the certificate. She said she instructed a nurse to get the records.
“”
“There’s a lot of pressure being put on providers and all of the staff to just churn through patients.”
— Dr. Adrianne Khanolkar, LifeLong
“I came back and found a speculated death certificate on my desk [to sign], and I had to remediate that. And that’s not [even] the most egregious situation,” Khanolkar said.
Amongst all the other work providers are supposed to do, sometimes these death certificates fall through the cracks. Khanolkar remembers seeing one death certificate that was not signed for close to 30 days, as it was not escalated to a provider appropriately.
“I am not sure how many times they may have had to reschedule that poor person’s funeral,” she said. “It’s also just harrowing for the families,” she added.
When asked about management’s response, “I think some of them were unaware that [this] ever happened,” Marino said. She and Khanolkar both said this issue was raised at bargaining meetings due to concerns about professional liability and judgement.
A LifeLong representative said that no bargaining proposals about death certificates were raised. The representative also said there were several other avenues in which doctors could have raised concerns about death certificate completion earlier.
Ultimately, Marino, Khanolkar, and Jenkins were all emphatic that they have the same goal of serving the underserved patients of the East Bay.
There is an all-day bargaining session set for Thursday, and it’s expected to be the last session before a strike could potentially take place.
