'Serious concerns' raised by physicians about leadership, workloads at CancerCare Manitoba
Distrust of leaders, dissatisfaction with workplace culture, burnout among issues cited
A lack of trust and a fear of reprisal from leadership for raising concerns are among several issues raised by physicians at CancerCare Manitoba, according to a letter obtained by CBC News.
"We have been contacted by a number of physicians raising serious concerns," stated the letter from Doctors Manitoba, which was sent on Sept. 20 to all members who provide medical services at the cancer agency in Winnipeg.
"Many are concerned these issues have caused significant burnout and distress and are creating significant challenges with physician recruitment and retention. Some are also concerned about how these issues are affecting patient care, noting that wait times have been climbing in some areas as resources have not kept pace with growing patient demands."
A spokesperson for the physician advocacy group told CBC in an email that the letter was prompted by "a cluster of concerns" and aims to get a better understanding of the issues and how widespread they are.
Physicians at CancerCare are being invited to contact Doctors Manitoba, confidentially if desired, to share their experiences and concerns, or to simply reach out for support.
The letter, signed by Doctors Manitoba director Ian Foster and medical lead for physician health and wellness Dr. Shelley Anderson, lists the following issues as being among the ones it has heard about so far:
- Increasing and excessive workload demands due to inability to retain physicians, and increasing complexity of patients.
- Lack of engagement and communication from CancerCare.
- A lack of trust and a fear of reprisal from leadership for raising concerns.
- Dissatisfaction with the workplace culture and support.
- Individual contracts including recognition and remuneration for extra work.
"We are at the very early, diagnostic stage of understanding the problem and how widespread the concerns are," the spokesperson said in the email to CBC News.
Representatives from Doctors Manitoba met with senior leadership at CancerCare on Monday, "and we look forward to productive dialogue continuing," the spokesperson said.
Not a popularity contest
CancerCare CEO Sri Navaratnam said she doesn't take the complaints personally.
"When you do this job, you make some difficult decisions and it affects a few people at times. I'm not in the popularity contest," she said.
She acknowledged there have been workload issues due to less-than-ideal staffing levels and appreciates the feedback.
"Physicians, in spite of all they're doing … the burnout and stress, they put the patient first. We want to hear [their concerns] because they are coming from a good place — they want to help Manitobans."
She was surprised, though, to see distrust and reprisal fears in the list.
"That part, I'm really finding it difficult to digest. And especially the department heads are really distressed by that comment because they said they had a retreat two weeks ago with all physicians. So why didn't they bring it [up then]?" Navaratnam said.
"They are very upset. They [the department heads] feel like they're being undermined, so that is something we need to look into."
As for recruitment and retention and workloads, those are being addressed, she said.
Over the past five years, CancerCare has lost 16 oncologists in all departments — medical oncologists, hematologists, radiation oncologists and pediatric oncologists. In that same time, 19 have been hired, including six this year alone.
As well, an interview was held Tuesday for another medical oncologist, while interviews are planned next week for a radiation oncologist and the following week for a hematologist, Navaratnam said.
"That is exactly addressing the workload of the physicians. We are in a good place right now," she said.
A committee is also being struck to assess workloads "and act accordingly," she said.
"And it's not physicians alone who take all the load, so we need to think about the entire system," she said, mentioning nursing staff and radiation therapists.
"It is a multidisciplinary, interdisciplinary team [that] provides care to cancer patients. We have to come together to solve it. This is not the time to [point fingers]. We all [have] the same shared priority to bring the best care to our patients."
Navaratnam said the situation is not unique in Manitoba. In fact, she was headed to Toronto on Wednesday to lead a pan-Canadian meeting about human resource challenges in the cancer care system.
She also expects more meetings with Doctors Manitoba.
"We need to understand … to get at what are their concerns."
The Doctors Manitoba spokesperson said it is not uncommon for the organization to send out letters broadly to its members when it receives a concerning number of complaints.
"We have been doing this type of work more and more in recent years across Manitoba, which is perhaps not a surprise when our annual physician survey finds only a third of physicians feel they can raise concerns in the health system without fear of reprisal," the spokesperson said.
"We hope to see a change in the culture broadly in health care, one that prioritizes front line feedback and embraces physician engagement on a regular and ongoing basis."
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With files from Meaghan Ketcheson