Burnout, poor communication, distrust plague CancerCare Manitoba: docs Doctors Manitoba demands independent review into ‘toxic’ workplace By: Tyler Searle Posted: 6:35 PM CST Tuesday, Dec. 17, 2024

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This article was published 17/12/2024 (293 days ago), so information in it may no longer be current.

A group representing Manitoba physicans is calling for an independent investigation into operations at CancerCare Manitoba after a months-long review into the health-care agency revealed a “high level of moral distress” among doctors there, the Free Press has learned.

Details surrounding the review, launched by Doctors Manitoba in September, were outlined in a final report sent to physicians Monday and obtained by the Free Press.

The 14-page document determined complaints about burnout, heavy workloads, recruitment challenges, lacklustre communication, favouritism and distrust in the executive leaders are credible and widespread.

“Overall, the (Doctors Manitoba) review found serious concerns from a majority of physicians, concerns that require urgent attention to disrupt a workplace culture described by many physicians as toxic,” the document said.

“An over-arching sense of powerlessness and diminishing hope was evident in the submissions received.”

The physicians’ advocacy group became aware of concerns within CancerCare around 18 months ago, with the volume of such reports growing “significantly” over time, the document said.

Doctors Manitoba sent a letter to all physicians working within the agency on Sept. 20, announcing it would examine the complaints. The final report includes feedback from 57 physicians, out of 117 asked to participate.

Most submissions came from current employees, while some were provided by people previously connected to the cancer agency. Some physicians were reluctant to participate for fear of reprisal, the report said.

Many of the physicians praised their respective department heads, suggesting the issues stem from the most senior levels of leadership, it said.

“The environment was described as top-down in its leadership approach, reluctance to receiving feedback and indeed punitive when such feedback was offered, and a lack of sincere listening with a view to solving real problems affecting patient care,” it said.

According to the document, several physicians shared serious allegations about inappropriate conduct by senior administration, which could include breaching the organization’s code of ethics.

Doctors Manitoba did not detail those allegations but noted they are beyond the scope of its authority to investigate. It has referred them to the Manitoba ombudsman.

“Given the nature of these concerns and the level of distress among physicians about them, there is a need for a truly independent and impartial review,” the document stated.

The ombudsman did not respond to a request for comment.

Health Minister Uzoma Asagwara received a copy of the report and reviewed it Tuesday.

The minister stopped short of committing to an independent review, but said the concerns are being taken seriously.

“Given the nature of these concerns and the level of distress among physicians about them, there is a need for a truly independent and impartial review.”–Doctors Manitoba report

“We want to make sure that concerns that are highlighted are being addressed and my understanding is that’s exactly what is happening,” they said.

Asked what specific steps are underway, the minister deferred comment to CancerCare.

Asagwara stressed CancerCare has been a “distinguished centre of excellence for decades” and is a “beacon of hope” for patients and their families.

The report noted nine physicians provided positive comments about CancerCare leadership but said they were similar in content, raising concerns they may have been coached of coerced.

The document warned issues within the agency could impact patient care.

According to the report, an analysis of data from Manitoba Health and the Canadian Institute for Health Information showed Manitoba’s median wait time for radiation therapy — nationally considered a priority procedure — has been increasing for several years.

Patients are still receiving such treatments within the four-week benchmark recommended by medical professionals, but wait times are rising at a degree beyond the national average, it said.

The median wait times in Manitoba have risen to 17 days in 2023 from nine days in 2019. The national median increased to 12 days from nine days during the same period, the data shows.

The report said turnover inside CancerCare is also cause for concern, with physician turnover rate roughly three times the provincial average for other facilities (around 5 per cent).

CancerCare previously confirmed 16 physicians left employment over the last five years, and 19 people were hired as replacements.

In a statement Tuesday, CancerCare board chair Jeoff Chipman disputed the report’s account of turnover rates, pointing out it only amounts to around 4.3 per cent.

He said the organization has successfully recruited an assortment of specialists to fill the outstanding vacancies, with all but one job left unspoken for.

The report referenced the new hires, saying they are expected to start work between January and August of 2025. Some of those are net new positions.

The document noted CancerCare is mired in ongoing litigation from a physician that has exacerbated recruitment and retention challenges.

Dr. Maclean Thiessen filed a lawsuit against the agency in August claiming CancerCare reneged on the terms of his employment after recruiting him to work in Manitoba.

CancerCare has filed a statement of defence denying the allegations. The case has not been tested in court.

Doctors Manitoba said other physicians have similarly reported unilateral changes to their contracts.

“Some physicians disclosed they could not, in good conscience, encourage colleagues from other jurisdictions to take a position at (CancerCare) given the current conditions,” the report said.

A review of court records shows the cancer agency has not been named in any additional lawsuits from physicians.

An annual physicians survey, conducted by Doctors Manitoba in February, found 72 per cent of physicians working for the agency are distressed, while 51 per cent were experiencing a high level of burnout.

The survey also found 33 per cent of doctors described the CancerCare workplace as positive; 13 per cent said the health system is responsive to their concerns; 38 per cent felt they could raise concerns without fear; 21 per cent were given the opportunity to provide input on changes that affect their work; and 28 per cent were informed of changes in a timely manner.

In the past decade, less than half of the medical students who completed residencies in oncology and hematology in Manitoba still practise in the province, Doctors Manitoba found.

Chipman said issues with burnout are not unique to Manitoba, and are being seen in health systems throughout the country and beyond.

He referenced a 2020 report from the British Columbia Medical Journal that found 77 per cent of oncologists had negative scores in at least one of three burnout domains (exhaustion, cynicism, or inefficacy).

The board chairman addressed the Doctors Manitoba report in an email to physicians sent last week.

“This should be considered a pivotal moment for (CancerCare) and all of our stakeholders — physicians, nurses, staff, leadership, the Ministry of Health, the University of Manitoba,” Chipman wrote.

“We have heard your feedback. While there are aspects of the report with which we may not fully agree, we acknowledge the concerns raised and are committed to working collaboratively.”

CancerCare president and CEO, Dr. Sri Navaratnam, also issued an email statement to staff Monday.

“I am saddened to read some of the quotations. It is troubling to me that there are physicians who are not happy at CancerCare Manitoba,” she wrote.

“Let me thank you for your candid comments; I appreciate that you have come forward to articulate your concerns … I will reach out to you so that we can have an open, honest and meaningful conversation.”

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Navaratnam’s contract with the agency expires in 2025; CancerCare announced in November it has begun the search for her replacement.

Doctors Manitoba declined to comment on the report, citing its confidentiality. Each page of the document includes a watermark indicating it is intended for internal distribution only.

The report culminated with a series of recommendations for leadership, including rebuilding trust, improving physician engagement and focusing on physician well-being.

—with files from Chris Kitching

tyler.searle@freepress.mb.ca

Tyler Searle
Reporter

Tyler Searle is a multimedia producer who writes for the Free Press’s city desk. A graduate of Red River College Polytechnic’s creative communications program, he wrote for the Stonewall Teulon Tribune, Selkirk Record and Express Weekly News before joining the paper in 2022. Read more about Tyler.

Every piece of reporting Tyler produces is reviewed by an editing team before it is posted online or published in print — part of the Free Press‘s tradition, since 1872, of producing reliable independent journalism. Read more about Free Press’s history and mandate, and learn how our newsroom operates.