Patients, observers concerned as community health centre lays off health-care workers during global shortage

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Four health workers with decades of cumulative experience are set to lose their jobs at one of Ottawa’s busiest community health centres later this month.

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The two family physicians, a nurse practitioner, and a registered nurse were given notices of termination without cause in April. Their last day of work is July 29.

They were given no explanation for the terminations, according to current and former employees who asked to remain anonymous because they feared repercussions at work or impact on future employment if they were identified.

Pinecrest-Queensway Community Health Centre (CHC) says the terminations are part of a restructuring that will allow it to serve 2,500 more healthcare clients without new funding at a time when primary health care is in short supply. The centre’s CEO says the restructuring is about providing better care.

But the move, during a global health worker shortage, has raised concerns by some who fear loss of the experienced health professionals will disrupt and harm the centre’s many vulnerable patients. Others say the restructuring doesn’t explain why four experienced health-care professionals have been let go. That, they say, will mean less access to care, especially in the short term.

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“They work with some of the most marginalized folks in our city. I am very concerned at what I am hearing,” Ottawa Centre NDP MPP Joel Harden said of the terminations.

“At a time when everybody is starving for staff in healthcare or people are burnt out, I don’t know how people who have good performance revues are being told they’ve got to go because of restructuring.”

Chandra Pasma, newly elected NDP MPP for Ottawa West-Nepean, which includes the Pinecrest-Queensway catchment area, says she is worried about the wellbeing of patients. She says many of the centre’s patients have undergone traumatic experiences, including war, abuse and more. “Losing trusted health-care workers adds unnecessary stress.”

One of those patients said she was shocked to receive notice that her doctor of 15 years was leaving.

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“I am devastated that she is leaving,” she said. “It affects me medically. I am very concerned they are taking away a person who knows me and knows my file.”

The patient, who asked not to be identified to protect her privacy, noted the health workers had “been there for us during this crazy COVID pandemic. To see this done to them is bad enough, but during COVID?”

Other upset patients called the clinic looking for information.

The centre, which serves an area around Bayshore and the west end as well as parts of Barrhaven, has hired people to replace the nurse and nurse practitioner who are being let go. The replacements are fairly new graduates, according to current and former staff members. But the CHC has not yet replaced the two doctors. The centre says it expects to be fully staffed before the end of the summer.

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It has “restructured internal teams and has changed roles to build a stronger team and to ensure healthcare appointments are available when clients need them,” Pinecrest-Queensway Community Health Centre said in a statement.

It said the CHC is serving 25-30 per cent fewer patients than it is funded to serve “because of outdated employee and patient scheduling practices.” Forty-five per cent of the centre’s patients have sought care from another health provider or emergency as a result, officials with the community health centre say.

The restructuring means a small number of employees are no longer with PQCHC, the statement says.

“Because of the desperate need of many for primary care, this work has been underway for years and has accelerated in the past few months.”

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But observers, health providers and former and current workers are concerned about the disruption and inability to replace experienced staff at a time when it is difficult to hire.

Those with knowledge of the situation also say some of those being let go were among the busiest at the centre and others were willing to take on more patients but had not been asked.

Harden, who had not spoken directly with managers at the centre, said restructuring right now “doesn’t seem to make a lot of sense.”

In an interview, Pinecrest-Queensway CEO Christopher McIntosh said hundreds of people were on waiting lists for the centre.

“We know at the centre we need to see 2,500 more health-care clients and we know we can do that without new funding.”

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That will mean shortening many primary care appointments from the current default of 30 minutes to an average of 20 minutes, he said.

“We know from other providers that the average appointment can be shorter and address the complexity of our clients’ needs without impacting care.”

He said the centre “needs to do a better job” of asking clients in advance what the appointment is about and then booking the appropriate amount of time with the appropriate professional, which could include a dietician, chiropodist or registered nurse, rather than a physician or nurse practitioner. Clients who require longer appointments will still have them, he said.

“The plan is to make care better.”

The current and former employees said the health workers affected have all had strong performance reviews and, cumulatively, have more than 50 years of experience. The physicians who have not yet been replaced care to more than 700 patients.

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The current and former workers said they are worried about how disruptive the move will be, especially to vulnerable clients. They are also concerned about the extra pressure it might put on others working at the centre.

Many of the Pinecrest-Queensway’s patients have experienced physical or sexual trauma, have complex health issues and are struggling with poverty, housing and other social issues. Appointments tend to be long because many of the patients need a translator and, because it can be difficult for them to get to the centre, they bring more than one issue at a time.

“This patient population needs very experienced and committed (health-care) providers,” said one of the group of concerned former and current workers. Last year, five health-care providers left the centre.

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Dr. Alison Eyre, a family physician at the Centretown Community Health Centre and associate professor in uOttawa’s department of family medicine, says she is particularly concerned about the fact that some of those losing their jobs include health workers who speak French.

There are many members of the city’s Franco-African immigrant community in the Pinecrest Queensway catchment, Eyre said. For them, being able to get services in their own language is crucial.

A study published in CMAJ (the Canadian Medical Association Journal) this week underscored just how crucial it is for patients to receive health-care in their own language. Among other things, it found that Francophones who received care in their own language had a 24 per cent lower chance of death while in hospital than those who did not receive care from a French-speaking physician.

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Eyre says her concern about the situation is heightened because it is difficult to hire any health workers right now, and more difficult to hire those who speak multiple languages and have experience.

Pinecrest Queensway, however, says it expects to have a “more diverse” health-care staff as a result of the restructuring.

Eyre, like Harden, said she was baffled why the centre would be letting people go as part of a restructuring during a pandemic, a health human resource crisis and some of the biggest pressures the province’s health system has ever experienced.

“I can’t fathom what kind of restructuring would have you let go health workers in this climate,” she said. “I would need to understand the thinking behind it.”

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Former and current workers describe the management culture at the community health centre as rigid and said managers were reluctant to accommodate health

care staff who had young children at home during the pandemic by allowing them to work flexible hours.

They say it can be difficult to hire doctors to work in community health centres because the work is demanding and seldom ends with appointments. Burnout levels are high, they say.

Pinecrest-Queensway is one of 75 CHCs in Ontario, a primary health-care model aimed at combining care and health promotion, especially to communities with barriers. CHCs are mandated to provide health care to refugees and other people without health cards. Current and former staff said the number of patients on their rosters can be misleading.

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In 2017, Ontario’s Office of the Auditor General looked at CHCs as part of its annual report.

Among its findings was that the ministry of health and Local Health Integration Networks did not have effective systems in place to oversee and co-ordinate community health centre programs and services.

“They do not have sufficient information to ensure that CHCs deliver programs and services in a timely and cost-effective manner that meet community needs, including those of the priority population.”

The report noted that 80 per cent of CHCs, at the time, were serving fewer patients than they were funded for and others were serving more patients.

At the time, the ministry of health said: “Community Health Centres across Ontario provide important health care access to over half a million Ontarians, many of whom are vulnerable populations including new Canadians, homeless populations and seniors”.

Ottawa’s six CHCs employ more than 1,200 staff, engage more than 1,300 volunteers and serve more than 118,000 residents “facing barriers to health care and social services.

“For more than 50 years, community health centres (CHCs) have worked with and within marginalized communities to ensure that everyone in those communities receives equitable access to high quality health and social services,” according to a 2020 joint annual report of the Ottawa CHCs.