Deteriorating working conditions at the BC Cancer Agency have led to declining morale, rising staff burnout and increased waiting times, compromising both patient care and research, say three leading oncologists at the institute.
In a letter written to the head of the provincial health authority that oversees the agency, the doctors say inconsistent leadership over the past several years has helped foster an intolerable situation that is not allowing the agency to fulfill its obligations to the public.
"In our view, it is not possible to continue to provide quality care and research under the existing conditions," says the Oct. 29 letter to Carl Roy, president of the Provincial Health Services Authority. The letter, obtained by The Globe and Mail, is signed by doctors Sharlene Gill and Tamara Shenkier, co-presidents of the Association of BCCA Medical Oncologists and physician Paris-Ann Ingledew, president of BC Association of Radiation Oncologists.
The BC Cancer Agency, which encompasses six centres around the province, has long been considered one of the top cancer organizations in the country. But the letter highlights the turmoil in which the agency now finds itself. Last month, Max Coppes resigned as president after barely two years on the job. His predecessor lasted only 18 months in the position.
A couple of weeks ago, a past president, Don Carlow, published a letter blaming the many problems at the agency on Mr. Roy's provincial health authority, which was given direct control over the BC Cancer Agency (BCCA) in 2001. He said the priority the cancer agency was once given by government was radically downgraded in the process. Staffing numbers have not kept pace with demands, which have created waiting-list problems.
In a public rebuttal to Dr. Carlow's letter, Mr. Roy played down the concerns, instead focusing on the fact that B.C. has the lowest cancer mortality rates in the country – outcomes most often linked to lifestyle and genetics. Rather than be in any state of decline, Mr. Roy suggested the agency was "thriving."
On Tuesday, The Globe reported on how significantly waiting times at the agency have increased in recent years. In 2004-05, the percentage of British Columbians who saw a radiation oncologist within two weeks of being referred by a surgeon or family physician was nearly 58 per cent, according to the B.C. Cancer Agency's own statistics. In 2014, the percentage was just more than 38 per cent. In Ontario, 80 per cent of patients see a radiation oncologist within two weeks of referral.
Access to a systemic-therapy (chemotherapy) oncologist in B.C. within two weeks was 62.4 per cent in 2004-05. This year, that number has dropped to 44.5 per cent. In Ontario, the percentage is just under 70 per cent.
In their letter to Mr. Roy, the three physicians disputed his characterization that the agency is thriving.
Patients are waiting longer than ever to see oncologists, they say. "Despite the BCCA's goal of having 90 per cent of patients seen within four weeks of referral … the proportion of patients in B.C. waiting longer than four weeks to be seen has more than doubled in the last seven years."
The lack of new hires has placed an increasing burden on current staff. "In 2011, 65 per cent of responding BCCA medical and radiation oncologists reported severe levels of distress on at least one aspect of the MasLach Burnout Inventory, the most widely used tool to measure burnout among physicians. This is far in excess of the prevalence of 35- to 40-per-cent burnout among U.S. oncologists. Earlier this year, nearly 80 per cent of BCCA medical oncologists reported moderate to extreme dissatisfaction with their current workload and cited patient safety and physician burnout as their biggest concerns."
The Victoria cancer centre has lost nine medical oncologists in the past three years because of poor working conditions, the doctors said.
They conceded the achievements of the cancer agency's research department have been notable. However, they said, clinical trials remain the key to translating new knowledge into improved outcomes.
"Sadly, our Clinical Trials Unit at all regional centres are struggling to remain viable …and are now increasingly unable to pursue scientifically important trials due to limited resources and finances."
The three characterized relations with the provincial health authority as "strained and at times adversarial."
Arden Krystal, executive vice-president and chief operating officer of the provincial health authority who was copied on the letter, said she was aware of the concerns outlined in the correspondence. She said many of the complaints were being addressed by a "physician workload committee," of which the three letter writers are members. She said she understood that the physicians on the committee felt the most serious problems were being addressed.
Asked why the three oncologists would write such a letter if they felt the agency's problems were being tackled, Ms. Krystal said: "All I can go on is what they told us privately." She also said she didn't dispute that there is a labour issue, but wouldn't say what will be done about it. The health authority is supposed to meet with the workload committee on Thursday to share recommendations it is planning to make in response to the group's feedback.
B.C. NDP health critic Judy Darcy said the letter was "extremely alarming" and "an obvious cry for help." She said B.C. Health Minister Terry Lake needed to meet with the three doctors immediately to find out what is going on at the agency, and not rely on second-hand reports from Mr. Roy. Ms. Darcy said the waiting time outcomes were particularly disturbing in a province where the rate of cancer is increasing 3 per cent every year.
"These are the people who we depend on to save the lives of our loved ones," Ms. Darcy said of the letter writers. "And the minister needs to meet directly with them."