WELLFLEET — Outer Cape Health Services is regrouping after a rash of staff departures over the past several months left the organization with a shortage of top leadership and primary care physicians.
According to archival records of the community health center’s website, six clinicians have left OCHS since May, as have Chief Financial Officer Manuel Pineiro, Chief Development and Communications Officer Kathleen Weiner, and, most recently on Aug. 30, Chief Clinical Officer Marianne D. Harris, who served in that role for less than a year following the departure of Chief Medical Officer Andrew Jorgensen.
In an interview with the Independent, CEO Damian Archer, who has been heading the nonprofit since Dec. 1, 2023, said that the change in staffing has required the organization to reexamine its structure.
“Anytime that we have any significant position opening, we look at ways to ensure that we are making the best decision about how to backfill that position and how to do it in a way that is responsible and financially sustainable,” Archer said.
According to publicly available financial records, OCHS had a $2-million deficit in 2023. Archer said that, with limited funding resources, the health center’s organizational strategy requires frequent changes.
OCHS’s website lists 21 current job openings across its three locations, all of which were posted between Aug. 30 and Sept. 6. The positions are almost all clinical, with only a couple of front desk positions.
The C-Suite
According to Archer, the organization is looking for a chief clinical operations officer to replace Harris as well as two chief strategy officers. The organization has also lacked a development team since Weiner and Senior Development and Communications Officer Gerry Desautels left their positions.
Archer said he could not comment on “the specifics of their personnel issues.” Desautels was hired by the Lower Cape Outreach Council in June as its development director, according to a press release.
Harris left her position in August because she was not able to secure housing on the Cape, Archer said, and had been commuting from off-Cape. She had moved here from Chicago, where she was the director of clinical practice at the University of Chicago. Harris’s salary is not publicly available, but according to the most recent tax filings, her predecessor, Jorgensen, was OCHS’s second highest paid employee at $243,000 per year.
“We really need to have a chief clinical officer that is on-site the majority of the week,” Archer said. “It wasn’t a sustainable situation.”
Since OCHS lost CFO Manuel Pineiro in late June, it has been restructuring its financial operations, which has included outsourcing certain jobs, Archer said. The organization has contracted with financial advisory and accounting firm Gray, Gray & Gray of Canton to take on the duties of a financial officer.
“They have very specific expertise with supporting federally qualified health centers,” Archer said.
OCHS is also outsourcing its billing operations, which has affected internal billing team members “who we are currently helping to transition to other roles at the health center,” Archer said.
Pineiro declined to speak with the Independent, instead referring a reporter to the organization’s “communications team” — which at this point appears to be Archer himself.
Meeting the Need
OCHS has lost six clinicians since May, five of whom worked in the Harwich office, but the total number of clinical staff has remained the same since last October at 39, internet records show. “We are holding steady, especially with our primary care teams,” Archer said.
The records show that OCHS has lost five primary care physicians in the last year, including Dr. Cody Nolan in Provincetown and Dr. Teresa Corcoran in Harwich. Only one physician was hired in the past year — Dr. Marie Andrine Constant, who is chief population health officer and director of the Provincetown medical center.
The sudden departure of doctors has left patients waiting months for appointments, the Independent previously reported. There have also been problems with last-minute cancellations, delayed referrals, and getting answers over the phone.
Quick turnover among primary care physicians is not unique to the Cape, Archer said. Nationally, many primary care doctors are leaving the field, and fewer doctors are starting their careers in primary care. According to the federal Health Resources and Services Administration, the shortage of primary care physicians is projected to reach 68,000 by 2036.
The decline was exacerbated by the pandemic. According to the nonprofit Mass. Health Quality Partners, access to primary care has declined for three years.
“I don’t know a single primary care service that didn’t lose staff, money, and services as a result of the pandemic,” said Sally Deane, who served as OCHS’s CEO from 2009 to 2016.
Finding the Funding
According to OCHS’s most recent tax filing from 2023, the organization had a $2 million deficit last year. Tax records also indicate that the organization’s net assets have dipped from $10.8 million in 2022 to $8.7 million in 2023.
Deane told the Independent that the health center has experienced a “financial crisis” in recent years. “There are not enough medical supplies because they can’t pay the vendor that supplies them,” she said. “Morale among staff must be lagging.”
Doctors currently at OCHS reached by the Independent said they were not authorized to speak to the press.
Archer said that Deane’s statement about medical supplies is “not factual” and that OCHS has “no challenges making our debts.”
But he also said that OCHS is experiencing the same funding challenges that all community health centers face. “As a primary care organization, our ability to be reimbursed adequately for the level of services we are expected to give is challenged,” Archer said. “Even though we get lots of support from the federal government and donors, the compensation model for primary care is woefully inadequate.”
According to OCHS’s 2023 tax filings, it spent $34 million last year, while taking in $32 million in revenue. It is the largest deficit in the available tax records, dating back to 2011. The organization had previously experienced deficits from 2015 to 2017, ranging from $17,000 to $850,000.
“It requires a lot of change and a lot of flexibility,” Archer said. “We are doing our best to make ends meet. But we are going to continue to be here for the community for the foreseeable future, regardless of the challenges that we may have to face. Our communities need us.”
Editor’s note: An earlier version of this article, published in print on Sept. 12, inaccurately reported that Dr. Damian Archer has been CEO of Outer Cape Health Services for a year. He was promoted from chief health equity officer to CEO as of Dec. 1, 2023, succeeding Patricia Nadle.
