Antonette Teel found out last week that her job at Chestnut Hill Hospital was being eliminated.

Now, Teel, a secretary at the hospital’s Senior Behavioral Health unit, has a decision to make: Should she apply for one of the new positions the hospital created — a position that includes patient care responsibilities but might pay less than her current job? Or should she look for another job altogether? But what would that job even be?

“I have no idea,” said Teel, a 36-year-old single mother to twin boys and a member of SEIU Healthcare Pennsylvania, a union that represents 45,000 health-care workers in the state.

Last week, Tower Health announced that it would eliminate 65 positions across the only two union hospitals in its network -- Chestnut Hill and Pottstown -- including 45 unit secretaries and 15 “patient sitters," who sit with high-needs patients. It’s replacing those positions with fewer jobs: 29 unit support coordinators and 11 patient care assistants. Tower Health said that unit support coordinators will be paid the same, or more, than unit secretaries, while patient care assistants would make less than the secretaries. The average unit secretary makes $18 an hour, according to the union.

Tower Health, which recently agreed to buy St. Christopher’s Hospital for Children out of bankruptcy, said these changes would improve patient experience.

For a company that employs nearly 11,000 workers in the state, the layoffs don’t represent a significant number. Still, the cuts are part of a broader trend of hospitals’ contracting workforces and having a disproportionate impact on low-wage service workers.

“Hospital jobs are the premium jobs in the industry,” said Cheryl Feldman, executive director of the District 1199c Training and Upgrading Fund. But the growth in the health-care industry is not in hospitals: It’s in home health care and outpatient facilities, such as urgent care, which typically pay less and are not unionized.

When Hahnemann University Hospital abruptly closed, putting 2,500 workers out of a job, the roughly 700 unionized service workers — food service workers, housekeepers, nursing assistants — left behind jobs that paid well over $15 an hour and came with strong benefits and job security. Those kinds of service jobs are a rarity now, especially outside of hospitals.

The trend of these “good” service jobs being cut raises the question: If Philadelphia is a hub for “eds and meds" but its institutions can’t sustain lower-wage jobs, what does it mean for the city’s persistently high poverty rate?

It’s common for hospitals, faced with competitive pressure and high labor costs, to cut positions that don’t directly deal with patient care, said Joshua Nemzoff, a health-care consultant in New Hope.

“If you downsize areas where an employee has no contact with patients, it typically doesn’t impact quality of care,” he said.

Teel’s job, however, is something of a hybrid: The door to the senior behavioral health unit is locked and visitors must ring a doorbell to enter. Teel controls who comes through the door. She also answers the phone, checks people in, and orders supplies for all the staffers on the unit. She didn’t know how the new unit support coordinators would manage all that with their extra responsibilities.

“I wonder who’s gonna check the cameras when people come to the door,” she said, “because if I’m a unit support coordinator, I may be in a meeting.”