Chapter 07: Research and Administration at Baylor College of Medicine
Files
Description
In this chapter, Dr. Tweardy sketches the work he accomplished once he joined the Department of Medicine at Baylor College of Medicine (in 2006) and assumed roles as deputy chair, chair ad interim, and chair. He notes that at the University of Pittsburg he learned to love administration and sketches the reasons he found Baylor attractive: administrative opportunities, clinical practice, and research technology.
Next, Dr. Tweardy talks about developments in his research as he began to work on small molecule probes. He explains that he began to act on his desire to mentor the next generation of physician-scientists [via a K award]. He illustrates some leadership lessons with anecdotes and comments on the stressed financial climate at Baylor. He also describes his leadership style and proclivity for working with teams. He gives overview of what he gained working in administrative roles at Baylor College of Medicine and comparing the culture at Baylor to MD Anderson’s.
Identifier
TweardyDJ_02_20190320_C07
Publication Date
3-20-2019
City
Houston, Texas
Interview Session
David J. Tweardy, MD, Oral History Interview, March 20, 2019
Topics Covered
The Interview Subject's Story - The Researcher; Leadership; On Leadership; Mentoring; On Mentoring; The Researcher; Overview; Definitions, Explanations, Translations; Understanding Cancer, the History of Science, Cancer Research; Personal Background
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey. A. Rosolowski, PhD:
So why the move to Baylor?
David Tweardy, MD:
Ah, so—
Tacey. A. Rosolowski, PhD:
I mean, unless—did you have other things you wanted to say about—?
David Tweardy, MD:
No, no, that’s a nice summary of how I got to Baylor, and what was happening right before I moved. Well, it turns out I’m a person who, even though I seem to think I’m focused, there are certain things I couldn’t jettison, one of which is clinical medicine. So I maintained my expertise in infectious diseases, and I was effective as a physician, as well as an administrator, and I kind of liked administration, as well as researching clinical care. And so (laughter) I couldn’t make a decision. And so I moved up to the interim Chief of Infectious Disease at Pittsburgh towards the end of my tenure there.
Tacey. A. Rosolowski, PhD:
I have ’97 to ’99 there.
David Tweardy, MD:
Yeah, exactly. And part of it was I was able to do that without really—and maintain laboratory work—I still worked in the lab.
Tacey. A. Rosolowski, PhD:
What was it that you liked about administration?
David Tweardy, MD:
I just liked—I liked allowing people the opportunity to have the early career I did. I mean, I liked—the thing that most excited me about administration was it gave me the opportunity to mentor physician-scientists, and also to mentor even midcareer faculty on the clinical side. Because I think once—(laughs) it’s sort of the curse of the chief medical resident. Once you’re a chief medical resident, it seems, you never can get away from clinical medicine, because what it told you back when you just said yes to being a chief medical resident is that you really like to oversee care of patients. It doesn’t matter if it’s you doing it or other younger, next generation. You just like to make certain that that works and the patient gets what they need out of that interaction. So I think that’s probably—it was my chief—I’ve now clearly labeled my chief medical residency as the job that I took that made the difference about my career in terms of—it sort of tagged me as an administrator, to some degree, for the rest of my life. (laughs)
Tacey. A. Rosolowski, PhD:
And was there anything about serving in that administrative role in a new cancer center? How did that affect the experience?
David Tweardy, MD:
Well, actually, it’s interesting: I was a bit schizophrenic, because it wasn’t within—the Pittsburgh Cancer Institute is not like MD Anderson. In fact, at the time I went there, the great fame of the University of Pittsburgh Medical Center … The most famous individual in Pittsburgh, arguably—yeah, I would say maybe besides Mario Lemieux, who played hockey and won a Stanley Cup for the Pittsburgh Penguins-- was Tom Starzl. And Tom Starzl headed the liver transplant group, and up until 1992 the University of Pittsburgh Medical Center transplanted more livers than the rest of the world combined. It was the mecca of the liver transplant. So the Pittsburgh Cancer Institute was growing in influence, but at that time the major player, if you will, the 96-pound gorilla, clinically, in campus was the liver transplant program. So the reason I say all that is that it’s not like MD Anderson; UPMC was not uniformly and monolithically interested in cancer care. It was interested in growing cancer care, but it had very well-established cardiovascular and lung and liver transplants, as well as just general other great head and neck program. Jeff Myers did his residency there. That’s where I got to know Jeff. It had a phenomenal ENT surgery program, it turns out. And so as I was an infectious disease physician, I saw cancer patients, but my chief of infectious disease was across all of the disciplines that needed infectious disease care, not just cancer patients but transplant patients and other patients with heart disease who develop pneumonia, etc. So I took on that Chief of ID role at interim. And, again, as I say, because I did find administrative roles fulfilling. And so the answer, getting back to why did you go to Baylor, I was offered the permanent job at Baylor, and it was an ideal opportunity because the technology that was available at Baylor was mouse knockout technology, okay. So I thought I really wanted to see how STAT3 functioned, and my genetic probes were not well-developed enough, but I wanted to come to a place where I could knock out STAT3 and answer the question using mouse knockouts. And Baylor was at that time the premier institution in the country to do knockout technology. And also do my clinical work in infectious disease, as well as administer the department—or the section, I should say—of infectious diseases. It was one of those fortuitous opportunities that it had a huge impact on my life. Coming to Houston was the best thing I ever did, in terms of city-to-city transfer. Yeah.
Tacey. A. Rosolowski, PhD:
Well, tell me about that. What happened once you got here?
David Tweardy, MD:
So once I got there I was able to establish my lab, and continue the progress on genetically modifying STAT3, but, more importantly, developing these small-molecule probes that I became committed to, even with my last year or two at Pittsburgh. And probably the most impactful—and then, basically, continued to train—in fact, it was really at Baylor that this sort of desire to train the next generation of physician-scientists kind of fully bore fruit, because I was able to write a training grant that brought ID fellows interested in the physician-scientist track, gave them funding for a couple of years, mentored them to write K Awards, which is the first career award most people get. I actually believe I was awarded the first K Award during its first cycle it was ever offered, at NIH, and so I became very attached to that way of transition to independence for physician-scientists. So we had a T32 grant, we had the ability to get aspiring physician-scientists K Awards, which we ended up --because of circumstances-- of all the sections of internal medicine at Baylor College of Medicine, we had 11 successful K Award grants over the time I was there, roughly one a year. Basically nobody else had anything close to that kind of record. And that was because of my commitment to that. And so it was a great experience, in terms of mentoring, but mentoring in a way that actually was impactful, because it got people started in their academic careers, with money that they could cover their salary with, which is the hardest part of going in a physician career track, is how do I pay my salary if I’m not seeing patients? So this allowed them to do that. And so the administrative role allowed me to mentor. And also the faculty at Baylor were phenomenal. I just loved them. I mean, we had four different venues where we had—five venues, four to five venues. We had the Thomas Street Clinic, the VA, Ben Taub, and actually—and at one point Houston Methodist then became St. Luke’s. So those four venues, where each of them had their own service line chief, if you will, and each one of those was superb at their jobs. So I could administer with a light hand, and continue the research. It was—and, in fact, it was (laughs) perhaps, the reason I came here, because I saw when I came—if I were to come here, and if I was fortunate enough to be offered the job as Head of the Division of Internal Medicine, the situation was similar. There were strong chairs, and they were fully empowered and resourced, and what I had to make certain is that they just didn’t get in each other’s way.
Tacey. A. Rosolowski, PhD:
So I was going to ask you how you would describe your leadership style, and—
David Tweardy, MD:
Yep, it’s—you can tell it’s pretty much—I won’t say laissez-faire, because there are aspects of the way some of the departments were oriented and that needed direction to align with the current vision, the new vision of the institution, both Ron’s [Ronald DePinho; oral history interview] vision and now Peter’s [Peter Pisters] vision. But it’s one of the things about being an administrator: if you do it enough times, you can get it right. Yeah, I was an interim chair, or I was an interim section chief or chair five times, it turns out, and every time—at least, this is my assessment—every time I did it, I did a better job of it. And I think the reason I ended with my style, almost a style statement of how I administrate, is—the thing that’s absolutely spectacular about medicine is the quality of the people that get into it. It’s just—it’s unlike any place or any other business that I know of. And I’m now getting a little bit of the pharmaceutical field, and my brothers have been in engineering and finance and teaching. I mean, teaching may be similar in some respects, but when you get into a service-oriented field, it just recruits or attracts a certain type of person who is not a cat. It’s not like herding cats so much. And so one of the things you realize is you just have to—you don’t want to over-manage. You want to undermanage, because the quality and the motivation and the intelligence—and often the emotional intelligence, not just intellectual but the emotional intelligence—is there, and you just have to tweak it. You don’t have to come in and just wreck it. It’s not like the Marines. You don’t have to tear down that individual and rebuild them in the mold of a Marine. That’s completely inappropriate. So I’ve always—and it took me a while to learn that, I think, because I think, especially if you’re a lab director, it’s kind of a—it’s a different—it’s the end. It’s not that you’re working with—not working with very smart people, but you’re really driven to get this done, and—
Tacey. A. Rosolowski, PhD:
What were some scenarios that you had a-ha moments? I mean, do you have some particular anecdotes or scenes?
David Tweardy, MD:
Well, I would say, in terms of that, the revelations—
Tacey. A. Rosolowski, PhD:
Yeah, the learning curve.
David Tweardy, MD:
You know, I would say certainly in terms of … There were a-ha experiences, meaning when I came to Cardiology, for instance, my last role as the interim Chair—and maybe the very last; I don’t know, we’ll see, but I’ll probably attempt to do something else. I just can’t help but think that, since I’ve done it five times. I’m a serial interim. (laughs)
Tacey. A. Rosolowski, PhD:
Yeah. Well, some people specialize in it.
David Tweardy, MD:
Yeah, and maybe (laughs) I’m viewed as that. But anyway, I won’t make any more comments around that. But I guess the thing, the a-ha moment I had being the interim Chair of Cardiology was I looked—I assessed that department from the perspective of is anything really broken here, or do the individual faculty just need to be enabled to achieve their fullest potential? And the dynamic of that department, prior to my taking over, I knew reasonably well because I met with the Chair of Cardiology every month, and he had a style of leadership that was —he kind of kept the lid on too tight. His level of oversight was a little bit, maybe, misplaced, and he wasn’t enabling his faculty as much. And I think in the bottom line is he had a very high standard, and he was a laboratory researcher, and expected himself to publish in the highest-impact journals, and he somehow thought that his faculty should be able to achieve that same level of success. And I looked at that and went, there’s no way on Earth that those faculty who are 80% clinical can achieve that kind of success. And so it’s just a realization that you have to manage expectations. You can’t expect it. So I went in and said, “Hey, you guys are really”—gals; (laughs) there was one woman in the Department of Cardiology at that time. I said, “you need to tell me about what you do, what you like to do, and what you want to do, and I’ll make it happen. I’ll allow it.” Not make it happen, but, “I will provide what resources and facility and time and effort that I can, and resources to allow that to happen.” So it was just—we provided a clinical nurse to help with the clinical protocols. We reintroduced one of our faculty, who had been kind of ostracized, Michael Ewer [oral history interview], probably one of the more productive writers in that department, in terms of clinical oncology, into the fold, and he very generously volunteered to kind of help with writing. And we just—and, frankly, then they just—it was almost like they were sort of kept in the cave for a few years, and they came out of the cave, and they realized the sun was shining, the grass was growing, the flowers were blooming, and they just took off. This last year, they probably published four times more papers in the last year than they did when I first took over.
Tacey. A. Rosolowski, PhD:
Wow.
David Tweardy, MD:
It was just—they just blew the place up. And so it was not a single epiphany; it was just more of an assessment of what this group needed, and it really wasn’t a heavy hand. It wasn’t really a whole lot of oversight. It was just allowing them to reach their potential by giving them a little bit more resources than they had had, and they just took off. So I—
Tacey. A. Rosolowski, PhD:
Sometimes it is trusting people, too. I mean—
David Tweardy, MD:
Oh, yeah, I had no reason not to. I mean—
Tacey. A. Rosolowski, PhD:
Right, and trusting in the sense that I trust you know what you have to do, and thus I trust you have it in you.
David Tweardy, MD:
Yes, that’s right. That’s right. You are self-directed, and you know your capabilities. Your self-assessment is on target, with maybe one or two exceptions, as always. And they just had a fantastic last two years. And the first year, they were just grateful to have free rein to do what they thought they could do, and they’re really looking for—we’re getting close to a permanent chair now, and—
Tacey. A. Rosolowski, PhD:
That’s cool.
David Tweardy, MD:
Yeah, and I’m just delighted with that experience.
Tacey. A. Rosolowski, PhD:
When did you start in that interim role?
David Tweardy, MD:
It was September two thousand and—so, ’18, ’17. So I’m finishing up my second year now.
Tacey. A. Rosolowski, PhD:
Okay, cool. Well, were there more things that you wanted to say about Baylor? Because we’ve already started talking about MD Anderson, and I want to make sure we didn’t give that short shrift.
David Tweardy, MD:
No, I think I will owe a lifetime debt of gratitude to them, because their science was fabulous. I was able to get the scientific collaborations that I needed to move this project, the molecular probe, the small chemical molecular probes forward, and get the funding I needed. I learned to write grants in Pittsburgh, and I further honed that skill at Baylor. You may not have heard this, but for every percent effort that you have at the lab at Baylor that’s not clinical, you have to earn—you have to get that money, 100%.
Tacey. A. Rosolowski, PhD:
Hundred percent. Wow, yeah.
David Tweardy, MD:
Yeah, yeah, and that’s the way it was at Pittsburgh, so I’ve been—(laughs) So when I came to MD Anderson, I mean, I left three grants that I was coinvestigator on at Baylor, because I just didn’t need them. That took me up to 80% funded, and I just—I came here, I had to be—I ended up coming here, I think, with like 50% outside support, but I didn’t even need that, so … But that’s the different culture here. But the timing was perfect, because the things that I had—the small molecule probes that I had developed were getting ready to go into patients, and so—or getting close, and we were able to kind of use the expertise and resources here to kind of further that effort, write grants that we had MD Anderson as our base so that they had additional credibility and weight in study sections. And so it was—I mean, the Baylor experience was really an experience administratively in doing more with less, and really—and actually, the analogy, the overwhelming, overarching analogy I use at Baylor was—it was a tough place; as you probably know, it was increasingly resource-challenged, and how you maintain morale, esprit de corps, and success in that environment is kind of like a bit of an oasis—how do you create an oasis in a desert, or a calm island in this sea of turbulence? And we managed to do that. I had a—developed a—over the course of the early years there, I established principles that were able to tide us through essentially the rest of my career there, which were lean and somewhat turbulent.
Tacey. A. Rosolowski, PhD:
What were some of the strategies you used?
David Tweardy, MD:
I think empowering the individual service line chairs, and because they were on the ground they knew the facts, making certain those people were competent. I mean, that is, they were capable. They had high emotional as well as intellectual intelligence. And part of that is luck. In the case of the VA, the individual I replaced became service line chief there. He was already service line chief. He was the chief of the academic division. I replaced him at the VA as the—not at the VA but at the mothership at Baylor. He, when he returned to being service chief at VA, was very effective. I mean, I had to tweak him a bit, and he was malleable, and that was the good thing. So he helped, for instance, to help recruit junior faculty using VA resources, because the only institution, frankly, in the Baylor system now that has resources, ironically, is the VA, for faculty development. So he was willing to allow that to happen. The first fellow who started with—when I came to Baylor in 1999, one of the two fellows, they were phenomenal. They moved on. They were the basis for my successful T32 because of their academic success. Tom Giordano, who’s the wife—or the husband, I should say—of Sharon Giordano here, became the Medical Director at Thomas Street Clinic, and has had enormous success both in clinical care of patients, as well as mentoring faculty. Barbara Trautner, who was the other fellow with Tom, was very successful in her own right, and actually is mentoring faculty in the Department of Surgery. She has a joint appointment in Medicine and Surgery, and she’s gone on to great success. But Tom, in particular, along the lines of mentor, or of service line chiefs, Tom, Dan at the VA—Dan Musher—Laila Woc-Colburn, who—and this is—she’s a hyphenated name; it’s Laila, and the first part of her hyphenated last name is Woc, W-O-C, dash Colburn, C-O-L-B-U-R-N—was one of the most—probably the single most successful recruit outside the institution I ever made. She came from Case Western, where I had actually done my ID fellowship, as you know, and she was like a guided missile: all you had to do was point her in the direction. We brought her in, actually, to open a second service line at the Ben Taub solely dedicated to HIV patients, because they were just—their falloff was atrocious, and they would just come back again with the same or different severe opportunistic infection, so we knew that they were not transitioning to Thomas Street. And so we set up a service just to transition them, to care for them in the inpatient setting and then effectively transition them to Thomas Street to reduce their recurrent admissions to the Ben Taub and just get them into care, which by that time was having tremendous impact, as you know. And she was [fabulous?], and we moved her over, actually, to the faculty group practice, which is really the one moneymaking operation within our Division of Infectious Diseases, and she just networked like a champ, and just became the major referral for ID patients in the private practice group. And so as Laila Woc-Colburn is the third service-aligned boss. And then Bob Atmar at Ben Taub, longstanding Baylor and Ben Taub physician, did a fabulous job. So I really just told him—here’s what I did: I said, “You’re doing a great job. Keep doing the great job.” And pretty much that was pretty much my recipe for success. And I resourced them as best I could, but I also just shared with them the situation. I mean, there were just limited resources. So I think it was a great team. We were just all—I think we were all working together. It’s interesting that group historically had factions, because of just the history, and so I came as somewhat of a unifier. I didn’t realize that immediately, but I learned that relatively quickly, is that my presence as the Academic Chief of Infectious Diseases really brought together these four venues in a way they’d never been brought together, and it empowered them to do … I basically resourced them as best I could, and they knew that I wasn’t holding back. And so all of this turbulence and sort of leanness was around us. We were able to recruit faculty. Actually, I came in, there were 28 faculty, or 25 faculty when I started, and I left with 28. I’d replaced every member of the faculty except Dan, who, as I say, preceded me, and Bob Atmar. Everybody else basically had been replaced. So being able to just continue with the churn, retirements and people moving on to other maybe in their mind greener pastures, we were able to bring in really strong people. And that’s hard to do in a not fully-resourced environment. So I think, again, it was just empowering the people, being transparent, giving them what I could, and then asking them to make good, or make do, and it worked. And so you can imagine when I came to MD Anderson in 2014 it was like, holy mackerel, you’ve got to be kidding me. This is— And my first reaction, if you want to know, is you guys should be, like, kissing the ground you walk on here. I mean, this is unreal. It’s just unreal. And to hear people complain here, talk about triggers. I had to kind of bite my tongue. And Steve Hahn knows this. Steve Hahn and I—he came about a month after me. Every time we’d be in a division head meeting and a comment would be made about lack of resources or something, we’d just look at each other and take a deep breath. But, so—
Recommended Citation
Tweardy, David J. MD and Rosolowski, Tacey A. PhD, "Chapter 07: Research and Administration at Baylor College of Medicine" (2019). Interview Chapters. 1389.
https://openworks.mdanderson.org/mchv_interviewchapters/1389
Conditions Governing Access
Open
