Chapter 11: Growth in Education and Prevention
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Description
Dr. Mendelsohn outlines MD Anderson’s faculty-driven efforts to improve its educational programs and attract top students, noting that the institution has one of the top programs in radiation physics. MD Anderson recruits from its own programs to staff diagnostic laboratories. He sketches the histories of how the Health Sciences Center and MD Anderson were given degree-granting status, noting that MD Anderson is now in a position to have some of the world’s leading scientists. (He also comments on why it has taken MD Anderson so long to get to this stage.) Next, Dr. Mendelsohn talks about the institution’s cancer prevention initiatives inaugurated by Dr. Charles LeMaistre and implemented by Dr. Bernard Levin, who was head of the new prevention division. He evaluates why prevention was so slow to get started –and has been slow to evolve: the prime reason is that healthy people do not think to come to a cancer center for education or testing. What’s needed, Dr. Mendelsohn explains, is a prevention clinic such as the Mayo Clinic has, but he also points out features of that model that don’t work with MD Anderson’s culture. Dr. Mendelsohn points out that each area had the responsibility to create funds for its own growth.
Identifier
MendelsohnJ_02_20120928_C11
Publication Date
9-28-2012
City
Houston, Texas
Interview Session
John Mendelsohn, MD, Oral History Interview, September 28, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution The Administrator Professional Practice The Professional at Work Understanding the Institution Leadership Growth and/or Change MD Anderson Culture The Business of MD Anderson Institutional Processes Institutional Mission and Values
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 Ann Rosolowski, PhD:
Do you want to talk about education and prevention and finish out the 4 areas?
John Mendelsohn, MD:
Education is a complicated area, because we have no medical students. We have a graduate school program which is shared with the Health Science Center, and each of the chief academic leaders here has shared with me the idea that we want it to be better. It’s very good, but we want it to be better. We want to attract the top students. The main training programs involve the people that deliver medical care, so we have lots of fellows and residents who are learning the specialty of oncology. We have nurses learning the subspecialty areas, and people learning how to manage the x-ray equipment and deliver the radiotherapy and run the diagnostic laboratories. In the area of our clinical fellowships, we work very hard, supporting the people who run those fellowship programs. I know that in surgery, Dr. Pollack is very proud that they have 6 positions, and they only have to list 7 to fill the positions from the national lottery. They knew they’d get filled. We improved the teaching in all of our programs. When the word gets out that really bright people are coming, other bright people want to join them. We raised the standards in those programs, and we did it in many programs. We have one of the top programs in radiation physics in the country. We have one of the biggest physics groups in any academic center. I think it’s 80. They’re not all faculty but when you’re running 22 CT scanners, and all the radiotherapy and proton therapy equipment we have, you need a whole lot of engineers and physicists. Many of them are faculty members, and some of them are really strong professionals that are not on a tenure faculty track but are here because they love working on this kind of operation.
Tacey Ann Rosolowski, PhD:
What has been the effect of having raised the standards in an arena like radiation physics and having critical mass of people who are really, really into this particular area?
John Mendelsohn, MD:
As you’re growing, you advertise and you’ve got some good friends you can call for names to recruit. In parallel for example, we train students in how to run the kind of diagnostic tests that you need to run in the pathology department’s diagnostic lab, then each year, we hire the very best students. There’s a big shortage of these people. You’re training the people you need. And you’re also hiring some of your best fellows in medicine and surgery and radiation, so you’re creating a next generation.
Tacey Ann Rosolowski, PhD:
There was also the great milestone of the degree granting status that happened. Maybe you can talk a bit about that.
John Mendelsohn, MD:
MD Anderson started out giving degrees in 1970 or ’71. When they created the Health Science Center, the regents decided that the graduate school should be combined. We already had one. Dr. Clark was very generous. He said, “Well, they can give the degree, because they’re a complete medical school.” There is a lot of feeling here that they are excellent partners to have. But MD Anderson was carrying a disproportionate share of the reputation and the load; the majority of the teaching, the majority of the lab work were going on in our labs. If the degree came from both institutions, then that would help us attract the very best faculty and students. I went to the UT system and said, “We’d like to make it a joint degree.” Of course I was told this was very complicated and don’t waste your time on that. Everything’s fine. I was also told not to build anything on the other side of Holcombe Boulevard either, but we needed it. We went through all the hoops, and Dr. Tomasovic, who is under Dr. Kripke, had to produce 2 telephone books’ worth of documentation. We had to prove that we were good scientists in order to get certified. We did it, and I have in my office a copy of the 1st degree that has both signatures of the 2 presidents on it. When we do the ceremonies now, both presidents simultaneously award the degrees. I think it’s very important for MD Anderson to be a degree granting institution. We now completely join the field of academic medicine, not just in research, but also a degree granting education.
Tacey Ann Rosolowski, PhD:
The idea that MD Anderson has been a bit weak in the basic sciences area has always been a sticking point. To what degree has the degree granting status helped to change that, if at all?
John Mendelsohn, MD:
From the very beginning, we put a concerted effort in trying to take what was, I think, a very strong basic science program and make it into an outstanding basic science program. We succeeded more in building the clinical research program than in building that program. All of them grew. It’s interesting and good that our new president comes in, and after sizing things up, he has decided he really wants to make an even stronger effort to build up the basic science and bring in people that are of the caliber of the national academy and that can capture Howard Hughes Grants, and I applaud that. Now, we certainly set the groundwork for it, and we built on the groundwork that had been set by my predecessors. I think MD Anderson is ready to have more of the world’s leading scientists. I know Dr. DePinho has made that one of his goals, and that’s good.
Tacey Ann Rosolowski, PhD:
What do you think is the reason for MD Anderson being slow to come to that point, being ready?
John Mendelsohn, MD:
I’m the first laboratory scientist that has run MD Anderson. It was a confluence of issues involving personalities that I’d rather not get into and what was emphasized and where you could make rapid progress where in other areas you might make slower progress. It was also a matter of competition. Right next door was Baylor. Baylor’s science program was in the top 20 of any American academic medical center, and it still is. That kind of competition is now becoming more and more of an interesting collaboration and an asset. I think the collaboration and interaction with Baylor has been improving. It’s complicated because officially we’re tightly collaborating with the Health Science Center, which also has some very good scientists in it, but not, as a whole, of the caliber of Baylor. Here you have 3 institutions all within a 5-minute walking distance of each other. I think there were a lot of sociologic issues, a lot of internal issues in terms of what the leadership here was experienced in and good at and what was being emphasized. There’s a time for everything. I think right now the goal should be to maintain this incredible strength we have in translational and clinical research, which certainly expanded and helped rank us number 1 over the past 15 years, and add to it an equivalent strength in fundamental laboratory research, which would round things out.
Tacey Ann Rosolowski, PhD:
Let’s talk about that 4th area, prevention.
John Mendelsohn, MD:
My predecessor, Dr. LeMaistre, was very interested in prevention. He was on the original Surgeon General’s Report that said smoking can cause cancer, which was a very brave thing. He always wanted to bring prevention into our mission, which it wasn’t. He convinced Bernard Levin, who was a gastroenterologist, to become the head of a new prevention division. He had the ability to move some resources in that direction, and we built a prevention program, which became very strong academically and moderately effective in having an impact clinically. I think the main challenge, and it’s a very difficult challenge, is most people that come to MD Anderson as patients have a sign on them, “I’ve got cancer,” or “I’ve got pancreas cancer, or breast cancer.” The people who come to our prevention clinic are usually people that are well. They’re probably going to their family doctor, and ordinarily when they get sick, they go to Methodist or St. Luke’s or Hermann Memorial. People who are healthy usually want to avoid coming to a cancer center hospital and this is a challenge. We thought of putting up a prevention clinic out near the galleria, away from all of our patients with cancer. That’s still something we’re considering. If we’re going to have a major impact on prevention beyond researching it and learning how to do it, and impact the many of thousands of people that need to be screened in order to carry out prevention, we have to develop the model to do it. Frankly, there are so many things pulling on the resources we have that that has not moved into the top priority so far. We talked about having an executive program. People fly to the Mayo Clinic to get a complete workup. If you’re going to do the complete workup, you’ve got to have cardiology and diabetes covered with world-class experts, which the Mayo Clinic can do and Hopkins can do and many places can do. We’re not set up that way. Our world-class experts that we have high numbers of are in cancer; it gets complicated to ask somebody to come and do an executive workup just for cancer. At one time, we thought of setting up a joint program with Texas Heart. There are a lot of ways to carve this up. It needs some attention if we’re going to do it right. If we don’t do it right, we don’t want to do it.
Tacey Ann Rosolowski, PhD:
Were there some conversations with the Texas Heart Institution about that?
John Mendelsohn, MD:
Yes, there were. It didn’t rank high enough on the priority list. The amount of effort it would take and the impact it would have on what we’re already very good at wasn’t as strong. Wisely, people here are really focused on what we’re really good at. If you go to the airport, you can buy these books on how to be a great executive. One piece of advice came from Jack Welch: Be number 1 or 2 at something or don’t do it. Well, we didn’t articulate that, but I think that’s part of the feeling here. If we do it, we want to be number 1 or 2, but the setup of a major prevention screening program that would be 1 or 2 would be a very major undertaking.
Tacey Ann Rosolowski, PhD:
You mentioned the executive workup. Not only are they very elaborate processes that require an individual to go to a lot of specialists, but they’re also extremely costly. I assume that part of the thinking about MD Anderson beginning to offer this would be that it would be a real revenue generator and maybe get some real important people to come in. How was a model being thought of to kind of offer that kind of service, offer prevention for the community? What were those conversations?
John Mendelsohn, MD:
There’s an unnamed hospital in this city where if you’re a wealthy person, you go in and you’re in a luxury environment. We’re very proud here that all the patients are in the same environment. In 1 room might be the CEO of a Fortune 500 company and in the next room might be a gardener or someone in a small business. They have their white gowns on, and nobody knows the difference. They’re all getting the same standard of care. I don’t think there is a strong sentiment, on my part or anyone’s part, that a public university that reports through the regents to the state government should set up some boutique program for wealthy people to fly in from all over the world. If we’re going to set up a prevention program, it’s got to be for everybody, and that was the way most of us thought about it. Get rid of the traffic jams. Get rid of the waits. You should go to a prevention clinic, and to be able to have an appointment say, at 2:00. There are no emergencies, so you ought to be able to keep the appointment. If you go into one of our prevention clinics you’re seeing a prevention specialist, but often they’re also taking care of a sick breast cancer patient who suddenly comes in because she’s having seizures because it went to her brain. This prevention specialist is going to peel out of that clinic. We have ideas on having the prevention clinic staffed in a separate location, and specialists would say, “I’m not doing general cancer work that day. I’m just going to go to the prevention clinic.” There’s been a lot of thought on it.
Tacey Ann Rosolowski, PhD:
How do you want to tell the narrative of attacking these problems, these areas now?
John Mendelsohn, MD:
The attacking was done by 18,000 people. It wasn’t me attacking. The people that did the attack were the people that were on the front lines and were in charge of those areas. When you want to grow, you need a budget. In the clinical areas, we had a rule of thumb. If you want 10% more income and 10% more money to spend, figure out a way to bring in 10% more revenues. If you’re going to hire some scientists, you better hire some more clinicians, because the system is balanced and working now. We set targets for departments, the leadership did not set a target for each individual. The breast program wanted to grow 20%, and we said, “Okay. You want to grow 20% in clinical activities and research? You’ve got to see 20% more patients.” Remember, we talked about the balance. You can hire 1 person to see all the patients and another one to do research, or you can hire 2 people and each of them do half and half. We don’t care how you divide it up, as long as you produce the needed patient volumes, and that was the approach we took.
Tacey Ann Rosolowski, PhD:
What was the result to that demand for change?
John Mendelsohn, MD:
The clinical faculty doubled, and each area handled it differently. You’re going after people, and each person has different aspirations. Of course, they come in here and apply for a job: “Well, I want to do research, patient care, and teaching.” But you learn that some people really just love patient care, and they’re doing the research because they want to feel they’re contributing. There are some people that just love research, and patient care is a drag. I believe people are going to do their best if they’re doing the things that they fit with the best. We used the word fit in the last discussion often. My encouragement to the department chairs was get a fit with a group of people so you get your bases covered in the clinic and are doing the kind of clinical trials you want and have the research you want.
Tacey Ann Rosolowski, PhD:
I already knew from what you said that there’s not a micromanaging attitude. It’s just really let the individuals within each of their sphere of influence figure out what works best for them.
John Mendelsohn, MD:
Yes. I talked about how we approached resources. The limiting thing became space. You could have a great research plan, but if there’s no lab space open, you better not ask for the plan this year.
Tacey Ann Rosolowski, PhD:
Would you like to talk about space, or would you like to talk about capital campaigns next?
John Mendelsohn, MD:
Oh, I don’t like talking about space. That’s the hardest. We built a lot of buildings here. It takes 4 years to build a building. Until recently, every time we built a building that was supposed to have shell space in it that we could grow into, it was full by the time it opened. With our expansion of the hospital, we built enough space so that I hope it isn’t full until 2018 or 2020. That was the plan; we’d open 2 floors every couple of years. We haven’t achieved that in the clinics, because they’re crowded. We haven’t achieved that in the labs, which are really crowded. Space is always a challenge.
Recommended Citation
Mendelsohn, John MD and Rosolowski, Tacey A. PhD, "Chapter 11: Growth in Education and Prevention" (2012). Interview Chapters. 1427.
https://openworks.mdanderson.org/mchv_interviewchapters/1427
Conditions Governing Access
Open
