Chapter 13: From Provost to Physician in Chief

Chapter 13: From Provost to Physician in Chief

Files

Loading...

Media is loading
 

Description

Dr. Buchholz begins this chapter by observing that the role of provost gave him an entirely new perspective on the institution. He talks about role of the provost and why he considered staying in the position long-term, though the Division wanted to see him return as leader. He talks about the selection of Ethan Dmitrovsky, MD for the Provost's role, then being offered to position of Physician in Chief, a better fit for his background, in his view. Dr. Buchholz then talks about stepping into the Physician in Chief role, which he had considered not taking (2014 � 2017). He notes that he ""jumped back in to the firestorm"" of controversy surrounding Dr. DePinho and the Executive Committee. He also notes that he ""underappreciated the job,"" noting that the Physician in Chief has responsibility for 80% of a 4 billion dollar budget. Taking the role, however, Dr. Buchholz said he felt empowered to make changes in the clinical environment and he lists what problems needed to be addressed. He concludes that he is very proud of what was accomplished and notes that MD Anderson offered a ""most unique place"" to effect management over a system of clinical care.

Identifier

BuchholzT_02_20180131_C13

Publication Date

1-31-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; Character, Values, Beliefs, Talents; Professional Path; The Administrator; Building/Transforming the Institution; Institutional Politics; Controversy; Evolution of Career; Professional Practice; On the Nature of Institutions; Understanding the Institution

Transcript

Thomas Buchholz, MD:

So the provost, for me, was—again, talk about learning a new perspective on the institution. It was a great learning experience. It was stressful. It was fast-moving. I mean, when I walked in that first day with Maureen Cagley, we had decisions piled up to make. Should we transfer this grant to Dartmouth where the faculty member moved? Well, now we have this department chair in here screaming at me that, no, we can’t release that grant. What do I know about this? (laughter) Oh, this person’s being arrested, and here’s the whole backstory, and it’s like, whoa, this person has fabricated science, and how are we going to...? Wow. Well, this person needs lab space, but we don’t have any lab space, and now Ron wants to recruit another Nobel Laureate, and now we’re going to have to kick six people out of their lab space, and whoa, you know? So it was an amazing firehose of information, all of which needed to be done quickly, that had built up. And when Ron first offered me the job, I didn’t know if he meant like a provost. That’s how he said it. He didn’t say, “I want you to do this for a couple months.” He said, “Tom, I want you to be Provost of MD Anderson.” It wasn’t until I went over to Tom Burke’s house that he said, “Oh, Tom, you’re never going to be Provost of MD Anderson. He just wants you to do this. He’s going to appoint a National Academy member, of course.” And appropriately so. If you’re going to have another National Academy member, provost is the position, and my expertise is not in laboratory sciences. And so then when we went around with this search process, there was like, well, who’s going to be the next provost? And all sorts of names were flying. And as we had gone through that month, I think Ron decided initially there’s not going to be an internal candidate for provost. And then after about six months or so, he called me in his office and he said, “Tom, I’m really liking the job you’re doing. Would you be an internal candidate for the provost job?” And I said, “Sure.” So then I interviewed, and there was a search committee, and I think Tom Burke was on the search committee. Leon Leach was on the search committee. Various department chairs were on the search committee. Almost universally everyone came and said, “Oh, we told Ron we want you to be provost. We told Ron we want you to be provost.” And so I ended up being a final candidate. Ethan [Dmitrovsky; oral history interview] and I were the two final candidates. And I was like, oh my gosh, this is kind of strange. And then Ron didn’t decide, and it just went on and on. And he invited me back, and we go out to dinner or something. He’d ask me all these probing questions of “What is the most important thing in science in seven years from now?” And I’d be like, “Oh, Ron, stop.” (laughter) I said, “I’m not even going to answer that question.” But it was fun. And I didn’t really care that much. I saw the huge negative consequences. I saw the fun, too. I was still the Division Head of Radiation Oncology. My division was screaming for me not to be the provost.

Tacey Ann Rosolowski, PhD:

Why?

Thomas Buchholz, MD:

They wanted me back as their leader. When I was gone, kind of the interim fill-in type of thing wasn’t working the same way it had been. People were kind of unhappy. People were really wanting me to be the division leader. People would come up to me and say, “Don’t do that.” And then I said, “Well, I have to explore this.” And then...

Tacey Ann Rosolowski, PhD:

What was the reason you felt you had to explore the provost role?

Thomas Buchholz, MD:

I don’t know. I think that’s how I led my career. I always say yes. Someone says, “Do you want to do this?” I say, “Yes.” I mean, it is a more impactful role. I thought, if Ron’s going to be the president, he needs someone like me to... He doesn’t need another National Academy member. We don’t need another person that’s just going to create... They need someone that the rest of the institution... He’s recruited 20 people. There’s 19,080 people who are feeling disconnected, and they need that, right?

Tacey Ann Rosolowski, PhD:

They need somebody familiar, somebody who represents their values, yeah.

Thomas Buchholz, MD:

Yeah. So in the end, I was at an NCI meeting, and Ron called me and said, “Oh, I’ve decided to pick Ethan.” And I was like, “Ah.” [Again?], it was a devastating day in my life. I just kind of moved on. And I met Ethan, and I wanted to help Ethan, and I said, “Ethan, this is a very complex job.” And so I worked with Ethan for about three or four weeks, and we had a really good relationship. And I said, “You’re the Provost now. I’ll help you get acclimated.” And I think people saw that, too, and it’s like, wow, this isn’t... There wasn’t any bitterness. I came back to Radiation Oncology. They were so happy. (laughter) They were just so happy that I’m not provost. Yay! Oh, it’s going to be great. Coming back, though, it is different, you know?

Tacey Ann Rosolowski, PhD:

How so?

Thomas Buchholz, MD:

It’s different because, again, you’ve seen the landscape over here, and you’re involved in decisions like this, and it takes a little while to reacclimate, to say, well, now I’m just... I’m not worried about the IACS anymore. I’m not worried about the Moon Shots program. You had such a focus on these institutional things, and then they’re kind of gone.

Tacey Ann Rosolowski, PhD:

Was it sort of... Was that a negative? Was it kind of a sadness in letting it go?

Thomas Buchholz, MD:

Well, it was just different. But so what happened pretty quickly was Ron, through a consultant, kind of approached me about being Physician-in-Chief. And that was—for me, I feel like that’s a better fit in terms of the two faculty EVP roles, because I’m not a lab-based scientist. I’m a clinical scientist, and clinician, and clinical care giver. And so he kind of tried to woo me into being... He said, “You’ve just undergone a national search, right? You’ve been vetted by our community. I’ve only heard really positive things. I could just appoint you to be Physician-in-Chief.” And I think that started in September, and probably I accepted it in November, and January 1st I became Physician-in-Chief. I didn’t—

Tacey Ann Rosolowski, PhD:

This is 2014, and you became Physician in Chief in 2015, January 2015. Yeah.

Thomas Buchholz, MD:

If that’s what my résumé says. (laughs)

Tacey Ann Rosolowski, PhD:

Yeah, it’s on your résumé. I’m just saying it for the record, so... (laughs)

Thomas Buchholz, MD:

And so then it was a different type of transition. At first, I wasn’t sure I wanted to do it.

Tacey Ann Rosolowski, PhD:

Really?

Thomas Buchholz, MD:

That one I didn’t say yes to over the weekend. I...

Tacey Ann Rosolowski, PhD:

So what was that about?

Thomas Buchholz, MD:

Just because I knew that... I was in the midst of this institutional chaos, and suddenly I stepped out of it again, right? And I also recognized that this institutional chaos wasn’t going to be something simply I could turn around by telling everybody, “Oh, hey, I’m here now, trust me. It’s all okay. Your perceptions, you don’t have to...” Even if I felt as if some of these things, they weren’t validated, you don’t have to worry about that, you don’t have to worry about your research, it wasn’t going to work that I could just make it all better. This was going to continue, and it was going to... And then do you want to be a part of that, or not?

Tacey Ann Rosolowski, PhD:

Well, I was going to ask you that. I mean, did you feel that there were certain people who began to see you differently because you worked so closely with Dr. DePinho?

Thomas Buchholz, MD:

Oh, sure. Oh, definitely. Look what happened to me. (laughs) This is a good story, for sure. And it did. I mean, and it continues to, right? For sure.

Tacey Ann Rosolowski, PhD:

Well, tell me about that journey.

Thomas Buchholz, MD:

And it was portrayed that way, just by... You didn’t have to do anything. You just had to accept the job as provost, and within a day people said, “We’ve written you off. We don’t trust you. You’re no longer a faculty member.” I was told, “You’re not a faculty member anymore. You’re an administrator, and we hate administrators, and you’re an administrator, and we hate you.” You crossed the line, right? You walked over the picket line or something, and...

Tacey Ann Rosolowski, PhD:

You walked to the dark side, yeah.

Thomas Buchholz, MD:

Yeah. And yeah, Tom used to be a good guy on Friday, but on Monday, he’s not. Now we’re going to have to view him as part of the problem, rather than part of the solution.

Tacey Ann Rosolowski, PhD:

I mean, it’s interesting that they didn’t—because certainly another perspective would be, oh, here’s a person who we know. We’ve known him for years. We’ve worked with him for years. We really do trust him. He would bring a positive influence to this scenario. Interesting they didn’t say that.

Thomas Buchholz, MD:

Oh, yeah. Well, they did, too, right.

Tacey Ann Rosolowski, PhD:

They did that, too. Good. Good. (laughs)

Thomas Buchholz, MD:

Yeah. So it wasn’t all one or none. It’s just probably the people who thought that are less apt to jump in in a very positive thing when there’s chaos going around, right?

Tacey Ann Rosolowski, PhD:

Yeah, and somehow naysayers are very vocal people.

Thomas Buchholz, MD:

Naysayers are (laughs) very vocal people. And there was an agenda, even at that time, I think, to have Dr. DePinho removed. And they weren’t looking for solutions that would make it okay. And so it was a challenging thing. And I wasn’t naïve to that, right? I had lived that for a window of time, and I had my own credibility, and my reputation, and now I think it was recoverable, because it was a short period of time, and I did the best that I could, and they might think of me as, well, obviously, Tom, you’d never be the final provost because you’re not that type, and, okay, we’re going to let you back into our community. (laughter) So it was challenging. But then I jumped back in, and I jumped back in as Physician-in-Chief. And I thought I knew physician-in-chief, because a physician-in-chief and provost work very closely together, because we co-managed the faculty. That’s a big job. I had been managing our clinical care enterprise here as division head. I kind of felt like I knew that, but the scope of our clinical enterprise at MD Anderson is daunting. So I underappreciate how big a scope the Physician-in-Chief job was, particularly under Ron’s leadership. This wasn’t where he had a lot of experience himself. So he wanted someone that he could really count on to do it. And we were implementing Epic, right? We were on our three-year journey. Are we still going to be US News number one? What’s this whole healthcare reform issue? What’s value-based reimbursement? How is healthcare going to change our clinical environment? I’m suddenly responsible for 80% of a $4 billion budget, in terms of revenues. It’s like, wow, there’s still a lot for me to learn. (laughter) So I quickly realized, number one, I had to step down as Division Head of Radiation Oncology. I think that was a given. And that came with a lot of sadness, and challenging for our group here, which, again, I had a great degree of loyalty to. But it was fun. And I felt as if I was empowered as Physician-in-Chief to really tackle some of the things that we didn’t do well in the clinical environment that everybody knew about. I’d worked here. If anybody ever had cancer, I would say, “We give the best cancer care. We have the best outcomes. We have surgeons who work closely with radiation and medical oncologists. We have our best pathologists. The talent of our people is par none, and the integration by which they are colleagues and work together, truly outstanding. But being a patient here can really suck, right? You could... It’s impossible to get an appointment. So many people call and want to come to MD Anderson, and they can’t get in. The systems are broken, the operational systems. You could sit in that waiting room, in chemotherapy, for eight hours before they give you a transfusion.”

Tacey Ann Rosolowski, PhD:

Really?

Thomas Buchholz, MD:

The whole patient experience of being a patient here can be great, because everybody’s passionate and caring. It can be a nightmare, too, right? People just wait and wait, and you’re lucky you got in here. And even the whole focus was we were research-driven patient care. So sometimes people would say, “Oh, we don’t want to see patients unless they’re eligible for a protocol. We got too many patients.” And then people would say, “Oh, thank God I got to see you. I’ve waited for four weeks. My tumor’s growing, but I wanted to come to MD Anderson.” “You’re lucky you got in here, yeah, because we’re...” It’s not overly patient-centric. So I want to change that culture. I thought that was my calling. We’re going to become patient-centered, value-driven care. And we did it right in the same time we were having a framework of our strategic plan. Remember that? And that gave me kind of an organizational structure by which to build a team. We lost—our Senior Vice President of Operations quit before I started.

Tacey Ann Rosolowski, PhD:

And who was that? Remind me?

Thomas Buchholz, MD:

Gerald Coleman. He worked with Tom Burke.

Tacey Ann Rosolowski, PhD:

Yeah, I know—

Thomas Buchholz, MD:

And I know Gerald quite well. He’s a good guy. But it also gave me the opportunity to create my own team. I felt like there wasn’t sufficient administrative faculty partnering in coming up with these clinical solutions, that it was kind of... Memos would come out on Friday that sometimes as Division Heads you weren’t even aware of, and, like, hmm, what do you mean? And so I tried to create a system where we had more dyads of faculty, and so I created executive medical directors to work with executive administrative directors. We created an access program. We created a patient experience program. We highlighted quality and safety. We implemented... I’m really proud of what we’ve done. In the end, when you write it all down in a résumé or something, wow, we’ve made transformative changes at a time when our institution really needed to do that. And it was fun. I think after a year’s search, I brought in Bob Brigham. Bob literally, I think, is the best hospital administrative person in the country. His talent in that space is incredible, and his leadership ability, to... If you want to interview a good leader, go fly up to Duluth, Minnesota and interview Bob, because he really knows how to implement these leadership trainings in a real logistical way, and he knows how to run a hospital, and he knows how to run a clinic, and he knows how to build a team, and he knows how to get engagement. He could relate to faculty’s perspective without alienating them, and he could relate... He was a really tough person. I was a philosophy major. I studied medicine for four years. I’d studied radiation oncology for five years. Then I learned how to practice cancer, and I learned how to do research, and I learned this, and... I had never once studied how do you run a 660-bed hospital. Right? How do you purchase drugs. How do you do... How do you run a blood bank, right? What does it take to be a high-quality inpatient care for a bone marrow transplant? I don’t know, you know? (laughs) I mean, what kind of training did I have to be the person in charge of MD Anderson’s massive clinical enterprise? It’s kind of intimidating when you think about that. But, again, I felt completely competent in that, because of the people you surround yourself with. And then the leadership... MD Anderson is definitely a faculty leadership place, so they need to have that faculty leadership voice leading that. So that was actually fun for a while. It was, again, challenging: hard decisions, unpopular decisions. We tried to move towards a system-based approach to clinical care.

Tacey Ann Rosolowski, PhD:

And what does that mean?

Thomas Buchholz, MD:

It means if you are a patient in the GI Center and a patient in the Breast Center, you should have the same experience, and we should have some sort of equal consistency to—if you’re called MD Anderson, that we should have courtesy, and patient-first type of... We should care about how long you wait in the clinic. We should develop systems that aren’t always faculty-first, but are patient-first. But I think it also means if we’re going to be successful we’ve got to take out the cost structure of our organization to become leaner. If we have each department have their own IT department, it’s less efficient than if you have a central IT department. If you have each department have a scientific editor who’s there to help you whenever you wanted to write something, it’s probably less efficient than having a department of scientific publications. By centralizing things, even in the Breast Center, you say, “Do you really need the same...? Can somebody handle the Breast and the GYN Center in terms of some administrative function, that we could share some of these resources?” People like to build their own domain. As a department chair, I wanted to have all that stuff. “This is my stuff. I want to have my own IT department, because then I could manage it.” You don’t want to give up. But lean healthcare organizations have to look at it from the systems standpoint, and manage... This is the most unique place where you could actually effectively manage as a system. If you go to Duke, you probably have a dean of medical school over here and then a hospital CEO over here, and the two are trying to marriage, and the faculty are caught in the middle. Here, we’re all one entity. We have one budget. We don’t have private practitioners who have a different agenda. Our academics and clinical are intertwined. It’s an ideal system to be really effective at doing this, because we have a reporting structure that works to do it that way.

Tacey Ann Rosolowski, PhD:

I know that we’re almost at noon, and you have another commitment. Would you like to stop for today and make another appointment?

Thomas Buchholz, MD:

Yeah, sure. (laughter)

Tacey Ann Rosolowski, PhD:

I know.

Thomas Buchholz, MD:

We’re getting near the end, I guess.

Tacey Ann Rosolowski, PhD:

We are, I guess, yeah. No, I really appreciate this conversation. It’s just really interesting insights into the organization, and, yeah, it’s going to be... I appreciate your time.

Thomas Buchholz, MD:

Sure.

Tacey Ann Rosolowski, PhD:

All right. Well, let me just say I’m turning off the recorder at—what time is it? Probably about five of, ten of noon, or...?

Thomas Buchholz, MD:

Yeah, 12 of.

Tacey Ann Rosolowski, PhD:

Twelve of, all right. Thanks very much.

Thomas Buchholz, MD:

Okay.

Thomas Buchholz, MD:

Interview Session Three: March 8, 2018 Chapter 00C Interview Identifier

Tacey Ann Rosolowski, PhD:

And we are recording, and it’s about three minutes after 10:00, and I’m at the home of Dr. Thomas Buchholz for our third session together. Today is March 8th, 2018, and, for the record, I’m Tacey Ann Rosolowski. And thank you so much.

Thomas Buchholz, MD:

You’re welcome.

Tacey Ann Rosolowski, PhD:

You retired on the 28th of February.

Thomas Buchholz, MD:

I did, yeah, after a twenty-and-a-half-year career.

Tacey Ann Rosolowski, PhD:

Yes, though it’s not going to be true golfing and eating bonbons, right? (laughs)

Thomas Buchholz, MD:

Well, that’s true. Yeah, on April 16th I start my new job.

Tacey Ann Rosolowski, PhD:

Oh, it is, okay. April 16th, yeah. So that’s a little bit—like, five weeks?

Thomas Buchholz, MD:

I know.

Tacey Ann Rosolowski, PhD:

Six weeks? That’s exciting.

Thomas Buchholz, MD:

I know. Thank you. I’m excited.

Conditions Governing Access

Open

Chapter 13: From Provost to Physician in Chief

Share

COinS