Chapter 09: The Department of Thoracic and Head and Neck Medical Oncology: Reorganization; A New Fellowship Program

Chapter 09: The Department of Thoracic and Head and Neck Medical Oncology: Reorganization; A New Fellowship Program

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Dr. Hong explains the reorganization that integrated the sections of Head and Neck Medical Oncology and Thoracic into a single Department. Dr. Hong headed the section of Head and Neck from ’84 – ’93. Thoracic was included in that section in ’87. The section became a department in ’94 and Dr. Hong was chair until 2001. He explains that he was brought in to head the Section of Head and Neck because of his work on lung and head and neck cancers. Since these were specific to aero-digestive cancers, it made sense to bring in Thoracic. Dr. Hong explains that he developed clinical and research programs. He specifies the links between that integrated these specialties, making it clear that they should be identified as a single unit. (He acknowledges that some physicians still have reservations about sharing their patients, even at MD Anderson.) Trans-disciplinary research depends on a culture of collaboration, which also attracts younger researchers. He notes that the Department of Thoracic and Head and Neck Medical Oncology has been particularly effective at stimulating research. He lists the awards program begun six or seven years ago. Awards to faculty, instructors, fellows, and staff are listed in the annual reports.

Dr. Hong also talks about the Department’s Fellowship program designed to cultivate more young medical oncology researchers. Dr. Hong himself created the Advanced Scholar Program that allows a fellow to extend his or her fellowship period for one year to focus completely on research. He explains why this period is so important for a researcher’s maturation. Dr. Hong also talks about the time, mentorship, and support that physician-scientists need to be successful.

Identifier

HongWK_02_20131016_C09

Publication Date

10-16-2013

Publisher

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

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Administrator; The Administrator; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Education; Critical Perspectives on MD Anderson; Professional Practice; The Professional at Work; Collaborations; Mentoring

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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:

Very interesting. How long were you section head of Head and Neck?

Waun Ki Hong, MD:

I was appointed in 1984 and then continued until 1993. Then I became section head of Thoracic Medical Oncology in 1987, so I combined both.

Tacey Ann Rosolowski, PhD:

Now how were those different? Because when I was looking over this, I was kind of confused about the reorganization. Could you explain that?

Waun Ki Hong, MD:

Initially, the section was a small part. Then the lung section was bigger than the head and neck section. Then my chief asked me to cover the thoracic section, so I ended up covering both Head and Neck and Thoracic. That was in 1987.

Tacey Ann Rosolowski, PhD:

In 1987?

Waun Ki Hong, MD:

In 1987. And then we called this the section of the Thoracic, Head and Neck Medical Oncology.

Tacey Ann Rosolowski, PhD:

Did this reorganization reflect a strengthening of medical oncology at MD Anderson?

Waun Ki Hong, MD:

Oh, yes.

Tacey Ann Rosolowski, PhD:

Tell me about that process of developing the specialty here at MD Anderson.

Waun Ki Hong, MD:

This is a comprehensive cancer center, so it was so specialized. It’s not like a general oncologist. So the area of head and neck and lung I covered was the so-called aerodigestive cancer—smoking-related cancer. So there is some sharing and some similar biology in head and neck cancer and lung cancer. I think I happened to be the person that opened up that field, because when I was in the Boston VA Hospital at that time, because of VA populations, I had seen some more head and neck cancer and lung cancer patients than other general hospitals. So it was a very smooth transition for me here focusing on those areas. Then in 1994, it became a department, because all those sections were expanding substantially. And also I had developed multiple research programs and had very strong clinical and translational research. Everybody agreed that this group should be recognized as a department. So I became department chair in 1994 and continued until 2001. Then I was drafted to be the head of the Division of Cancer Medicine.

Tacey Ann Rosolowski, PhD:

So am I understanding you correctly—and of course, we will talk about your role as the head of the Division of Cancer Medicine—but I wanted to make sure we get all of the story about Head and Neck and Thoracic. Am I understanding you correctly in that it was largely through pieces that you put in place that these three groups structurally were linked?

Waun Ki Hong, MD:

Yes, right. I made some connections, yes.

Tacey Ann Rosolowski, PhD:

Could you tell me a little bit more about the inner workings of these departments? You know—like what projects did you initiate? Not only research, but other kinds of projects that helped coalesce these groups into an identifiable unit.

Waun Ki Hong, MD:

It’s truly from the head and neck cancer and lung cancer—each area requires multidisciplinary approaches. It desperately requires collaboration from radiation oncologists and medical oncologists. Just to talk about patient care again, we discuss together what is the best treatment that we can offer to this particular patient. I was not the first person, but I really did promote strong collaborative multidisciplinary patient care. There are some concerns that still exist. That is that some doctors don’t like sharing the patients. “This is my patient, this is your patient.” So I think that is very selfish. I discourage that kind of approach and promote more and more multidisciplinary team patient care.

Tacey Ann Rosolowski, PhD:

Were you saying that there are still some physicians at MD Anderson that resist sharing their patients?

Waun Ki Hong, MD:

Yes, that’s human nature. Then, also, at the same time, they developed some multidisciplinary and transdisciplinary translational research in both lung and head and neck cancer. Like organ preservation and chemoprevention and personalized targeting therapy—like a BATTLE trial—is a final product of the transdisciplinary team research effort. I cannot do it. You cannot do it, unless we work together as a team. I think once you develop that kind of culture, then that’s a magnet to attract some more young people to join, and also it’s an opportunity to provide any research project to youngsters. That’s more on the menu that you can offer. I think we have done very well there. It’s strong multidisciplinary patient care and state-of-the-art transdisciplinary translational research, and then offer the young people the opportunity to do the research through the education process. So it’s a triple threat—patient care, research, and education.

Tacey Ann Rosolowski, PhD:

When I’ve spoken to some other people, they’ve talked about instituting certain rewards or building encouragement for collaboration into the evaluation process. Were there strategies like that that you used?

Waun Ki Hong, MD:

That’s always the carrot in your pocket.

Tacey Ann Rosolowski, PhD:

It certainly helps to reinforce.

Waun Ki Hong, MD:

Oh, yeah. That’s always an underscore, constantly.

Tacey Ann Rosolowski, PhD:

Were there any particularly effective techniques that you felt you instituted? Those kind of brownie points or however you would call it.

Waun Ki Hong, MD:

Oh, yes. I recognized them by giving awards. You can see my annual report there. Did I give an annual report to you last time? I’ll give you one. There’s about five different categories—patient care—I have one right over here.

Tacey Ann Rosolowski, PhD:

I’ll just pause the recorder briefly. (End of Audio Two)

Tacey Ann Rosolowski, PhD:

Okay, we’re back again after a quick break while Dr. Hong went to get some copies of the annual report. So when did you start the awards?

Waun Ki Hong, MD:

I started the—I don’t know exactly what year it was. I think it was six or seven years ago. It’s been very successful and really helped to inspire the people to do a better job.

Tacey Ann Rosolowski, PhD:

And these awards are for faculty?

Waun Ki Hong, MD:

Yeah, this is a faculty award. Let me see—I think this is the faculty recognition award—team science—

Tacey Ann Rosolowski, PhD:

I see, and it says, “Faculty recognition and awards program celebrates dedication to patients, research, and education.” So in each of these areas you give an award.

Waun Ki Hong, MD:

Yeah. And then there is a team science one. It inspires young people, like the non-tenure track instructors. We created the Division of Cancer Medicine Research Award.

Tacey Ann Rosolowski, PhD:

And there is the junior research faculty awards, instructor awards, and post-doctoral fellows awards and classified research staff awards.

Waun Ki Hong, MD:

And then we have recognition for outstanding employees, too.

Tacey Ann Rosolowski, PhD:

So who came up with this idea to give the awards?

Waun Ki Hong, MD:

We worked together. I wouldn’t say it was my idea. It was a collective idea.

Tacey Ann Rosolowski, PhD:

It’s a great—and what impact has this had? What impact do you see from this since you’ve been issuing awards?

Waun Ki Hong, MD:

Again, the impact is very simple—encourage them, inspire them to do more and better work. There is quite a bit of recognition, and everybody will receive their award and take a great deal of pride. It’s just simple. Like I got something, and now I’m very happy. That’s human nature. I use some more carrots and rewards.

Tacey Ann Rosolowski, PhD:

I’m also seeing it connecting up with a number of themes that you talked about earlier, like being generous with giving credit and also creating trust that when people make an effort it will be rewarded. It will be recognized, and it will be part of the community. I mean, those are all really, really important. Well, thank you. Can I take these?

Waun Ki Hong, MD:

Sure, absolutely.

Tacey Ann Rosolowski, PhD:

Fantastic, that’s great.

Waun Ki Hong, MD:

This is our fellowship program. Then another very exciting thing I implemented was to cultivate some more young people to be successful academic oncologists. A fellowship alone is not good enough. So I created an advanced scholar’s program, where I had to raise the money through philanthropy. Then each person can really focus a hundred percent on research—a hundred percent research.

Tacey Ann Rosolowski, PhD:

And this is for fellows?

Waun Ki Hong, MD:

This is advanced scholar.

Tacey Ann Rosolowski, PhD:

Advanced scholar?

Waun Ki Hong, MD:

Yes, so this has been very exciting.

Tacey Ann Rosolowski, PhD:

And so—I’m not clear. So these folks are younger than fellows?

Waun Ki Hong, MD:

No, older than fellows.

Tacey Ann Rosolowski, PhD:

Older than fellows?

Waun Ki Hong, MD:

After completing the fellows, then there is a gap. A three-year fellowship is completed, but they’re not quite good enough to be appointed as a tenure track assistant professor. So we give them one more year of an extension to work with a hundred percent effort in research so that they can really be productive. And then they publish some good papers, and then they can be ready to be appointed as assistant professors. That was my idea.

Tacey Ann Rosolowski, PhD:

So why is—what is so complicated about medical oncology that the three-year fellowship cannot prepare an individual to do real high-quality research?

Waun Ki Hong, MD:

Again, this is science and medicine. It’s not like the stock market or Wall Street. I think you have to have some experience. You have to have gone through a maturation stage. So that’s why this is a huge advantage. But they are good enough to be doctors in the community or even here as oncologists. Once you complete the fellowship, you’re good enough to practice, but these people are beyond that. They have practice plus research, so physician scientists. Then you have to work in the lab. That requires an extra year to be matured. Like you cannot play major league baseball first, you have to spend a couple of years in a farm league. Not everybody can make it to the major league, only select people. Same thing, it’s very competitive.

Tacey Ann Rosolowski, PhD:

You know—that reminds me of conversations I’ve had with individuals who talk about how difficult it is to operate as a physician scientist given that pull between laboratory and clinic. What do you see as the challenge and the solution to that problem?

Waun Ki Hong, MD:

The challenge is that you have to have some adequate protected time so that the individual can really focus on really cutting-edge research. Also, another challenge is that mentorship is important. You have to mentor—

Tacey Ann Rosolowski, PhD:

I’ll just pause this. (End of Audio Three)

Tacey Ann Rosolowski, PhD:

All right. Okay. Let me ask you, why is mentorship so important?

Waun Ki Hong, MD:

It’s like having good parents. Some people can be successful without a mentor but—a guy like Obama, he became President, and I don’t think he comes from a silver spoon. It happens. For me, I didn’t come from a silver spoon, I came from a blue collar background. If you’re smart and thoughtful, then you know how to create an environment where you can be comfortable and the environment where you can find the right mentor. There are two ways to it. I think some smart kids—I see them constantly—but many smart kids don’t have any sense. You have to bring them to water to drink, and they will never be successful. That’s the challenge. Human beings are not heterogeneous. Not everybody can be successful. I think that’s the huge challenge. In terms of solutions, I don’t know. The solution is you have to work hard, number one. And you have to have passion and commitment, and you have to ask the right questions. Then, also, you have to be in the right place at the right time and work with the right people.

Tacey Ann Rosolowski, PhD:

There always is an element of luck.

Waun Ki Hong, MD:

Yeah, and then you have to have luck too.

Tacey Ann Rosolowski, PhD:

You talked about luck the last time we met.

Waun Ki Hong, MD:

I’ve been very lucky.

Tacey Ann Rosolowski, PhD:

Yeah, I mean it is—that’s the right place at the right time.

Waun Ki Hong, MD:

Some people can be their own worst enemies. That’s their problem. You have to be more generous. You have to be creative. And then, I think, you have to give more than you receive. Then people who receive, they will pay it back to you. That’s Oriental Confucianism, but sometimes it works.

Tacey Ann Rosolowski, PhD:

A lot of people talk about that formula—sending things out and then they come back. Sure.

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Chapter 09: The Department of Thoracic and Head and Neck Medical Oncology: Reorganization; A New Fellowship Program

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