Chapter 30: Stepping Down as Chair of Breast Medical Oncology

Chapter 30: Stepping Down as Chair of Breast Medical Oncology

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In this chapter, Dr. Hortobagyi explains the issues surrounding his decision to step down as Chair of Breast Medical Oncology (effective on 31 August 2012). In part, he realized he no longer wanted the leadership position, he explains. In addition, cultural changes at MD Anderson have created a shift so that businesspeople, instead of physicians and scientists, now lead the institution. He talks about how medicine in general is “in a profound state of disarray,” and these factors dulled his enthusiasm, as MD Anderson is currently asking “how can we function optimally within this (dysfunctional) system,” not “how can we change the system.” He also notes that leaders should not remain overlong in their positions. He lists some of the personal interests he would like more time to pursue (music, literature, poetry, history) and also notes his interest in medical policy issues. Finally, he observes that his professional life took precedence in the early part of his career, and now his private life is perhaps more important to him.

Identifier

HortobagyiGN_05_20130315_C30

Publication Date

3-15-2013

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 AdministratorEvolution of Career Professional Values, Ethics, Purpose Critical Perspectives on MD Anderson The History of Health Care, Patient Care Character, Values, Beliefs, Talents Personal Background Professional Path Inspirations to Practice Science/Medicine

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:

I wanted to ask you a few questions about leadership and about the administration, so I'll kind of go through those in sequence. The first one was you left the position as head of the division, and when did that happen? And I wonder if you could comment on why you left that position.

Gabriel Hortobagyi, MD:

So it happened on August 31 at midnight. I actually wanted it to happen a year earlier, but I was requested to put in an extra year. Why? Well, multiple reasons but probably the major reason is that I had reached a point in my mind where I realized that I no longer wanted that leadership position so badly as to justify for me to continue. That's probably the most candid way to express it, but there are many details to that as to why. Part of it was because over the years I have noticed that as the institution grew, it had gradually made the transition from a healthcare institution into a corporation. And in that transition it went from a physician- and scientist-led institution. It converted into a business people-led institution where physicians and scientists stopped being important members of the employee group, and they just became interchangeable cogs in the machinery. We are no longer called physicians. We are called providers or we are called some other—for me—offensive term. And I became increasingly disenchanted with that. Also as part of the process and part of that, of course, comes from pressures from outside the institution.

Tacey Ann Rosolowski, PhD:

Medicine is in a profound state of disarray. This country has one of the most dysfunctional healthcare systems in the world, and if you have, first, best insurance and if you have lots of money, you are likely to get very good care. But if you are not—and especially if you are not very careful about how you go about getting healthcare—we provide healthcare that is inferior to most industrialized countries. And this is reflected in statistics. Our infant mortality rate puts the US in, I think, number sixteen in the world. Our average life expectancy is nowhere close to the top. We have a number of other countries from Europe—including North America and Canada—where life expectancy is several years longer than here. And we have a very large proportion of disenfranchised citizens who have no insurance and who get really very poor care. And the entire system is based on the whim and caprice of for-profit organizations who have taken over the decision making about how we treat patients. And it's largely for-profit hospitals and for-profit insurance companies right now. Some of the hospitals call themselves not for profit, but they are still making a profit. I assume you read [Steve] Brill’s article in Time magazine? Yeah. So that's just scratching the surface. Actually, despite protestations to the contrary from a number of CEOs including ours, it is largely true. And it is much worse than what he managed to uncover. So that has gradually come to grate my enthusiasm. And the reaction of our own institution has been not to fight for changing the system but to say, “Let's figure out how we can function most optimally in the current system. And for that, we need to continuously increase the revenue.” So for the past I don't know how many years, I have been asked every year to increase the generation of revenue by—I don't know—ten percent or fifteen percent—mostly unrealistic levels. And it was—it has become my task to force my colleagues to do something that they didn't really want to do. And there was not much joy in doing that, especially when I didn't agree with the process.

Tacey Ann Rosolowski, PhD:

In many organizations in the world, you generate your yearly budget by realistically looking at your capabilities and at your missions and say, “What should be our goals for next year based on that?” In our institution as of late, we get a figure that comes up from the top, that someone pulls out of their hat, saying, “We have this much debt in terms of our capital campaign. And our buildings—we need to pay for those; therefore, we need this amount of money for next year. Therefore let's just distribute it to our various units so they can generate the money that we need.” And I think that's the world upside-down. And that's not the purpose of an institution—a healthcare institution—so I was unhappy with that. And then deep inside my mind, for many, many years has been that what you learn in your—I remember in our Rice course that most leaders should not remain in their position—in the same position for more than about ten years. And of course, I had been a department chair for about twenty years and the leader of this group for about thirty, so I thought I had overstayed my welcome by much. And I thought that our department would be best served by opening the position to someone who is truly hungry to make an impact and to take the department to the next level. So all of those were sort of influences.

Tacey Ann Rosolowski, PhD:

And on a personal level, I have many outside interests. I'm passionate about music. I'm passionate about literature and poetry. I'm an avid reader. I love history. I love to travel, and my work is now—despite the fact that I travel a lot professionally, my schedule truly interferes with what I would like to do in terms of travel. And I've also become a whole lot more interested in policy, and the more I have to deal with the nickel and dime stuff of every day, the less I can think of policy. And then there are a number of other personal interests that have grown over the years, and when you get to the point where—at the beginning of my career, it was clear that virtually everything that counted for me was my profession and what I did in my profession. And my private life was, to a large extent, irrelevant. It wasn't completely like that because, obviously, I've been happily married now for almost forty years and that was important. But now I realize that my private life is just as important and perhaps much more important than my professional life. And that's again a transition. It's a gradual transition. And now that I'm starting to have grandchildren, I realize that I have the opportunity of watching them grow, which I missed, to a large extent, with my own children because I was constantly either here working or reading or writing grants or papers or traveling somewhere. And then as you get older, you think about your own mortality and you say, “Well, I'm more than likely past my fifty percent point. In fact, I might drop dead at any moment. Why not give it a little bit more prominence and enjoyment for the rest of my life?” So those are considerations that—every time you go to sleep, I'm sure the wheels are whirring and turning and considering that. So it was the right time to do it. I was very content and happy with that decision. My wife and I discussed it over several years, and I had discussed it with [Waun] Ki Hong and eventually with John Mendelsohn. So it was one of the most satisfying decisions, especially after I took it.

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Chapter 30: Stepping Down as Chair of Breast Medical Oncology

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