Chapter 08: An Evolving Economic Context –and New Challenges

Chapter 08: An Evolving Economic Context –and New Challenges

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Description

Dr. Leach states that MD Anderson is defined by its commitment to translational research, and in 2012 one half of funds for research come from operations, with over 250 million spent on research per year. He then talks about factors that shape the institution’s balance between investments in patient care versus those in research. He notes that in the current economic climate, faculty may be required to find a different balance and spend more time in the clinic.

Dr. Leach then explains why the “triple threat” model of a faculty member (one equally devoted to research, patient care, and education) may no longer exist. The institution, he says, may have to depend more and more on specialists, as the economic context is evolving and the institution must respond to be successful. This will demand different faculty roles.

Identifier

LeachL_02_20121127_ C08

Publication Date

11-27-2012

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - The Finances and Business of MD Anderson; The Administrator; Institutional Mission and Values; This is MD Anderson; Healing, Hope, and the Promise of Research; Understanding the Institution; Overview; Definitions, Explanations, Translations; Fiscal Realities in Healthcare; Growth and/or Change; Research, Care, and Education; On Research and Researchers

Transcript

Tacey Ann Rosolowski, PhD:

Yeah, what I’m thinking—of course, what’s in the back of my mind, and I’m sure what’s one of the many things in your mind too, is the issue of research. The faculty part of what they do or the reason they want to travel is not just education, but obviously they’re making connections, they’re finding collaborators, and they’re contributing to their national profile, which is helping the research piece and which is helping MD Anderson be what MD Anderson is. So what are the discussions like when you’re balancing that, because that certainly is not going to go away?

Leon Leach, MBA, PhD :

Yeah, and you certainly—MD Anderson is who we are today because of our research and because of our ability to translate that research and get it into care. Because ultimately the research serves no end if it doesn’t result in patient care—better patient care. So you do have a balance. The money that we spend on research—this year for the first time ever, half of it will come from MD Anderson, and that means from the operations of the hospital and clinic. So one feeds the other. If you cut down too much on research, you’re compromising your future because that’s how we stay leading edge—stay at the leading edge—and bring our science to bedside and be who we are and have the clinical trials that we do. If you over invest in research without the financial support from the hospital and clinic, you’re not going to be able to do that because you’re not going to ultimately have the money to pay for it. You may be able to start it, but you won’t be able to finish it. You’ll have to come back at some point if you don’t have the funds to fuel it. So you’ve got to grow them both in a balanced fashion. What determines that balance is going to be somewhat the external environment, because if the external environment is saying, “I’m not going to pay you any more money” in terms of the per-unit basis for care and you’re costs are going up, even if it’s just at the rate of inflation which has not been the history with healthcare—it’s been double the rate of inflation with healthcare—so if your costs keep going up at double the rate of inflation and your revenue doesn’t, then you’ve got a problem. That means that bolus of money—that 250 million dollars a year that we spend on our own research from our own resources—250 million plus—that could dry up. So you have to take a balanced approach. A balanced approach in today’s environment may mean having to spend a little bit more time in the clinic, or it may mean going to more specialty type of providers. Folks that gravitate to education and research—they’ve used the term triple threat, a term from sports—but they could do research, they could educate, and they could treat patients in the clinic, and they would divide their time between such. Well, I was at a forum put on by the Health Science Center right across the street two years back when Larry Kaiser was president there and John Mendelsohn was still president here, and there were a couple of other players, and they had a debate at the forum about, does triple threat still exist? Has science gotten so sophisticated, has education become so specialized, and has the clinical side become so specialized that it is impossible to be a master of all three of them, to be the triple threat? Is a more realistic model somebody spending most of their time in the clinic and someone else spending most of their time doing inside research and the translation of that in between? Which is what we tend to do—we tend to have people who are eighty percent clinicians and twenty percent research and people who are eighty percent research and twenty percent clinicians, and they have educational responsibilities woven in there too. But more and more, the emphasis is going to be on being one or the other. I think we are still strategically advantaged because we have folks that are triple threats, but our triple threats aren’t anymore one-third, one-third, one-third. They’re more skewed towards one end or the other. And maybe we need more on the clinician side to support the critical few on the research side—that are really good with the research. So we’ve got to be able to be nimble and evolve with a changing environment.

Tacey Ann Rosolowski, PhD:

I’m putting this conversation in the context of others that I’ve had with other interview subjects about that kind of rare and important creature, the physician scientist, who has been really, really important to MD Anderson. I’m curious how you see that kind of individual fitting into this scenario that you just described where there’s got to be a choice made between one or the other.

Leon Leach, MBA, PhD :

Yeah, well I’m not saying it’s absolute. I’m not saying you can either be left-handed or right-handed. But what I am saying is more and more, you’re going to be more research or you’re going to be more clinical, because it is getting so difficult to be credibly the triple threat, to have that kind of credibility in those different dimensions. And why isn’t it the quadruple threat? Why don’t we have tremendous business people who are scientists, clinicians, and educators also? Because without the financial side and without the business acumen, it’s what a Catholic nun once said, “no margin, no mission,” if you can’t produce a margin out of it. So why don’t we have the quadruple threat? The reason is very simple working around people like that—it’s a bridge too far. It’s a range too far. We do have some physicians and faculty members that are talented business folks in their own right, and they probably could be quadruple threats if there were thirty-six hours in a day. It depends on how granular you want to get on any one of these as far as— To really—I believe—to really be the true great scientist, you’ve got to be pretty granular. To really be truly a great business person, you’ve got to be pretty granular. Well, you can’t be pretty granular in all four of those—education, research, clinic, and the business side. So you’re going to have to depend more and more on specialists, and we do that on the business side. Anderson looks to us as specialists in that area. Yet we tend not to deal with the other critical functions that you need for an academic medical center. So why would the business side be different? There’s a valid reason for it. It’s you can’t be that Renaissance man in all those topics at the granularity that is needed for that. As a society, we have chosen to specialize. We have school teachers. We have businessmen. Academic medical centers bring those together. You can bring those talents together without having them all embodied in one person. And then it would be very difficult to bring them together if you had them all embodied in one person. So this is a challenge that academic medicine is going to have to face because there is an evolution in our external world. And for us to not be cognizant of that and not address that, then we would be the equivalent of the dinosaur.

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Chapter 08: An Evolving Economic Context –and New Challenges

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