Chapter 09: The MD Anderson Presidents: Continuity of Leadership

Chapter 09: The MD Anderson Presidents: Continuity of Leadership



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Dr. Tomasovic begins this segment with the observation that MD Anderson is unusual because of the long tenure of its key leaders and administrators. He characterizes the three presidents and gives examples of how the institution successfully met the managed care crisis. He notes that the institution has faced strong, external financial challenges at the transitions between Dr. LeMaistre and Dr. Mendelsohn and Dr. Mendelsohn and Dr. DePinho.



Publication Date



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


Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Key MD Anderson Figures; MD Anderson History; MD Anderson Snapshot; Portraits; Institutional Processes; The Business of MD Anderson; Understanding the Institution; The Institution and Finances; The Healthcare Industry

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.


History of Science, Technology, and Medicine | Oncology | Oral History


Tacey A. Rosolowski, Ph.D:

And we left off this morning at a real turning point in the institution's history. In the mid '90s with many many changes. And before we embark on a description of those inner workings of the changes, one of the points that I wanted to touch on this morning but we got lost with, because there was a lot of important detail, was a comparison between MD Anderson and peer institutions. The turning point that we're talking about in the mid '90s it was obvious many of these things were internally generated. But I'm also wondering about how some of the changes were necessitated because of other movements that other institutions were responding to because of changes in cancer research or cancer treatment.

Stephen Tomasovic, PhD:

Well, the primary -- I can reflect on that from a couple directions. First, MD Anderson was very -- and still is unusual relative to most universities and even other cancer centers, comprehensive cancer centers, in the tenure, the length of tenure of our leaders. So we just celebrated our 70th anniversary this spring, and we had a director initially but very shortly after that progressed to having our first president R. Lee Clark. So over the course of that nearly 70 years we've had three presidents. And John Mendelsohn is finishing 15 years. The average in the United States is around eight years for university presidents. And you can contrast us to the UT Health Science Center across the street, which has probably had double that many. I don't know the exact count. But they've been through a number more than we have. Their last one, Dr. Kaiser, left after only two or three years. And so that has had some advantages to us in that the board of regents have chosen well. They've each been the right person for their time and have set a course for the institution that was correct for most of their tenure here. And it's been a very stable strategic direction and vision for long periods of time, which has helped the institution move very progressively, very stably along its path, without a lot of veering as leadership changes occurred. And since they have been good leaders, that's been helpful. And I've lost track of the original question. The outside influences. Well, I can talk about that a little bit.

Stephen Tomasovic, PhD:

R. Lee Clark was the master politician and visionary who established the strong culture of the institution and who gained us our reputation within the state and began to position us as an international leader near the end of his term. Dr. LeMaistre was also a very sophisticated politician. He had been chancellor of the University of Texas system before he came to us. He was also on the national stage as he was one of the original participants in the smoking panel, the national commission that studied the effects of smoke on cancer and respiratory problems and so forth. And he came into the institution and continued along the path of growth and tried to -- as I talked earlier -- develop the research strength. Another area that he was foresightful about was cancer prevention. Probably going back to his time studying the effects of tobacco, smoking, and how you could prevent lung cancer and many respiratory diseases or greatly reduce the chance of them by preventing people from smoking. And so he established our Division of Cancer Prevention and began to emphasize prevention in the institution. And that was something new to the institution and new to comprehensive cancer centers, which had previously focused mostly on dealing with cancer after people already had it.

Tacey A. Rosolowski, Ph.D:

I think I read that in establishing the Department of Preventative Cancer Prevention in '79 it was the first department of that sort anywhere.

Stephen Tomasovic, PhD:

Yes. That was a very new and innovative idea. And one of the most important things that he did for MD Anderson. Near the end of his tenure here in the early '90s we began to be threatened by some external events. Managed health care was happening. And more rapidly so in some states than others. And in California it had had dramatic effects on the reimbursement of hospitals and the way in which -- the impact that it had on academic health hospitals in particular. There was a lot of concern that patients would move into managed care plans and wouldn't have access to these advanced academic centers. And they would lose all their income and wouldn't be able to do their mission. So we were concerned about that. We commissioned a study by some external consultants that basically said yes in fact MD Anderson is going to suffer a big decline in its income. And you're going to have to tighten your belts and do a number of things. And with that forecast in mind Dr. LeMaistre set myself and others -- I was a participant in this -- to looking at ways to reduce the expenses of the institution. And that was -- just looking to see if I can find that committee, what it was called. Let's see. That would be an internal committee. Let me flip pages here. So I had been a member, I was the faculty senate chairman. And so I got involved in this. I had been. So I was one of the people picked to work on this. Institutional reengineering process steering committee.

Tacey A. Rosolowski, Ph.D:

Oh my. I hear drums rolling.

Stephen Tomasovic, PhD:

Institutional reengineering process steering committee. 1994 to '96. Fred Becker, myself, a number of other people were charged to suggest ways that we could reorganize and reengineer the institution to meet this threat that we were worried about and that the consultants had warned us was coming. And so we did a number of different things in '94 to '96, one of which was to realign a bunch of people. We cut our workforce. That had a very negative effect on the institutional culture that lasted for some time. And there's still some suspicion around that. But other things that were done were to change some of the legislative things that impacted the way we did business. We got approvals to -- we got exemptions from some of the state agency regulations that made it hard for us to act as a medical business. And we got the ability to have for the first time patients to refer themselves directly to MD Anderson. Prior to that time from the 1940s to the mid 1990s patients only came to MD Anderson through referral of a referring physician. Now they could send themselves directly if they chose to do that. And the outcome of that was to begin to open MD Anderson up to patients in a way that had a huge impact. And in I guess it was '96 when Dr. Mendelsohn arrived -- so this was at the end of LeMaistre's tenure, some measures that were pretty severe that we were taking to prepare for the impact of managed care on the institution. Dr. Mendelsohn came in then in '96 and had heard this advice. Needed to reduce the growth of the institution. And he didn't take that advice, and decided to grow the institution. And he was greatly aided by the things that had happened just before his arrival. But those steps that we took -- not the reduction in staff. That was a stupid thing to do, because we hired almost all those people back within a year or two, and many many more, yet still had created some damage to our culture. So it was the dumbest thing we did as it turned out. But the institution began to double every few years during -- from that point on through Dr. Mendelsohn's whole tenure here. And we had completely turned on its head the projections of the consultants. And we weren't affected in any severe way at all at that time by those types of health care reform.

Tacey A. Rosolowski, Ph.D:

Were other institutions taking similar measures?

Stephen Tomasovic, PhD:

I think they were, yeah. People were very concerned about that. I don't know much about --

Tacey A. Rosolowski, Ph.D:

Were they equally successful?

Stephen Tomasovic, PhD:

No. I think we were probably one of the most successful because we had some fundamental barriers that weren't helping us in this business of getting patients referred to us. The state agency purchasing and construction barriers. There were a number of things that made us inefficient. And when we got rid of some of those things -- and I don't know enough about how other organizations are set up around the country to know how they were affected by it or how they chose to react to it. But those things coupled with John Mendelsohn's vision for the institution completely turned this on its head. Now we're at one of those points again. Now we're even more concerned because it's not an insurers-driven change, it's not the insurance companies that are creating the change now, it's the federal government. And we think this time that it's going to be a much more dramatic and longer term effect on the institution. And again we're participating in committees, looking at -- I served on one of these. Institutional ad hoc expense analysis committee is the name now. And thinking of ways to save money, make money. We're not talking about reducing staff but we're thinking about we're going to lose 20% plus of our margin over the next five years. How can we make the institution more efficient? And what steps can we take? And that's coinciding with the arrival of Dr. DePinho and we'll see where that all takes us. So again I've lost track of the original question. But there have been external forces that have interacted with this, that have affected the institutional decisions. And so far we've had the right people and the right set of circumstances that when those external stressors, pressures have reached an inflection point or a nexus for us it's happened that they've been close to our leadership transitions. Interesting in a way. And the transition between LeMaistre and Mendelsohn and the transition between Mendelsohn and DePinho have both been during times of -- very close to times where the institution is facing very strong external concerns.

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Chapter 09: The MD Anderson Presidents: Continuity of Leadership