Chapter 16: MD Anderson in Periods of Change and Crisis
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Description
Dr. Sawaya begins this Chapter by noting that the periods of major change at the institution are tied to administrative changes. He first reviews the period of change that came when Dr. John Mendelsohn [Oral History Interview] replaced Charles LeMaistre [Oral History Interview] in the aftermath of the Sharp Report and Charles LeMaistre’s successful attempts to convince the Texas Legislature to allow patients to self-refer to MD Anderson. Dr. Sawaya recalls the dramatic increase in the numbers of patients seen at the institution, with more business and money coming in. He also notes some of the programmatic expansions made under John Mendelsohn. He then notes that after Dr. Mendelsohn’s tenure, the institution was due for a change and welcomed a major scientist such as Dr. Ronald DePinho. He explains, however, that the institution is currently facing “a crisis” caused by too much controversy surrounding Dr. DePinho. He notes that the faculty feels ‘disenfranchised” and that morale is low. Though, as he says, the situation is not yet affecting patients, he has concerns for the long-term damage to the institution. Dr. Sawaya then explains that he uses the term “corporate” to describe a situation in which senior leaders are separated from faculty.
[The recorder is paused]
Dr. Sawaya says that an institution is greatly influenced by how a leader responds to employees’ concerns. As MD Anderson in still in the midst of crisis, it is not possible to answer questions about this administration.
Identifier
SawayaR_03_20130625_C16
Publication Date
7-16-2013
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Institutional ChangeMD Anderson Culture; MD Anderson History; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Controversy; The Business of MD Anderson; The Healthcare Industry; Politics and Cancer/Science/Care; Critical Perspectives on MD Anderson
Transcript
Tacey Ann Rosolowski, PhD:
I wanted to change subjects a little bit, if that’s okay with you, and talk about some of the changes that you’ve seen at MD Anderson since you arrived in 1990. How has the institution changed? What have been the big markers of change since your arrival?
Raymond Sawaya, MD:
Not surprisingly, these changes have been tied to the changes at the top of the institution of the leaders. When I came Dr. [Charles] LeMaistre [Oral History Interview] was president, and he was well established. This was in 1990-91. In ’96, he stepped down. We as an institution faced a major threat in 1994. And part of that threat was the concept of managed care coming from California, where they were limiting the number of beds and limiting the number of patients that were being covered and allowed to go to the hospital. A report was generated by the leadership of MD Anderson—generated meaning through a consulting firm. I believe it was called the Sharp Report. That was basically describing a doom and gloom scenario. MD Anderson overreacted. They fired many, many employees—not as much doctors, but like the file room, the one example I have. We have dozens of technicians in the file room that would carry the x-rays and give us the x-rays for us to review. There was no PACS system at the time, so everything was on film. This was disastrous, because we couldn’t take care of patients. We had to wait a long time to get your films to review for patients. And also, I had a faculty—a fellow in my department that I wanted to hire as a faculty, and they wouldn’t let me. This guy is with me now and is one of the top leaders in neurosurgery in the country. They wouldn’t let me at the time, because of this issue. So LeMaistre went to Austin and argued forcefully with the legislature to allow patients to self refer to MD Anderson. Because up until then there was a state law that prohibited that. Patients had to be referred by their doctors. And many doctors did not want to refer their patients to MD Anderson, because they feared they would lose them. So there was a strong economic disincentive to refer them here. LeMaistre, through his skills as a very strong, effective communicator and politician, convinced the state legislature to remove that law. And it’s like opening the floodgates. And it coincided with Dr. Mendelsohn starting here in ’96. So John Mendelsohn [Oral History Interview], in many ways, inherited this very positive development and benefited from that tremendously by seeing a huge number of patients coming to the institution. Therefore, more business, more money, more hiring. But also to his credit, Mendelsohn saw the need to develop many areas like radiology and pathology that were very underserved. The emphasis was more on the oncologist, not on these allied areas that play a critical role. So our research programs were being hampered by not having enough pathologists to help us with managing and handling and studying the tissues. So he really pushed that very, very hard. And then the biostatistics, this became a major issue that our studies didn’t have enough statistical fundamentals and basics taken care of. So they expanded that department hugely. And so all that was justified in part to build programs and in part because we were growing, and the money was coming in. So that’s what’s tremendous. We went through pretty much our recent history in an expansion mode. And if you’re down on the third floor of this building, where you are, you look at Mendelsohn’s bio that’s on the wall. I think there is one section that shows all the buildings that he has built, like half a dozen buildings—one president. That’s really unbelievable. And all that because we were expanding, patients were coming, and there was a lot of money. So all that was very positive. But clearly after fifteen years, in every institution you feel there is need for change. We need newer blood and newer ideas. And so I did feel, two years before Mendelsohn’s term ended, that there was a real need for change in this place. In many ways we are very excited that the change occurred, that a major scientist was selected to come and lead this institution, which is only less than two years ago—it was September ’11 that DePinho started. While we are excited that change is coming or was coming, we in many ways are facing somewhat of a crisis right now at MD Anderson. And part of the reason is, there’s been too much controversy about conflict of interests, too much controversy about certain—what is referred to as elitism, when the rest of the faculty are feeling disenfranchised and the morale has dipped. So that is not the kind of change that this place needs or needed. And the sooner that course is corrected, the better it’s going to be for MD Anderson. Because right now there is just too much negative press that is being levied against us. And that’s not good for the morale of the faculty and the employees. Fortunately, it’s not affecting patients, but if that continues not corrected, then that can very much affect the care of patients. So anyhow, we are in the midst of a change period. Many of us were very positive about the change and were expecting major improvement. Now it looks like we’re down a very bumpy road that hasn’t been the kind of change that was hoped for.
Tacey Ann Rosolowski, PhD:
I’m curious too. When John Mendelsohn came he did many things—among them, hiring Leon Leach [Oral History Interview] to provide some kind of intellectual rigor to the business model which MD Anderson operated. And there was more of a sense of, “We’re going to run MD Anderson like a business.” I’m wondering if you feel—how do you feel that’s played out from within John Mendelsohn’s tenure and presidency and now into Dr. DePinho’s? Has there been a shift in the kind of attitude of corporatism? How do you see that?
Raymond Sawaya, MD:
I think—I’m really reflecting more opinions of the faculty that this corporate approach or corporate value started with John Mendelsohn actually. Now a lot of people are talking about it, because it’s in the newspaper. But frankly, this started before it was John. Some people look at corporate as a term and view it in a negative way. I don’t want to label it as such. The concept, the idea, is an administration should be responsive to the needs of its employees. And if you create too much of a separation between the two, then that’s what is being referred to by the faculty as a corporate approach—it’s that we’re all dispensable. And there is definitely truth to that. There’s truth to that. I still feel, though, that with John Mendelsohn, his door was really always open. You could always get a meeting with him, and you could always approach him with issues that he would listen to and that he would consider. So in that sense, this corporate approach was softened by a leader that indicated that he cared. And I believe he did care. Now having said that, what we’re seeing now is probably less—and maybe this should be off record.
Tacey Ann Rosolowski, PhD:
Would you like me to turn it off?
Raymond Sawaya, MD:
Yeah. (The recorder is paused for about 2 minutes) (End of Audio 2 Session 3)
Tacey Ann Rosolowski, PhD:
Back on?
Raymond Sawaya, MD:
Yeah, you can turn that back on. It’s not as much that the term corporate is being used, it’s how the leader of a given institution responds to their employees’ concerns, ideas, ways of coping, and how much do they really care? And what I can say is that we are still in the midst of a change, and these answers are not available right now. It’s a work in progress. So we are very much in a period of change. And change is always unsettling. Positive as well as negative, but even positive change—you would think that—no, it changes our comfort zone. It changes how we have felt secure about doing things, and now suddenly, wow, maybe we cannot do that. Maybe it’s not acceptable. Maybe—. We are in the midst of that right now. So we need to fast forward five years.
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 16: MD Anderson in Periods of Change and Crisis" (2013). Interview Chapters. 1552.
https://openworks.mdanderson.org/mchv_interviewchapters/1552
Conditions Governing Access
Open
