Chapter 07: Challenges for the Section of Interventional Radiology in 1998

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Chapter 07: Challenges for the Section of Interventional Radiology in 1998

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In this chapter, Dr. Hicks explains how his experiences at the University of Washington in research served him when he came to MD Anderson to become Section Chief of Interventional Radiology. He notes that his mandate when he came to MD Anderson in 1998 as a section chief was to rebuild the Section of Interventional Radiology. He explains why the section had fallen into a period of dormancy with a very small faculty/staff and few resources. The section required new leadership and he describes his first steps. He also talks about the challenges of leadership during this period and how he set an example by pitching in.

Identifier

HicksM_02_20180501_C07

Publication Date

5-1-2018

Publisher

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

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; Leadership; On Leadership; Portraits; MD Anderson History; MD Anderson Snapshot; MD Anderson Culture; Working Environment; Institutional Mission and Values; Professional Practice; The Professional at Work

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

T. A. Rosolowski, PhD:

So how did those experiences, conducting that kind of research and working with individuals in this newly evolving field, how did that help you once you came to MD Anderson?

Marshall Hicks, MD:

A couple things helped me over that experience at Washington University. First was being able to develop as a researcher, get experience with that and understand, even conducting a clinical trial, the experience with that, again with a new device. Just having the experience, so when I came here and moved into a more senior role and had faculty members joining right out of training, to be able to help mentor them and be able to help develop them, and promote and look for opportunities for them as the field continued to grow. And opportunities for us, particularly in the oncology realm here, where a lot of the new device development around ablation --killing tumors by heating them or cooling them, by putting direct needles or probes right into them through the skin and using imaging to guide. That was a field that was really just emerging and developing at the time and helping. You remove barriers, if you will, to faculty members being able to get the resources they needed to develop their careers. The other thing that helped me there was not on the research side as much but on the clinical side. When I started there, I mentioned that there were two other faculty members; by the time I left, we were up to I think somewhere between six and eight, but we’d also gone from one fellow to six fellows, and I was the program director there for the fellowship, over most of the time that I was there, about eight years. So I was involved in helping to develop that program and also, just learning how to develop a successful clinical practice. And so when I came here, this was essentially a rebuild situation on the clinical side. The section chief unfortunately had died in a climbing accident about two years before I came.

T. A. Rosolowski, PhD:

Who was the section chief?

Marshall Hicks, MD:

It was “Tito” Carrasco, [Cesar] Humberto Carrasco. He was a friend of mine and we had gotten to know each other just through our professional society. He was a real outdoorsman, avid outdoorsman, and unfortunately was killed in South America. So they were looking for leadership. It had maybe drifted for a couple of years as they were trying to identify—the new hospital had not been opened yet, so the equipment was pretty old and they were waiting to get new equipment in the new hospital. So it was a time when it was probably a challenge to recruit. Bill Murphy had come as the division head and was actively working to recruit me and others I’m sure. But just having those experiences, I came in able to say what does it take to build a successful practice and recruit, and to continue with the fellowship program, because that was, at that point, the—what’s the expression about the cooks or the kitchen?

T. A. Rosolowski, PhD:

Oh, too many cooks in a kitchen?

Marshall Hicks, MD:

No, I was thinking of wearing all these hats.

T. A. Rosolowski, PhD:

Oh, oh, yeah, yeah. I don’t know the phrase.

Marshall Hicks, MD:

I’ll think of it in a second but anyway, I had a lot of responsibilities. As we added faculty members and were able to mentor faculty members into these roles. One of them --because the fellowship director, another one helped started to build certain programs.

T. A. Rosolowski, PhD:

Because you started as fellowship director, isn’t that the case?

Marshall Hicks, MD:

Correct, correct.

T. A. Rosolowski, PhD:

Because you came in 1998, as section chief and fellowship director.

Marshall Hicks, MD:

Right.

T. A. Rosolowski, PhD:

So let me just—I don’t mean to interrupt you, but I’m curious, when you arrived, what was the mandate, you know from the institution, and what did you personally want to achieve in this rebuild?

Marshall Hicks, MD:

I think primarily the mandate was that we wanted to have a very robust, current clinical practice of interventional radiology that really was able to offer the variety and full menu of what was available in interventional radiology. To be able to continue to develop the new technologies, the new procedures as they were emerging and to eventually be a part of developing that and being on the front end of that. At the time, it was really trying to establish it as a full line service for interventional radiology, in oncology patients.

T. A. Rosolowski, PhD:

Were there questions about its value within the institution at the time?

Marshall Hicks, MD:

I think there were some limitations.

T. A. Rosolowski, PhD:

And what did that arise from do you think?

Marshall Hicks, MD:

I think it was just probably over time, with Tito passing. Tito was a driving force in the practice, no question. A lot of the innovation and the drive to offer new procedures as they became available, or to be engaged in really offering that service, was really coming from Tito. I think when he left it kind of drifted a little bit. There was —you know, not that individuals weren’t committed to it, but I think the facilities weren’t quite as good as they needed to be. That was acknowledged and understood, and that’s why the new hospital was planned, but as I understand it, the new hospital was delayed because there was a problem with the foundation. They had to tear that out and restart, so it delayed a lot of the services that were planning on moving in, delayed for at least a year or maybe longer. The equipment has basically a service life of technology, and so the longer the equipment is not refreshed or you don’t get the newer technologies that are coming in from imaging, like ultrasound for example, at the time, then you’re really limited in what you can offer. That was part of the situation. I don’t think we even had an ultrasound that was dedicated to us at the time, to interventional. We had one CT and we borrowed another one. The four rooms were pretty old, but they didn’t have some of the newer digital technologies that helped you optimize the procedure and do it well. We didn’t do things that were unsafe, but there were things we couldn’t offer because the technology was limited, and then that kind of stifles creativity.

T. A. Rosolowski, PhD:

I’m just trying to get a sense --often with a new field there’s a learning curve with people outside the field: oh, this is available, it will improve outcomes. So you know that dormancy period sounds like not being able to build those networks and those collaborations.

Marshall Hicks, MD:

Great point, that’s exactly right, yeah.

T. A. Rosolowski, PhD:

So it sounds like Tito was also a driving force in building that.

Marshall Hicks, MD:

Correct, yeah, and that’s the thing I always heard about him and knew about him from a distance. Then when I got here realized that that was—he was very beloved here. I think he was the leader of the group, and people looked at him to develop and lead and continue to push it forward. Without that driving force, I think there wasn’t that push to continue to get newer technologies, to upgrade the equipment, the different things that need to be done, and it’s understandable. That was why I was asked to come in, was to help drive those things. Having experience at Wash U, of ten years of developing that, seeing what it took to really offer state of the art services not only in customer service, if you will, but also in the procedural technology, and knowing what it took to really maintain that was something that became invaluable to me when I came here, to really understand what it took.

T. A. Rosolowski, PhD:

So how did it start?

Marshall Hicks, MD:

It started by being very patient.

T. A. Rosolowski, PhD:

Why was that important?

Marshall Hicks, MD:

Because I was used to frankly, better technology, better equipment. I knew it was coming but I think it was six months or five months before we moved into the new hospital. It seemed like two years because you’re used to having high-end equipment and it limits some of the things you can do, so you can’t offer certain services. In all seriousness, it helped me develop patience to say, we’ve got to do what we can, do the best we can now but realized—chief cook and bottle washer that was it, that was the expression, chief cook and bottle washer. And I was, I was recruiting. I was taking a lot of call, holiday call, and one of the things I did at the time and I didn’t realize the impact. This is something we just did because it was the right thing to do --I was at Wash U-- is I would help bring patients in the room or do whatever it took to help the service run and do whatever we could for patients together, because we didn’t have a lot of the different components of the practice yet. We didn’t have PAs, we didn’t have a scheduler, we had two nurses that were borrowed. They were a great group of technologists, but we didn’t have nurses in every room during the procedures, really it was a transition time in the field in that sense.

T. A. Rosolowski, PhD:

How did that create—what kind of environment did that create, that sort of chief cook and bottle washer pitch-in sort of thing?

Marshall Hicks, MD:

Well, what I didn’t realize at the time, I was citing an example that that was appreciated. People saw I was really there to help, and it was about us and the patients. It was really --you know, I didn’t think about it all that much. It was just doing what had to be done to continue to make things better. The most frustrating thing, in a situation like that, is --we had one senior secretary for the entire group, so it wasn’t a lot of support. You’re trying to do the best you can to build it but even having the time to be able to put together a request for more resources or a request for why we need additional staffing, there’s not even time to do that. You’re trying to keep your head above water with patient care, recruiting, managing. You’re doing all these different activities: fellowship director, managing the fellows schedules and all that, maintaining the relationships with the other hospitals, where the fellows rotated like St. Luke’s [Hospital] and UT Health Science Center. That’s one of the most frustrating things. You’re so busy with all these different things. You know what you need to move it forward, but even finding the time and resources to be able to put that in front of somebody in a form that they can understand and be supportive was challenging.

Chapter 07: Challenges for the Section of Interventional Radiology in 1998

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