Chapter 16: Transitions under Ronald DePinho: Epic and Financial Struggles

Chapter 16: Transitions under Ronald DePinho: Epic and Financial Struggles



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In this chapter, Dr. Hicks begins to sketch the period of institutional turbulence during Ronald DePinho’s [oral history interview] presidency. He begins by sharing his personal view of Dr. DePinho and his vision for developing MD Anderson’s commitment to translational research. Dr. Hicks notes that many people saw Dr. DePinho’s Moon Shots program as a divisive force in the institution, but he saw its potential for bringing people together.||

Next, Dr. Hicks touches on factors leading to negative views of Dr. DePinho’s leadership: poor communication, top-down decision-making, and a growing feeling among clinicians that their perspectives were not heard.||Next he focuses on the financial crisis in the institution. He explains that MD Anderson came out of the recession to face a new financial environment in healthcare and that the decision to implement Epic (in spring 2016) greatly compromised the institution’s financial comeback, despite the fact that a $250 million loss was anticipated. The comeback took longer. He explains that the immediate fix –to see more patients—was not adequate to the situation. The measures needed to remedy the situation were complicated and difficult to implement. He explains that solutions were proposed from many sources, but the siloing in the institution as well as lack of responsiveness from executive leadership delayed the recovery and intensified the growing sense of mistrust in the institution. Dr. Hicks also observes that payroll expenses were out of control in 2017.l



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 - Institutional Change; Leadership; On Leadership; MD Anderson Culture; Working Environment; The Business of MD Anderson; The Institution and Finances; Overview; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Critical Perspectives on MD Anderson; MD Anderson History; MD Anderson Snapshot; Portraits; Multi-disciplinary Approaches; Research; Research, Care, and Education

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, PhD:

Today is July 24, 2018 and I am today, on the 16th floor of Pickens Tower for my fourth session with Dr. Marshall Hicks. Thank you very much.

Marshall Hicks, MD:

Thank you.  

Tacey A. Rosolowski, PhD:

We were strategizing a little bit before the recorder went on. Oh, I wanted to say, it’s also about eleven minutes after three. We’re really at the point to start talking about when Ron DePinho [oral history interview] comes to the institution, and everybody knows that this is a big moment. I mean his arrival was very much anticipated by a great many people. A very charismatic speaker who excited a lot of folks from the Board of Regents down to the Board of Visitors down to ordinary folks in the trenches here at MD Anderson, so it was a period everybody knew was going to be one of transition. I wanted to get you started talking about that period in 2011. I mean what was your perspective, what was your involvement in his process? Did you meet with him before he arrived?

Marshall Hicks, MD:

Yes. He had come through for a tour and to meet individuals. I remember giving him a tour of the Diagnostic Imaging facilities and talking to him about some of the things we were doing. Particularly, we were doing some work with the University of Houston at the time, I may have mentioned it, with patient experience. So I remember talking to him about that. And so there were, I guess three finalists, and that was when I got a chance to meet him. After he was chosen, it was definitely transition time. It was a time when we knew things would probably be different going forward, because he was seen as somebody who could help boost our research enterprise, that part of the—that mission area, essentially recognizing that there was a perception, I think, by the Regents, in the [UT] System, that we were a very clinical enterprise, clinical translational research enterprise, but needed to be a little stronger on the research side, could be a little stronger on the research side, had a lot of opportunity there.

Tacey A. Rosolowski, PhD:

Now let me ask you what was your impression of Dr. DePinho when you met him and how he was going to fill that role. You know, what about that decision of [UT] System in the Regents?

Marshall Hicks, MD:

I think he’s obviously a very bright man and I had great conversations with him. I enjoyed talking to him. He had an incredible vision for the institution and for cancer care, for oncology. He always spoke about the uniqueness of MD Anderson, the ability for us to do something that no other institution could do because we had the resources. We had so many patients that sought care here and we could really do the translational piece, going from the development side and the basic sciences, all the way through to the clinical trials, and be able to provide that continuum of knowledge that would advance the field in a way that nothing else could. Of course, that was around the time we announced the Moon Shots. Frankly, I was a little worried that might be divisive, because you might have haves and have nots. But on the other hand, it brought teams together to say, let’s think about this in, obviously a multidisciplinary, but it was really more multidisciplinary science. We’ve always been more multidisciplinary on the clinical care for sure, but this was how do we be multidisciplinary in our science, in our approach to research. So actually, I saw it bringing people together. It had a little bit of a risk because patients could perceive it as well, if my cancer is not in the Moon Shots --as well as people who clinically or practiced in the areas outside the Moon Shots. But I think those were recognized. Then there were ones that were added on as a little early for Moon Shots but ones where we wanted to invest some resources in. So I think it started to be more inclusive. It was very bold and that’s what he intended it to be. [00:005:04]

Tacey A. Rosolowski, PhD:

So when did you sense that the winds were kind of changing?

Marshall Hicks, MD:

As time went on, I think Ron brought in some really good, bright researchers. In my conversation with him, he explained it so well: that the vision was to bring in scientists that could help provide the translational piece that --you could bring in basic scientists that really weren’t connected to the clinical piece. He wanted to bring in people that could bridge the gap, that actually could help, by their interactions and engagement and willingness to engage in the clinical piece, to be able to bring drugs to trial, new therapies to trial. And so that’s what he did. The people he brought in actually fit that role, and many of them are playing key roles right now in the institution. So I think his intent was right. It wasn’t always communicated as well in that sense because he had a great vision and would—there was a lot of one-way communication, too and I think people felt like he wasn’t listening as much to … people feeling disenfranchised or people feeling—I’m thinking on the clinical side—“there are these haves and have nots.” People were being brought in with a lot of resources and you know, what about the rest of us? So it started to become a little bit divisive there. I think that there just wasn’t a feeling that the clinical side was as appreciated as it could have been. That’s my sense of where --I think also there were perceptions of top down decision making. There wasn’t the engagement at the faculty level, the local level, for decision making. There were some missteps I think, in terms of how things are managed publicly, with some of the statements that were made, which Dr. DePinho acknowledged, but it was difficult to recover from over time. Ultimately, we were coming out of the recession. I think we started to do well, but it was clearly a different era in terms of expense reduction and paying much more attention to the expense side. The preparation for Epic became an enormous task for really almost two years, anticipating that that was going to be a major transition, transformation really, in how we practiced. When that was implemented, I guess it was the spring of ’16, we were able to get it implemented, we installed the software. How we dealt with the software, how we practiced and how our productivity in using that software, in using those tools, was where the challenge was. We knew that was going to be the case, but unfortunately, we didn’t recover from that in a lot of areas as quickly as we thought. That was in the spring of ’16 and we had budgeted a loss of $250 million for that fiscal year and we ended up losing a little bit more than that. I think it was $260 million roughly. We had budgeted for the next fiscal year, which I believe was fiscal year ’17, to be a year where we basically broke even or had about a $25 million margin. We started out, in the first quarter I believe we lost another $150 million roughly, or maybe a little bit more, and so we quickly got in a hole for that fiscal year. It was really because, you know, just because September one rolls around, doesn’t mean everything changes and everything goes back to normal.

Tacey A. Rosolowski, PhD:

No reset button.

Marshall Hicks, MD:

Yeah. We just continued on struggling, and so that struggle continued into the next fiscal year and while we were starting to have areas that we’re figuring it out, it was really happening at the grassroots level. There was, I think, a sense from many of us at the division head level, that a lot of us --most of us practice, we know the frontline, we listen to the frontline, the chairs here. There was a sense that there were things we could do to help fix it but they weren’t being addressed, weren’t being listened to, essentially. We were trying to help people. We were trying to help people where it wasn’t a simple one-fix solution. It was multiple things and multiple interactions, and it was complicated. I think there was an attempt to try to do a simple fix at the time of ‘just see more patients.’ The concern was if you’ve got a funnel or a bottleneck that is creating a problem and you try to push more patients into that, it’s not really going to get—as a solution, you’ve got to fix the bottleneck, fix the snags. People were starting to do that but it took time and that’s something. We’re also sharing best practices. The communication across the organization, things that—we were very siloed at the time. It wasn’t really conducive to being able to rebound quickly. So in that sense we were, as an organization, not only structurally, but functionally, we were struggling. That is how the first part of fiscal year ’17 started. We were at a point where our expenses were out of control. We had hired a significant number of employees. Our ratio of employee expense to revenue was, I think as high as it had ever been, and we were clearly out of whack there. Whether it was people that we’d hired for Epic or whether it was just not being able to say no and hiring more than we needed, we were clearly at a point where the employee expense was high and we had to reduce expenses going into that year, and that meant considering layoffs. It was a painful thing. No one wanted to do it. We discussed it with the Shared Governance Committee for probably two months in that fall and no one really wanted to do it, obviously, but we all kind of saw what was coming. I think we kept thinking every month --and it probably went on for more than three to four months-- thinking that it could turn around or maybe we were very close to turning it around, maybe we wouldn’t have to do this. Then eventually we got to the point where we realized we had to, we were really in a pretty deep hole.

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Chapter 16: Transitions under Ronald DePinho: Epic and Financial Struggles