Chapter 28: Experiences at the Mallinckrodt Institute of Radiology and Their Impact on Later Leadership (1988-1998)

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Chapter 28: Experiences at the Mallinckrodt Institute of Radiology and Their Impact on Later Leadership (1988-1998)

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In this chapter, Dr. Hicks talks about the ten years he spent in the newly established interventional radiology group at the Mallinckrodt Institute of Radiology at the Washington University school of Medicine, St. Louis, Missouri. He talks about the opportunities this afforded him immediately after his fellowship period to build a clinical and educational training programs and makes connections between these early-career experiences and his later leadership at MD Anderson, e.g. immersion in a positive culture at the Institute; the opportunity to build a clinical practice and develop excellent patient care. He also describes his experience observing issues that arose at University of Washington, the academic and healthcare delivery arms of the institution were divided into different financial areas.||Next, Dr. Hicks confirms that these experiences helped give him the skills to rebuild Interventional Radiology at MD Anderson and to recruit well. He also learned how to treat patients. He tells a story that illustrates how faculty in an emerging field can be tempted to push boundaries when the treat patients and how collaborative discussions can ensure responsible action is taken. He notes as well that he brought this team based approach to MD Anderson.

Identifier

HicksM_08_20190321_C28

Publication Date

3-21-2019

Publisher

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

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Leadership; On Leadership; Mentoring; On Mentoring; Professional Path; Evolution of Career; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; MD Anderson Culture; Influences from People and Life Experiences; Professional Practice; The Professional at Work; Ethics

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:

It is about seven minutes after eleven on the 21st of March, 2019, and I’m on the 16th floor talking to Dr. Marshall Hicks for what is our eighth session together. [laughs] So there we go. I don’t know, you can put that in some book of your records, right?

Marshall Hicks, MD:

Yes, definitely.  

T. A. Rosolowski, PhD:

All right. Well, we strategized a little before and we had that homework to do from the last bit from session one, and so I wanted to invite you to just think about that time at Mallinckrodt, and what it was like working in a new program, setting up a new program from scratch.

Marshall Hicks, MD:

Yeah, so that was my first job as a faculty member, first job right out of fellowship, and it was a prestigious radiology department, but they were really forming an Interventional Radiology Department. They had a guy there that had just finished his fellowship a year before and they basically appointed him section chief of interventional radiology. They were integrating it because it was very distributed to the different, really kind of organ systems. GI radiology did their own interventional, GU did their own interventional, musculoskeletal did, and they were consolidating it. Which is the way it was done really, at every other institution, because it’s common techniques, and the field was evolving, and really staying on top of all the technical aspects was kind of challenging when you don’t do it very frequently. So this was, How do you consolidate it into one group? And also I think to be competitive with hiring, the market being people coming out of training and getting into programs like that. So it was an opportunity to really be on the ground floor and help develop a program over the ten years I was there. To help build a clinical service, to help build the education program, the training program. I ended up being a fellowship director for about eight years out of that time, maybe nine.

T. A. Rosolowski, PhD:

And just for the record, the years were ’88 to ’98.

Marshall Hicks, MD:

To ’98, yeah, almost—it was, yeah, a month or two over ten years, so it was a great experience, but it was extremely busy, particularly when you’re building a practice and you feel like you’re—I was the third person hired. The other person that was hired had just finished her fellowship that year, so we were two of us right out of fellowship. One person a year removed, but I think a common [in audible] for the—you know, it was an institution where a lot of the textbooks in radiology were written coming out of there. So you’re meeting all these people that you read their textbooks, you learned from them, they’re kind of the legends in their field. Yet I went there and it’s call me by my first name, helping, just really like I’d been there 20 years. So as a faculty member coming out of training, I just didn’t expect that. Also it was a culture that was just very welcoming and also taught me how—you end up saying, “well that’s what you expect, that’s what you want a culture to be like when you go somewhere else.”

T. A. Rosolowski, PhD:

Okay.

Marshall Hicks, MD:

And in training programs, I’d been in places that were friendly as well, but not with the reputation that this place had and yet, expecting that you were going to see a bunch of professors walking around that you had to call doctor and all that. It was like they were just very welcoming. I think also, the collaborative opportunity, because you’re still learning when you’re coming out of training. As one of three who were essentially right out of training, doing interventional, we kind of learned from each other, but we also learned from some of the more senior people that had been doing it historically but were no longer doing it. Just having them as a resource and having them as a resource on the imaging side too, it was really a great atmosphere, it was kind of an interesting time.

T. A. Rosolowski, PhD:

How was it different from what you had experienced? I get that there was an informality factor, but were there other surprises from your previous programs, the environments there?

Marshall Hicks, MD:

I think in some ways, not so much, which was part of the surprise, because the quality of the residence was very strong, probably higher than where I did my residency and fellowship, but not incrementally higher that I thought well this --because I realized radiology is very competitive in general, so a lot of places got really good people. So there were just some surprises like that. Now what was an interesting thing that happened when I was there was Mallinckrodt owned the technical and professional side, so all the procedures, all the revenue from the technical side was owned by Mallinckrodt and then we would pay the hospital a piece of that. Over time, that piece was getting larger and larger, from negotiations, to the point where eventually it was sold to the hospital, and Mallinckrodt just became sort of the professional side. Our appointment was actually at Washington University, and so faculty members at Washington University, Mallinckrodt was the Institute of Radiology that was formed and may have been the first. It probably was the first in the U.S., to really establish a radiology department. So it was interesting on the business side, to see that transformation and learn a little bit about that, and then see some of how that transition worked. And then to be able to come here, which is more of a model like it was originally, where it was all integrated and so we all worked for the same employer. It became a situation where the physicians worked for Washington University, everyone else worked for Barnes Hospital. So it was more the classic sort of situation where you have the hospital and the university not being under the same umbrella.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

So it was kind of interesting to see that experience and how that transitioned to there, and then you could see sometimes, the interests that aren’t aligned and some of how that gets worked through. But just being in systems that differ in understanding strengths and sometimes challenges of those. So I think it was, that was a time also when you come right out of training, you’re really focused on trying to get your career going and trying to figure where you’re going and your way around, and develop in the specialty and start getting involved in that. Less involved in the politics of the institution or the governance of the institution. Most of that is you know you’re kind of trusting that to others if you will and really focusing. I think that’s natural. So I’m not sure. I just got interested in the education piece and became the fellowship director and focused a lot on that. And some of the research side, but it was very educational from the standpoint of building the practice, because we went from what were really three of us, to by the time I left six, about to become seven and eight. Then went from one fellow a year to six. So it was rapid growth in volume. It was very busy, but you learned how to really run a clinical service, what it takes to be successful. We would round once or twice a day at least and the hospital was right next door. You’d run over and see the patients. We developed a clinic to see patients ahead of time. It was really the things that were changing in radiology to make it more of a practice, clinical practice, rather than a consulting service that just saw the patient only when they came for the procedure and that was it.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

So learning about all that and learning about how you—to me, it was just common sense of taking good care of patients helps build the practice, and being responsible and responsive, and develop in those relationships. Also, what was interesting, I had mentioned this before, but Barnes is kind of shaped like a long, a wide T. So short top to bottom axis. Or like a capital T but short on the stalk, and this long hallway, and at the crossroads there was the faculty lounge, the physician lounge. It was a big lounge and it was a great place to go to get coffee in the morning and bagels, and they had lunch there, so you’d go in and grab a cup of coffee in the afternoon. Just get away or something, but you develop the relationships. And developed not only referrals clinically but collaborations on the research side, and that was something when I came here, I realize I missed. And it was probably something that was an opportunity, from a cultural standpoint to—I think here, the analogy was the Faculty Dining Room on the—which floor is it over there?

T. A. Rosolowski, PhD:

In the Mayfair?

Marshall Hicks, MD:

In the Hickey Auditorium, right where the executive offices were and there was a cafeteria there. There was like a center table that was really long and big, and people kind of would go there to commiserate and talk and discuss.

T. A. Rosolowski, PhD:

Yeah, well those kind of the town square places, where people cross paths and things can happen.

Marshall Hicks, MD:

And then when that went away --actually I think the same thing happened here. You know, people felt they missed that, a lot of people missed it. But that was one thing that I had that was new to that environment, that I hadn’t had before. But again, I wasn’t a faculty member before, so I don’t know how much of that existed at the places where I trained. It was just that collegiality and the welcoming culture, and a high degree of professionalism that was there. The expectations of excellence in all areas, and respect. It was a great environment. I didn’t know how great it was at the time. Looking back, I realized that it was really a pretty exceptional environment and I don’t know if it’s still like that, hopefully it is.

T. A. Rosolowski, PhD:

Yeah, yeah.

Marshall Hicks, MD:

Things can change over time.

T. A. Rosolowski, PhD:

Was there anything that you, when you look back, you see yeah, I kind of learned how to do X there, you know? Maybe not, but I’m just wondering, since you went on to --so many of the themes that you mentioned with Mallinckrodt, are themes I’ve heard you talk about with what’s an ideal environment.

Marshall Hicks, MD:

Right. I think the big thing was the practice building and just what it took to provide great service and you’re responsive and engaging. That’s what we ended up doing here with interventional radiology. Because when I came here, I think I told you it was a rebuild. The former section chief had died and they were an old area. We were about to move into the new hospital, but that was a few months away, and it had just been kind of withering because they didn’t have leadership. People were getting ready to retire, leave, and so to really build that kind of practice and respect within the institution. It just took a lot of the same things that I had learned, so it kind of came natural. I didn’t have to figure it out.

T. A. Rosolowski, PhD:

Yeah.

Marshall Hicks, MD:

And as I brought people on and recruited people, tried to look for people that were similar, that were collaborative, that had sort of an aptitude for practice, development and responsible, that like kind of attracts like. And that’s why you look today, Interventional Radiology is a very strong service with incredible people. It’s just grown over time and it’s really been almost nine years since I was really a major part of it, so it’s just continued, but from that kind of nucleus that we built from the very beginning. It just grew from there, but it was the things that I learned at Mallinckrodt in terms of really just treating other colleagues, treating patients like you want to be treated --you know, the golden rule thing goes a long way. And then being willing to—you know part of what I learned there, too, was from a practice standpoint as a developing field, but learning your limits. Learning to understand the difference between really being a cowboy or a cowgirl and maybe being a little—exploring those boundaries in a wild way versus doing it in a collaborative way where you might be pushed to do something that is out of the ordinary or a little bit beyond, but it becomes the best alternative. So you’re doing it understanding that there’s a higher risk to a procedure in a certain type of situation, but that everybody has understood and talked about it. You figured out that this is the best opportunity for success for that patient. That’s something that I think you learn and you’re able to translate into other colleagues as you’re mentoring and developing them.

T. A. Rosolowski, PhD:

Am I imagining correctly, this sort of cowboy mentality, it’s kind of oh we can do it, therefore let’s just jump in and do it. Kind of an ego-driven thing almost, really not entirely about patient benefit?

Marshall Hicks, MD:

I think so, or the confidence, the kind of overconfidence that’s there. You know that, yeah, we can do anything, this shouldn’t go to surgery or this shouldn’t go for another alternative. It’s like we can take care of it, as opposed to this is a little bit out of—maybe it’s using a device in a different way, but you’re doing it because there isn’t really another good alternative as opposed to yeah, we can do this because we can do anything, sort of mentality. In a new field, in an evolving field, I think you’ll find those sorts of individuals. There were clearly --I would see it in our professional meeting --we talked about that coming up this weekend-- is you would start to see some of that at the meetings. You have to be careful in a specialty that’s highly technologically driven and innovative. To make sure you’re exploring those boundaries in a responsible way, I think is the best thing. So I was able to learn that and bring that here, with faculty members who are coming right out of training. To be able to try to help counsel them and help them understand that weighing the risk benefit and the alternatives and do it collaboratively.

T. A. Rosolowski, PhD:

Interesting, yeah. It sounds like you had some concerning situations.

Marshall Hicks, MD:

Well, I mean I think it was—oh, you mean of people maybe going beyond?

T. A. Rosolowski, PhD:

Yeah, doing that or just they were kind of the almosts?

Marshall Hicks, MD:

Almost and maybe observing it in other places. Like when you go to meetings and you see people that you can—and you can see-- some people have a little bit more of a bent towards that. But I think good people, the best practitioners, know their limits and understand their limits and understand when it’s appropriate sometimes to go beyond those limits. But it’s always when you’re considering the best interests of the patient. Sometimes that’s not the primary interest in people who are very innovative and are exploring a new field. They’re driving it because they want to drive the field. I think there’s a good balance that you have to strike when you’re pushing that edge. You really have to find it, because it’s reputation, right? I mean it’s one thing I learned at Mallinckrodt and brought here, is you earned your reputation every day on the clinical service and so you’ll be mindful of that.

T. A. Rosolowski, PhD:

And I’m sure that gets embedded into culture too and you’ve got people who can have a conversation about that and reinforce prudent behavior on both sides.

Marshall Hicks, MD:

Yeah. And I think also, one of the things I was able to bring here was the collaborative side. I mentioned that there were senior faculty members there who treated me like I’ve been there forever. The relationship we had with our technologists and nurses as faculty physicians was a similar thing, where it was a team based approach. Nobody was above helping getting a patient on or off the table, or going and getting a patient. Helping if transport was tight or something. It was just that spirit of really trying to work together as a team. When I came here, again it just was natural. It’s what I knew and it also was --to me seemed common sense. But I didn’t realize until later here, that that had set an example, and how important that was. Because that gets back to reputation, but it also gets to creating an environment where people want to work, want to be there, be a part of it.

Chapter 28: Experiences at the Mallinckrodt Institute of Radiology and Their Impact on Later Leadership (1988-1998)

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