Chapter 18: Key Periods of Change at MD Anderson

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Chapter 18: Key Periods of Change at MD Anderson

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Dr. Yung offers his perspectives on periods when MD Anderson has undergone large changes. He first discusses Dr. Charles LeMaistre's role in handling the HMO crisis in the early nineties. He next talks about Dr. John Mendelsohn's in setting the institution on "an upswing" of growth and corporatization. He describes how hard it is to manage growth so the institution remains true to its mission of delivering research-driven care, rather than deviating and increasing patient care to generate income to sustain the institution. He notes the pressure and debates that come each year with requests to see more patients, cut back on expenses. Dr. Yung then talks about Dr. Ronald DePinho, who came in "with a good heart and an insightful" view of how to elevate MD Anderson to a position of making an impact on specific cancers. He explains that Dr. DePinho has brought in necessary change, notable addressing complacency and a lack of productivity among the faculty. He says that Dr. DePinho has yet to address the need for investment in infrastructure for clinical research.

Identifier

YungWKA_04_20140707_C18

Publication Date

7-7-2014

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 - Institutional Change; The Administrator; Institutional Processes; MD Anderson History; MD Anderson Culture; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Controversy; Understanding the Institution; Critical Perspectives on MD Anderson; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Business of Research; Fiscal Realities in Healthcare; 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.

Disciplines

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

Transcript

Tacey Ann Rosolowski, PhD:

I wanted to ask you about --- just some general questions about the institution. One of them is kind of, we talked about a big --- a key moment of change in the institution when the division system came in you know and how that got reorganized and you told me about that. I’m wondering if there are some other moments that you can identify in your career at --- at MD Anderson where there have been some really big changes in --- in the institution and you know how you saw that change?

Wai-Kwan Alfred Yung, MD:

Well, I --- Dr. LaMaistre not only engineered the division concept. I think Dr. LaMaistre is also very instrumental in --- in handling you know the assault of you know the first healthcare change in terms of with the insurance changes from --- from the managed care. In ‘99 --- I mean I remember in 1992 and 1993 managed care concept comes in and says it’s going to switch to Houston, Texas and we’re gonna be --- MD Anderson is doomed. I think Dr. LaMaistre was really instrumental in --- in --- in preparing for that change especially getting the legislature to approve the new law that MD Anderson no longer functioned under referral system but MD Anderson can take patients directly. And this I see change law that allowed the survival of MD Anderson and allowed MD Anderson to grow and --- and --- and --- and that --- that gave MD Anderson new life. Then Dr. Mendelsohn came in in 1996 and bring that growth curve into the next level.

Tacey Ann Rosolowski, PhD:

Can I ask you, I mean you mentioned Dr. LeMaistre [Oral History Interview] a number of times and I’m wondering did you have a working relationship with him?

Wai-Kwan Alfred Yung, MD:

No. Not really. It was mostly just a --- a rapport as the president.

Tacey Ann Rosolowski, PhD:

Right, right because I was wondering about your observations and what kind of a leader he was and what kind of a --- an individual.

Wai-Kwan Alfred Yung, MD:

I mean I --- I get to know Mickey [LeMaistre] because he was very interested in the brain program and so I interacted with him eith the different levels in the department and the growth. But --- So --- And I especially in working with Dr. ______ () on the global expansion that was started by Dr. LeMaistre That’s --- That’s --- That allowed me to talk to him some more. But these are the observations in terms of the critical moments for --- of MD Anderson and what Dr. LeMaistre done and just like you know Dr. Mendelsohn pj[o . With Dr. Mendelsohn the --- the --- The clear change that Dr. Mendelsohn brought in is riding on the upswing and I think he skillfully bring that upswing --- continued upswing and actually changed the angle of the upswing even faster. And I mean the first 10 years of Dr. Mendelsohn’s tenure was a rebuilding, one building after another building. I mean all these infrastructures is built by Dr. Mendelsohn.

Tacey Ann Rosolowski, PhD:

Were there changes that you saw to the culture as a result of that enormous expansion?

Wai-Kwan Alfred Yung, MD:

There are certainly changes in cultures I mean I think whether we like it or not when the organization gets bigger more people come in and it becomes more of a corporation instead of a family business. You know when it was small it was a family business and we know each other and --- but when it becomes big, it becomes a corporation and now we have multiple layers, you know. So I mean that’s the change. I mean with the increase of the size of the organization, the number of buildings, the number of programs, you have more administrators. Even though Dr. Mendelsohn say well we can limit our administration but there are unavoidable changes. There are also more vice presidents and more administration.

Tacey Ann Rosolowski, PhD:

Right. What are the pros and cons of that?

Wai-Kwan Alfred Yung, MD:

I mean you need growth. I think the --- the --- the challenge is that what we see you is a --- whether we are growing with a deviation from our base mission of research --- research-driven care as opposed to the growth of patient care for, you know, generating patient income to sustain the organization, which is --- which is a fine line. Because if we keep growing and we need to sustain the growth by patient income, when are we going to stop? Or is there a fine --- Or is there a fine line --- a moment where you sustain and say enough is enough because we really need to come back to say the kind of research knowledge that we have really has --- has to be --- has to have time to grow and have to have support so that we have the input into the pa --- clinical care and not to just grow in the clinical care without the research support.

Tacey Ann Rosolowski, PhD:

What were some signs that you see or have seen, you know, as chair of the department that that fine line is --- that the institution is dancing around that line?

Wai-Kwan Alfred Yung, MD:

It’s dan --- dancing around the line all the time because we --- as Department Chair --- as the administration grows, the department becomes lower and lower in the administrative level. Department Chair is a midlevel manager just like you know director of the janitor. Not a whole lot more power. You know, now if I want to hire another faculty I need to go “Mother, may I? Give me the money. Give me the approval.” So it’s --- if you go up here it becomes smaller and smaller down here. As you move more emphasis on generating the number of patients which we are going to see every year as we see more patients and see more patients, then we have to say, “Well give me more faculty to see more patients.” “No, you have enough faculty, you don’t need any more.” And it’s always a constant argument. “No, I need faculty to research.” “No, you don’t need faculty to research.” Just you know we cannot afford it. I mean you have this constant back and forth argument. Sometimes it’s more successful because it’s, you know, if my voice is stronger than I get more but my colleague’s voice is not as strong as me, he get less.

Tacey Ann Rosolowski, PhD:

Interesting, huh. What were some other --- have been some other moments? I mean John Mendelsohn brought in this expansion model. I mean I’m thinking obviously there’s been a big administrative change right now but maybe between you know and --- are there others between John Mendelsohn, you know, the big expansion. Were there other aspects of change in the department during John Mendelsohn’s administration that you could identify?

Wai-Kwan Alfred Yung, MD:

No. I mean, I don’t.

Tacey Ann Rosolowski, PhD:

That was a big one? The growth? Yeah. What about with --- now with Dr. DePinho [Oral History Interview] coming in? What have you seen or observed in the institution?

Wai-Kwan Alfred Yung, MD:

Well, I mean I think you know you --- you hear all these noises internally as well as externally. I mean I think, you know, Dr. DePinho came in with a very good heart and very you know insightful observation that in --- that one way to really put Anderson in the next level is that we make some big impact in certain cancers. But the question is how do we do it? Whether there’s big advertisement on Moon Shot. Whether by recruiting some --- some well-known scientists. Whether by, you know, looking at the internal people, how many you know have been productive and not productive. These are you know necessary change and I think you know there is a certain level of complacency among the faculty as we grow you know with --- with --- with the golden era of Dr. Mendelsohn. And when you --- when --- when the new person like Men --- DePinho comes in and say now this is --- we are going to bring in some --- a --- a new group of scientists and laboratory scientists that are well-known in the country and replacing you know some of what he consider not very productive, it’s painful. You know I think that’s where the noise comes from. You know, the change comes in. And you know he may have done it in a way that has you know --- that --- that has opened himself up to a lot of criticism. But I think the change is needed. You know I think he went on realized that we had grown too complacent. We had a group of faculty that really not performing up to par. The clinical research you know infrastructure needs more investment. I have not seen Dr. DePinho tackle that piece yet. He’s tackling some more of the organization with some of the scientists bringing this --- and --- and Moon Shot but he has not really tackled the clinical research infrastructure. Not yet. But I think what he wanted to do, his vision, is correct vision. The way that he has been doing it in the last three years has generated a lot of pain in some group and a lot of un --- you know uncertainty in some group. But I think that’s necessary pain.

Tacey Ann Rosolowski, PhD:

Growth is --- always hurts.

Wai-Kwan Alfred Yung, MD:

And I think both sides have to learn. He has to learn to how to really deal with the faculty. You know and get the faculty large support and so that he’s get the faculty large support and not to be affected by the smaller faculty and the --- the unsettled ones.

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Chapter 18: Key Periods of Change at MD Anderson

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