Chapter 15: Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing

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Chapter 15: Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing

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Dr. Rodriguez begins this segment by explaining how conversations with the outgoing and incoming physicians-in-chief around she came to her role as Vice President of the Office of Medical Affairs. When Thomas Burke, MD [Oral History Interview] became physician in chief in 2004, her role was expanded to include medical affairs functions. She was officially named in 2005 with service to the present. Next Dr. Rodriguez notes that learned a great deal about Texas law and regulations of medical practice. She also had to familiarize herself with the roles of Physicians Assistants and Advanced Practice Nurses. Next, as an example of a function within Medical Affairs, Dr. Rodriguez talks about the process of documenting the credentials that physicians present for employment. She explains why this process is key to the reputation of MD Anderson. She also notes that employees have occasionally falsified documents.

Identifier

RodriguezA_02_20150306_C15

Publication Date

3-6-2015

City

Houston, Texas

Topics Covered

Building the Institution; Institutional Processes; The Administrator; Fiscal Realities in Healthcare; On Texas and Texans; Ethics; MD Anderson Culture; Institutional Mission and Values; The MD Anderson Brand, Reputation

Transcript

Alma Rodriguez, MD:

So I sort of came to this, my current job, in a roundabout way, and that once I stepped down, you know, after having been in this very intense furnace of the interim chair role, and I suddenly was—they hired the new chair, although I did become the Director of Clinical Research, and that in itself was—clinical investigation within the department, that in itself was another set of lessons. I really have always had my heart in the hospital side, in the operation side, and the professional aspect of medicine side. So I simply had had a conversation with a person who, at the time, was the Physician in Chief. And I had said, you know, there are opportunities for operation leadership. Keep me in mind, I’d like to step back into leadership in operations.

Tacey A. Rosolowski, PhD:

And was this still Tom Burke at this time? The Physician in Chief?

Alma Rodriguez, MD:

Well, it was kind of a—that was yet another transition period.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

The person actually was David Callender [MD, MBA, FACS].

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

But he knew he was leaving, so he introduced me to Tom Burke.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

Who he knew was probably going to be—so that was a very interesting transition experience as well, because Tom Burke’s role was an interim role. And he just asked me to take on some of his responsibilities so that I could help him do both jobs.

Tacey A. Rosolowski, PhD:

I’ll be interested to hear about that! (laughter) So, I mean, just let me ask you question. So you had this conversation with Dr. Callender. You know, obviously, he was very open to the idea of you taking on this role. And why, what did he see in you? I mean, because obviously, I’m sure there could be any number of people interested in this role. So why you at that time?

Alma Rodriguez, MD:

Well, I can’t answer for him. But I can tell you that one of the things that I did, you know, and my relationship with Dr. Callender had been in my job as the Medical Director—

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

Of the lymphoma section. I think I was the only Medical Director that would, on a yearly basis, send him a report. (laughter)

Tacey A. Rosolowski, PhD:

The importance of documenting.

Alma Rodriguez, MD:

Yes. I mean, I still have some copies of those reports. I mean, I took my job of, you know, observing what—remember I told you I would prepare these reports for my own peers.

Tacey A. Rosolowski, PhD:

Right.

Alma Rodriguez, MD:

So-and-so, so many patients, so-and-so saw so many patients, this is how many, you know, on Mondays the clinic is overwhelmed with patients, but on Friday we don’t have enough utilization of rooms. So let’s try to reassign people, you know. So I would send yearly reports to him of, you know, this year we met the goal of blah blah, however, we fell short of blah blah. Next year we need more of this, you know, so I was always sending him reports that sort of justified whatever it was we were calling—we were asking for. I kept track of what I did. So I don’t know if that had any influence, but certainly my name was known to him because I was sending him those reports.

Tacey A. Rosolowski, PhD:

Well, so it shows you’re kind of on the wavelength—

Alma Rodriguez, MD:

Yes.

Tacey A. Rosolowski, PhD:

—of sort of seeing things in a big perspective, and understanding the need to document of a wide variety of activities from different perspectives.

Alma Rodriguez, MD:

Yes.

Tacey A. Rosolowski, PhD:

Very interesting.

Alma Rodriguez, MD:

So my guess is perhaps that’s what he thought. I truly don’t know. Also, in my interim role as the chair, the transition for the department was really very challenging. There were lots of disruptions; I kept him and Dr. Kripke, who at the time was a provost, I met with both of them, apprised them of who were being difficult. We had had a challenge in the entire, well, the Leukemia Department had been shut down because their research protocols had been shut down because of some problem. So that brought the big light on lymphoma.

Tacey A. Rosolowski, PhD:

Oh, wow.

Alma Rodriguez, MD:

(laughs) So suddenly all the hematology services are being looked at really critically. So I met with everybody, we sent reports. If there were things that were found wanting, we corrected them. I mean, I was, I think by my directorship role and my obsession for reports served me well in that role, because, you know, I wouldn’t let things just sit. You know, if a response was needed to a certain thing that was brought to our attention, we would respond. I had a good administrator that was also helping me very much, certainly it’s not just me. But we tried to keep things afloat through that transition period of a few years. And the department survived. (laughs) So I think that was—he was also aware of that.

Tacey A. Rosolowski, PhD:

Yeah. Yeah.

Alma Rodriguez, MD:

So my guess is those qualities served to bring me to his attention.

Tacey A. Rosolowski, PhD:

It’s always good to be a cool head in an emergency! (laughter) So you stepped in as interim Director of the Office of Medical Affairs in 2004.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

And what did Medical Affairs look like at that time? Because I assume that in the last ten years, it’s gone through significant changes.

Alma Rodriguez, MD:

It has changed significantly, yes.

Tacey A. Rosolowski, PhD:

Yeah. So in 2004, was it—

Alma Rodriguez, MD:

Well, essentially, I mean, the only charge that, or the aspects of the office that Dr. Burke delegated to me because he actually stepped in an interim role, when Dr. Callender left. He stepped in as the Physician in Chief. He still had the title of Vice President of Medical Affairs. I was only a Director, he delegated to me the title of Director, meaning I wasn’t quite him. But I mostly focused—or he asked me to focus most of my oversight responsibilities to the credentialing privileging of Physicians to the Office of Credentials, and oversight of the Physician Assistant programs, which really there was no such thing as an office of Physician Assistant’s programs, they actually all reported to me directly. And I learned a tremendous amount about Texas law, of which I was very ignorant, I must say. Not mostly, but I had huge gaps in my knowledge; I knew some, I knew enough, of course, to run the department and the clinic. But I learned much more in-depth all the regulations of medical practice, particularly in a hospital setting, which are huge, enormous. I mean, I was just overwhelmed. To this day, I’m still over—I am amazed that we float. (laughs) We float, despite all the regulations. So I did a very in-depth learning of the laws and regulations that govern medical practice, I familiarized myself with what Physician Assistants were, the rules and regulations that govern them. I learned also a great deal about Advance Practice Nurses, because they were also privileged to practice at the hospital, so oversight—they are governed by a totally different board. Both Physician Assistants and Physicians are governed by the Texas Medical Board. But the Advance Practice Nurses are governed by the Board of Nursing. And oh my God, if the Medical Board has complex rules, the Board of Nursing is unbelievably more complex.

Tacey A. Rosolowski, PhD:

Can you give me an example of a rule that’s complex? Sort of amazingly so?

Alma Rodriguez, MD:

For nursing? No, I can’t—

Tacey A. Rosolowski, PhD:

Either one. (laughter)

Alma Rodriguez, MD:

I do not even want to remember reading all of that.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

OK? But so, in medical practice, for example, there is a whole list of rules about how Physicians or who is worthy of getting a license in Texas.

Tacey A. Rosolowski, PhD:

Oh, OK.

Alma Rodriguez, MD:

OK? You had to have gone to a medical school that’s recognized by the Board, you have to have had training, post-graduate training completed. You have to have confirmation of that training. In fact, you even have to have transcripts all the way back to high school to confirm you are who you are. You have to be in good standing. You cannot have any criminal activity, you know, etc., etc. It becomes really convoluted for people who come from outside of the state, and most—and largely so for people who are trained outside of Texas, outside of the U.S., OK? There are different kinds of licenses. And each of them has a different set of forms that need to be submitted. We have a number of people who want to come as visiting professors—well, they have to go through a certain set of paper trails that we have to manage for them. On and on.

Tacey A. Rosolowski, PhD:

I mean, I’m sure the legislature has one answer to this question, but I want you to answer this question. Why is that important?

Alma Rodriguez, MD:

Well, it’s important to safeguard the larger community, to ensure that, frankly, we’re not quacks. Because anyone can falsify documents, right? And in fact, it has happened. So I see why they have built all of those rules and regulations; I think in today’s environment of electronic databases and so on, it might make it simpler for the physicians to jump through all those hoops. But it has been rather difficult. I mean, I’m not kidding about you have to have your transcripts, your grades, your original diploma, your etc., to show the Board to get your initial license. Now, one you’ve gotten your initial license, then it becomes much easier. You simply submit a whole pro forma every so many years. It’s still a very large, long document. But thankfully they keep a template of what you submitted the last year, so you can copy it all over again, because things don’t change that much from year to year, right?

Tacey A. Rosolowski, PhD:

Right.

Alma Rodriguez, MD:

So but yes, so all of that. Now, internally, hospitals have to have, and it’s not just from the state, but it’s from the federal government. We have to have oversight of the credentials of individuals. So the state has its own rules for granting licenses and renewing licenses. Internally, each hospital has to have what is called a credentialing process. So that’s the office that I was overseeing, the Office of Credentialing. And we, ourselves, have to do due diligence. We have to track on national databases, the national provider database has to have any actions, lawsuits, loss of privileges, and other adverse events being reported for this particular person. We have to search criminal databases, has this individual been charged, not only criminal in terms of the state, for example, but also at the federal level. We have found cases, for example, where the FBI is investigating someone for fraud, or because of violations of narcotics prescriptions, or etc. You know, so we do occasionally find those. It’s rare, thankfully. It’s rare, but it does happen. We have had people send us false documents, and we confirm all of that. So somebody sends us a certificate for their board certification, we confirm that by going to the Board and saying, is provider so-and-so, certificate number so-and-so, certified by you?

Tacey A. Rosolowski, PhD:

Wow.

Alma Rodriguez, MD:

I this particular case, they said, “Oh my God, we’ve been looking for that certificate for years. Send it to us immediately.”

Tacey A. Rosolowski, PhD:

It was a stolen certificate? Wow!

Alma Rodriguez, MD:

So, you know, it does happen. So that’s the reason why there are rules like that. We wish humanity was peerless, and we wish physicians were above misconduct, but, you know, we’re humans.

Tacey A. Rosolowski, PhD:

Right.

Alma Rodriguez, MD:

So it happens.

Tacey A. Rosolowski, PhD:

And it does seem like it’s remarkably rare.

Alma Rodriguez, MD:

So and then, of course, we also look at the Texas Medical Board to see if any complaints have been filed by patients or peers against that individual. So we do all of that on a continuous—well, not a continuous basis, but on a yearly basis to ensure that everyone’s information is up to date. Now, it is then up to me, if those issues float up, then I communicate that, share that with the chairs of the departments and say, “Are you aware that this is going on?” Because remember I said it’s one of the toughest jobs, it’ll be that chair’s responsibility then to say how they’re going to address that issue. Now, some of those issues may, because of the bylaws or the rules and regulations of the state, or whatever, may end up in termination. That, again, is extremely rare. But it could be a consequence. So we don’t take this as a trivial exercise at all.

Tacey A. Rosolowski, PhD:

Right. Right. And a lot of states—

Alma Rodriguez, MD:

It’s very serious.

Tacey A. Rosolowski, PhD:

—in the United States. Yeah. Well, Dr. Rodriguez, we’re almost at noon, and I want to make sure you get to your lunch and meeting.

Alma Rodriguez, MD:

OK, thanks.

Tacey A. Rosolowski, PhD:

So why don’t we close off for today, and then I’ll look forward to continuing our conversation at a later time.

Alma Rodriguez, MD:

OK.

Tacey A. Rosolowski, PhD:

Thank you very much. And I am turning off the recorder at about 11:58. Thanks very much.

Alma Rodriguez, MD:

Thank you.

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Chapter 15: Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing

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