Chapter 16: Changes at MD Anderson

Title

Chapter 16: Changes at MD Anderson

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Description

Mr. Stuyck gives an overview of the changes he has seen at the institution over the course of his career. He notes that people in the past worked just as hard as they do now, but worked differently. He talks about the dramatic expansions to ambulatory care and patient care in general and the improvement of quality of life issues for patients. He makes some observations on cultural changes and the increasing interest in work/life balance. He then talks about the plan to merge the University of Texas Health Science Center with MD Anderson, a move that was resisted to preserve the institutions mission and resources.

Mr. Stuyck also talks about changes that Dr. John Mendelsohn brought to the institution, particularly the dramatic growth, for which the institution is now paying the price, he says.

Identifier

StuyckSC_03_20130627_C16

Publication Date

6-27-2013

Topics Covered

Building the Institution; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Patients; Controversy; MD Anderson Culture; MD Anderson History; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Offering Care, Compassion, Help; Cancer and Disease; This is MD Anderson; Personal Reflections, Memories of MD Anderson; MD Anderson Past; The Business of MD Anderson

Transcript

Steve Stuyck, MPH :

You know, MD Anderson today is a wonderful place with very hard-working individuals. But the truth is, that MD Anderson has been a wonderful place in different ways in many years past, and there were many, many people who worked every bit as hard as the people do now. They just did had a different set of tools than we have now. There was no human genome mapped, and there was no electronic medical record, and there were a lot of things like that. But they worked just as hard and just as long as people do today.

Tacey Ann Rosolowski, PhD:

I was wondering if you could comment a bit on those changes that you’ve seen. And you can interpret that question very broadly or however you would like. Steve Stuyck, MPH Well, I’ll just mention a few things that occur to me, and this may be repetitious of things I’ve said in our other interviews. When I first came here, I arrived thinking MD Anderson was a great place. Certainly a place I had heard of in my childhood and it was. There were lots of great stories about it even then. I felt that—looking back, not at the time, but looking back I was impressed with how kind of a bus station look the place had to it. The clinic lobby was jammed with people all sitting in chairs, row upon row. I think the first great change I noted was the expansion and ambulatory treatment that when I first came here, there was one room with chairs and one room with beds that we called Station 19, which was the ambulatory treatment center and it has grown remarkably. So much care is offered in the outpatient setting that didn’t exist when I was first here. That was one thing I noticed. Another change was the great improvement in the quality of life issues. The antiemetics didn’t even really exist when I first got here. There was constant talk all the time about nausea and vomiting as an outcome, sequela of radiation therapy and chemotherapy. That whole field didn’t exist and has made tremendous changes. I’m sure therapy is still often unpleasant, but not like in the drastic ways it used to be. When I first came here, there were four protected environments, which we called Life Islands, which were beds enclosed in clear plastic bubbles. And now a lot of immunotherapy and transplants are given on an outpatient basis. A lot of things like that that came along over a period of time.

Tacey Ann Rosolowski, PhD:

I was going to ask you if you had observations about shifts in the culture or the kind of work environment. Steve Stuyck, MPH Well, we certainly didn’t have as much as focus on work/life balance and benefits and things like that as we do today. I got my five-year pin when they first started Surface Awards. We had this barbecue lunch in the HMB Lounge with paper tablecloths and things like that. It was like a big deal to be doing something like that. Now the whole focus on work/life balance is a tremendous change. There was a big drive underfoot at one point to merge the UT Health Science Center with MD Anderson—a serious drive in the mid-1980s. The Health Science Center was pleased to consider because MD Anderson was the cash cow with a lot more resources than the Health Science Center. We even had faculty and staff committees fighting it all the way up to the Board of Regents. I remember when Jack Blanton, a member of our Board of Regents, came to MD Anderson to talk with our faculty leadership and try to reassure us that the goal was not to merge the two institutions as much as to seek some economies of scale. Like the UT Police Department that serves both institutions. There was a big drive to try to merge a number of functions which we successfully resisted.

Tacey Ann Rosolowski, PhD:

Why? Steve Stuyck, MPH Why did we resist it? Typically, oncology is a discipline that is merged into several medical school departments, not a stand-alone discipline. You find it in internal medicine, you find it in surgery, and places like that. We thought that merging the two institutions would dilute the mission of MD Anderson and also dilute our financial resources, which were significantly greater than the Health Science Center. Even then, we had a lot of patient revenue that they simply didn’t have at the medical school, because it was Hermann Hospital that was taking that patient revenue. So that was I think the main—there was a lot of anxiety about that.

Tacey Ann Rosolowski, PhD:

What about the changes that came after Dr. Mendelsohn arrived and there was just an enormous expansion in the institution? What changes did you observe over the course of those years? Steve Stuyck, MPH I may have talked about this in earlier sessions, Tacey, but John Mendelsohn was from New York and from two excellent institutions, UC San Diego and Memorial Sloan-Kettering, and he had—there was kind of a Texas focus on MD Anderson in the LeMaistre years. Not so much a national one and Mendelsohn had a lot of ideas. He felt that if MD Anderson was to be a national resource and international resource, we should act like one, and we deserved to be one. So he focused a lot on our national image, on our national fundraising, and he also focused a lot on upgrading our research departments. He had had a decent amount of clinical exposure in his career, much more so than Dr. DePinho, and he had pretty good appreciation of the clinical activities of the institution, so he promoted that as well. He did a very good job of being a President of all of MD Anderson, all aspects of it.

Tacey Ann Rosolowski, PhD:

Uh-hunh (affirmative). How did you experience the changes in just the size, the scale? Steve Stuyck, MPH Yeah. The growth was phenomenal in his years. It really was. When I look back on it, I can’t believe. This is—

Tacey Ann Rosolowski, PhD:

The numbers are staggering. Steve Stuyck, MPH We had a display area on the second floor of the Alkek Tower, which we called the McGovern Visitor’s Gallery. It may have already been taken down by the time you were there. It was a big historical display and things about our mission and that sort of thing. Are you familiar with that at all?

Tacey Ann Rosolowski, PhD:

No, I’m not. Steve Stuyck, MPH They had to take it away to make way for the elevator lobby which now stands where it—to the second high rise part of the Alkek Tower, and we had a dedication and a Board of Visitors meeting of this new Visitor’s Center, and Dr. LeMaistre were walking through it, and there was a panel, and it said something like, that MD Anderson has 10,000 employees. And Dr. LeMaistre very legitimately said to me, “Steve, that can’t be right. Is it?” Because when he had left just a couple of years before, it had been like 8,500 employees, and in the Mendelsohn years, we went to—now it’s about 20,000 employees almost. I think Mendelsohn saw many opportunities and that’s why the growth was as it is now. Now in a way, I think we’re kind of paying the price for it now, that we’ve got a lot of construction and a lot of people, and I don’t know how to—what the future holds in store for that.

Tacey Ann Rosolowski, PhD:

What do you see as being the issues there? The problematic issues there? Steve Stuyck, MPH MD Anderson has a budget of about $3.5 billion. Somewhere in the neighborhood of eighty percent of it comes from clinical revenue. We talk about philanthropy. We talk about research grants. But the truth in fact is that we do many, many things on the back of clinical revenue. Not only do we pay for the patient care, but we build buildings and we hire people, and my salary really comes from that, and many others. So, there’s a lot of stress here, because we encourage the clinical faculty to do more patient care, to continue to research, to do other things, and we look to that revenue to support many worthwhile endeavors. It’s a real challenge. Mendelsohn said to me in private—I think he meant it—we were chatting just as he was getting ready to retire or step down, and I said to him, and there were some of these about revenue coming up, and I said to him, “You know, in many ways I think you got here at just the right moment and you’re leaving at just the right moment.” And he said, “You know, you’re exactly right.” And he—when he arrived, it’s a great story and true, he chose to reinvigorate MD Anderson with more cash rather than to continue to cut as they had at the end of the LeMaistre years, and they had a great effect. It worked. I mean it was—the Wall Street Journal had a page-one story about the economic turnaround of MD Anderson about 1998 or ’99, and it just—he was a very lucky guy. He had great insights and ideas, but he had a lot of luck on the side as well.

Tacey Ann Rosolowski, PhD:

I wanted to ask you now about—

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Chapter 16: Changes at MD Anderson

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