Chapter 14: Final Thoughts on Institutional Change and a ‘Job that Is Not My Life”

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Chapter 14: Final Thoughts on Institutional Change and a ‘Job that Is Not My Life”

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In this chapter, Dr. Baile talks about anticipating retirement and shares some final thoughts about MD Anderson. He notes that he is now in a “letting go processes” and wonders about the fate of the iCARE program he build, given the powerful effect of shifting institutional priorities. He notes how pleased he is that he has helped many people and has far exceeded what he believed he would do, though he does not want to continue to practice in the current institutional environment. He tells an anecdote to illustrate current culture, then offers some final words on his career a MD Anderson.

Identifier

BaileW_03_20160823_C14

Publication Date

10-25-2016

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Critical Perspectives; Leadership; Ethics; MD Anderson Culture; Post Retirement Activities; Critical Perspectives; Personal Reflections, Memories of MD Anderson

Transcript

Walter F. Baile, MD:

And it takes energy away from other things, and—so, you know, as I end my career here, which will be a year from January, I—you know, the letting go process is really a very interesting one.

T.A. Rosolowski, PhD:

Tell me about that.

Walter F. Baile, MD:

Because I’ve announced my retirement already, and, you know, the question of what do you invest in, and what do you not invest in, what kind of legacy do you leave to the institution, what can you do in the time that you have left. I decided to say I was going to leave a little earlier, because I wanted people to do the transition. So, you know, what’s going to happen to my program? It’s all unclear. Should I take any responsibility for what’s going to happen, or is that all up to other people? I mean, I’m sure they’re questions a lot of people face.

T.A. Rosolowski, PhD:

How are you thinking about the answers at this point?

Walter F. Baile, MD:

Well, you know, it’s—there are two kind of dimensions. One is the whole psychological issue of letting go, and the other one is the practical issue of letting go, you know, and what you invest in, what you don’t invest in. Are people interested, even, in what your thoughts are about what experiences you’ve had and what the institution might do with your work after you’ve gone? You know, I really don’t think it’s a big priority for our leadership. You know—

T.A. Rosolowski, PhD:

Yeah, do you have colleague standard-bearers for the iCare program or other initiatives?

Walter F. Baile, MD:

Who?

T.A. Rosolowski, PhD:

Yeah, so the answer’s no, yeah. (laughter)

Walter F. Baile, MD:

The only other person that could be a standard-bearer is 85% clinical.

T.A. Rosolowski, PhD:

Who is this?

Walter F. Baile, MD:

Danny Epner.

T.A. Rosolowski, PhD:

Okay. Why is that a problem? Is it a time issue, or—

Walter F. Baile, MD:

For whom?

T.A. Rosolowski, PhD:

For Danny Epner.

Walter F. Baile, MD:

He’s 85% clinical, which means he spends 85% of—what reserve do you have left after seeing patients four and a half days a week?

T.A. Rosolowski, PhD:

No, I get that piece. Yeah, I totally get the time piece. I’m just saying, the fact that he was 85% clinical, you know, means he’s a very powerful voice for the value of this clinical—in a clinical scenario, too.

Walter F. Baile, MD:

Now, why do you say that?

T.A. Rosolowski, PhD:

Well, you know, for people who are looking for justification, or for credentialing and—you know, I mean, that’s kind of the research model. What’s your proof? What’s your evidence? Do you speak about this from a position of authority? So I’m just saying that could be, you know—maybe I’m wrong.

Walter F. Baile, MD:

You know, in other words, how do you develop a compelling argument? You know, so, you know, again, this is a research institution. Now, JCAHO came in here and said, “Your communication skills program is woefully underfunded, and woefully underpromoted, and you need to do something about that,” there’d be a lot of resources given to that, right? But what are the external forces? You know, and how do external forces operate to make us change? Well, you know that patient safety and—patient safety and quality improvement have gotten a lot of resources. Why? Because of the fact that if we don’t give resource to those, they will get dinged all over the place by JCAHO, right?

T.A. Rosolowski, PhD:

Sure.

Walter F. Baile, MD:

But JCAHO was here and gone. Did they say one thing about educating the staff to improve their interactions so that patients are more satisfied with care? Not that I’ve seen. There is no pressure, you know?

T.A. Rosolowski, PhD:

Now, is that going to be hugely disappointing to you? I mean, say you hear a few years after you have retired that the program’s kind of tanked, because Danny Epner doesn’t have the time, nobody else has stepped up, and it’s sort of dissipating. You know, will that be—how will you feel about that?

Walter F. Baile, MD:

I’ll be too dizzy doing this stuff.

T.A. Rosolowski, PhD:

And you’re pointing at a photo. This is for the record. (laughter) Good!

Walter F. Baile, MD:

You know, you do what you can do in life. You know, I mean, I’ve never aspired to be famous, or to end my—I’ve been contemplating this a lot, you know, because some people who retire keep their fingers in stuff, you know? Because it’s the life mission. You know, if I had an opportunity to do that, and the culture changed, and someone said, you know, “We’re really going to get a new program, and we’d really like you to come, and do this and that and this,” sure, I’d love to come and consult and do that, okay, but I don’t think there’s much likelihood of that, also given our current fiscal situation. But I take a lot of, you know, a lot of comfort in the fact that I really—I’ve helped a lot of people. I mean, I’ve helped people become better doctors. I’ve helped patients struggle through their cancer, and keep their heads above water. So I don’t have any regrets whatsoever. I’ve been very successful as—you know, in terms of what—my career. And the place needs to do what it needs to do. It’ll go on in some kind of direction. I don’t know what, you know, and it would be nice if people saw this—I almost had a chance to go to Memorial Sloan Kettering, which has a much more developed communication skills training program, and I didn’t go. And they have a big infrastructure, because the communication program is embedded in the Department of Psychiatry, which had a lot of resources, and someone was recruiting me to direct it. And I didn’t go, one, because I didn’t want to live in Manhattan, and, you know, you’ve got the ones who commute two hours a day to live in Scarsdale. And, secondly, (laughter) you know, that—it’s—the people are scattered all over Manhattan. I mean, you’ve got to take a shuttle to get anywhere. We have shuttles now, too, but they’re only five minutes from one place to another. And I didn’t like the people that I’d have to work with, so I didn’t go because of that. And then they made a counteroffer here. But, you know, I’ve far exceeded what I thought I would be when I was a kid. I mean, I’m not one of those people who said, “I’m going to be great, and I’m going to be the person who invents communication skills.” So, I’ve had a lot of opportunities, and, you know, I grabbed at opportunities. And being a psychiatrist, it so happens that we are experts in communication skills, and so having—it was a natural flow of my career. And I don’t think I could see myself practicing outside of academics. So that’s been fun. I’ve had a good time, you know. And it’s hard to leave things behind. It’s hard to leave your colleagues. It’s hard to leave your connections with patients. But the fact is, you know, that at a certain point you kind of feel ready to go, and medicine is changing, and I don’t want to practice in this environment. I sit in my office, and I have to have, like I’m talking to you, my computer’s here, I have my fingers on the spacebar, so as not to be shut out of the computer by security every five minutes, and have to log back in, and turn my back on my patient. And who’s making those decisions? Legal.

T.A. Rosolowski, PhD:

Wow. I didn’t realize that that was going on.

Walter F. Baile, MD:

Well, it doesn’t go on in other clinics, because they don’t have a psychiatric practice, and when I went to my—to one of our leaders and said, you know, “Can we change this? Because—” “Oh, I don’t know, because it’s institutional policy.” So the institutional policy often overrides common sense. And I don’t want to practice like that, having to worry about logging in, and every five minutes logging back into the computer. And sometimes it just boots you out of one connect, you know, your Epic, and other times it boots you out of the whole computer. So not only do you need to log in to Epic, but you need to log back in to Windows.

T.A. Rosolowski, PhD:

Oh, gosh. It just does wonders for rapport with your patient. (laughter)

Walter F. Baile, MD:

Well, yeah, and, you know, I only practice one day a week. I can’t imagine if I practiced—if I had a four-day-a-week practice how—but this is sort of, you know, a little bit typical. And then they changed the travel policy, which used to be very generous. And now, if you have international travel, and you tack on vacation time to that, you’ve got to pay part of your own airfare. It seems like—and it’s funny, because the institution claimed that it was because of the IRS. I went and read the IRS regulations. There’s nothing there that says we need to do that. It’s because they wanted to save money, and if people had come out— And it drives me crazy when the lack of transparency—if people had just come out and said, “Look it, we cannot afford when you go on international trips to pay all of your airfare, even when you’re going on vacation, and that would be great. We want to recoup some of that money. That would be great.” But no, instead they got the accounting firm to say it was the IRS. The IRS exempts employees from that rule. The IRS rule is written for businesses, okay? So you’re a businessperson who goes on a trip for business, and then tacks on ten days of vacation, takes a lot of deductions for that. IRS said, “No, no, you can’t do that.” But I’m not—we’re not businesspeople. We’re employees. Employees are exempt from that rule. And we tried to argue that. And finally, what it came down to, the truth came out. And, you know, I don’t like that, if people are not shooting straight. So anyway, but that’s a minor thing. I mean, I think I’ve gotten a little more cranky in my, you know, older years.

T.A. Rosolowski, PhD:

You’re allowed.

Walter F. Baile, MD:

Huh?

T.A. Rosolowski, PhD:

You’re allowed.

Walter F. Baile, MD:

No, we’re not allowed. Really, we’re not, because, you know, I don’t think we should aspire to let people off the hook if they’re dissatisfied with things. You got to bite the bullet and find a way to work through it, and maintain your optimism in any way you can. But it is discouraging to see the way things are going. And I’ve never—and the people who make the rules aren’t necessarily the ones that take care of patients. So—

T.A. Rosolowski, PhD:

Is there anything else you would like to add, or—

Walter F. Baile, MD:

No, I, you know, I’d like to make sure that everyone knows—I’ve been here almost 23 years—that there’s no other place in the world like this place, and, you know, it’s been so gratifying to be able to help people in dire need, and to achieve the academic success that I’ve achieved—and would’ve liked to have done more. And, you know, I’m walking away kind of feeling there’s more I could’ve done, and, unfortunately, walking away at a time when we’re in the kind of crisis that it’s unlikely that’s going to happen. But, you know, I’ve got something to walk away to. And, you know, for me, my job is not my life. For some people it is, and that’s their identity. It’s not mine. And so I’m looking at new cameras, and I’m hanging my photographs around the house as decoration, instead of buying paintings of other people. And so, you know, it’s great to walk into my exercise room and have all my black-and-whites on the wall. That’s terrific. That’s my life now.

T.A. Rosolowski, PhD:

Yeah, it’s great to step into a new creative—have something creative to step into.

Walter F. Baile, MD:

Well, yeah, because, you know, that—you’ve got, I think—I’ve had a good run, and maybe, you know, that’s a little bit too kind of cliché for the movies in which kind of people are dying and saying, “I don’t regret anything.” No, I don’t. I had a good run. I had a great life, and great career, and this place has been extraordinarily supportive. And, you know, I’m not going to walk away bitter, because, you know, I’ve done a lot. But, you know, with a little bit of regret that things could’ve gone better, and maybe a little bit of questioning, well, did I not push hard enough, or make the right connections, or network enough. But, you know, in life, you can’t be perfect.

T.A. Rosolowski, PhD:

Walter F. Baile, MD:

Yeah. It’s the nature of creating new things: that you’re always learning on the job, so you do the best you can at any one moment.

Walter F. Baile, MD:

Yeah. So, that’s it.

T.A. Rosolowski, PhD:

Yeah. Well, I want to thank you for your time.

Walter F. Baile, MD:

You’re very welcome. You’re welcome.

T.A. Rosolowski, PhD:

I’ve enjoyed talking to you, and—

Walter F. Baile, MD:

It’s been interesting talking. I never thought I would talk this much.

T.A. Rosolowski, PhD:

(laughter) A lot of people are surprised that they find a lot to say, which is really interesting, yeah.

Walter F. Baile, MD:

Yeah, yeah, yeah. Yeah, especially if you catch them at a time when they’re in life transitions.

T.A. Rosolowski, PhD:

There you go. (laughter) All right, well—

Walter F. Baile, MD:

Well, if there’s anything that I can answer, you know—

T.A. Rosolowski, PhD:

Well, let me just say for the record—

Walter F. Baile, MD:

Thank you so much.

T.A. Rosolowski, PhD:

I’m turning off the recorder at 10:37. Thank you.

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Chapter 14: Final Thoughts on Institutional Change and a ‘Job that Is Not My Life”

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