Chapter 16: Financial Stress, Satellite Services, and Changes to MD Anderson Culture


Chapter 16: Financial Stress, Satellite Services, and Changes to MD Anderson Culture



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In this short section, Dr. Bruner recalls the early nineties, when managed care put the institution under threat and the Department had to fire 25% of its employees (including some faculty). The notes how Dr. John Mendelsohn's reaction to the financial stress was different from Dr. Charles LeMaistre's, and Mendelsohn "exploded us out of the doldrums." She also admits to nostalgia for the smaller MD Anderson. She also has some questions about how well quality of service can be maintained at MD Anderson's satellite locations, where analyses are made by general pathologists, rather than subspecialists.



Publication Date



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


Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; MD Anderson History; MD Anderson Culture; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Critical Perspectives on MD Anderson; The Business of MD Anderson; Beyond the Institution; The Healthcare Industry


Tacey Ann Rosolowski, PhD:

Coming back again to the transcriptionists and now with the frozen sections.

Janet M. Bruner, MD:

But we—our department grew and of course the institution grew. We had a really bad downturn in 1994 where managed care, we heard, was encroaching upon us from the West Coast and that our reimbursements were going to go down, our work was going to go up, everything was going to be horrible. The healthcare system was going to crash. There was a guy in Austin named John Sharp, and there was something called the Sharp Report. I remember that. And I think it’s the same Sharp that’s still there. I think he’s still kicking around the legislature or UT system somewhere. Because of the Sharp report, there was a huge initiative, a belt tightening initiative, and we actually fired a lot of employees. I think it went—we may have fired as many as a quarter of our employees. It was said—and I think it’s still said—that no faculty were fired, but that’s not true. I know of at least one faculty in our department who was let go and another one who was the next thing to it. We had to put part of his salary on research funds instead of on state funds. It was a really bad scene, and it was a very depressed time. The employees who were here at the time still talk about that. It’s still as fresh in their minds as if it happened yesterday, and it’s almost twenty years ago. I could be fired for no reason just because of this. It’s—it was really terrible for morale. It was just awful. That was during the transition time I think between Dr. [Charles] LeMaistre and Dr. Mendelsohn, and Dr. Mendelsohn came on right after that. It was so amazing and just uplifting that his whole attitude was not that we need to contract, but if we’re going to be on tough economic times, we need to expand. We need to get more patients coming here. What can we do to grow the patient population so that our people can work and so that we can hire more people, do more things? He was all about growth, and I think that just exploded us out of this doldrums that came with the Sharp Report. That was the greatest thing about Dr. Mendelsohn. He said, “No. We’re not going to contract. We’re not going to get smaller. We’re not going to do this anymore. We’re going to grow.” There’s two ways that we can handle this. Yes, that is—that’s one way. We can shrink. We can hunker down and just become this little cancer hospital. Or we can think big, grow the patient population, get more people in here, make more alliances with insurance companies, and grow. It was—the expansion was tremendous. It was a great thing for us, but that also is, I think, what—now you hear people look back and say, “Oh, gosh! I wish we were smaller! I wish it was like when we were smaller and we knew everybody and we all met together,” but now you can’t possibly know everyone. We’re too big. We’re just too big. I think that when an institution passes a number of employees—and I think it’s around 10,000—when you’re more than 10,000 employees, you’re not a mom and pop shop anymore. Now you’re a big business, and that’s what we are now. So for better or worse, I think we are, and it means there’s more rules. People can’t violate the rules, and they shouldn’t be allowed to. There’s more processes that have to be done just a certain way. Compliance is an issue. That started up, too, around that time. It was around the mid-90s—institutional compliance initiatives and so forth. But that’s what the growth of the institution just meant, that we’re just big. We’re no longer intimate.

Tacey Ann Rosolowski, PhD:

What about your view of how that growth can have an impact on patient care? And I’m thinking here in particular with the outreach programs—having the satellite MD Andersons. What’s your feeling about the value in those, the pros and cons, how the MD Anderson identity or brand, if you will, can be preserved through that kind of growth?

Janet M. Bruner, MD:

I have a lot of mixed feelings. I know why we’re doing it, and I do think that the patients out there in the suburbs really like it, and I do think it gives us an opportunity to reach more patients who just couldn’t physically travel here or wouldn’t travel here, and they get a quality of care out there in some areas that is equal to what we have here. They started as radiology oncology outpatient centers, and I think that is one type of care that can be offered with a similar quality to what we have here, and particularly I’m thinking of breast cancer patients. There’s so many of them and it’s usually women who aren’t—women who are in their forties and fifties who may have kids at home or teenagers, and they need to be closer to home, and so I think that is a really good thing. At the same time, I do worry about the brand. I worry about the quality. I know as far as pathology is concerned, the pathologists out at those hospitals are not subspecialized. They are not as expert as we are. They are making diagnoses, and we’re not sure always that it’s the same diagnosis we would make. The disturbing thing to me is that the leadership of MD Anderson doesn’t seem to understand that. We tell them that. We tell them that every time we meet, and they don’t want to hear it. “No, no. The quality of care out there is the same as it is here,” and we say, “No, it’s not.” I have ten breast pathologists. The Sugar Land hospital has a total of two pathologists—or Woodlands hospital has a total of two. They don’t have ten breast pathologists. “But we’ll just send a breast pathologist out there.” I said, “No, it’s not the same, because the breast pathologist here has nine colleagues to help them out if they run into trouble.” It’s just—the milieu will never be the same. I don’t know how bad that is. Obviously it can’t be a disaster, or a disaster would’ve happened. It’s disappointing to me that the leadership of MD Anderson doesn’t seem more cognizant of the important role that pathologists play, because until you have a correct diagnosis, you can’t treat the cancer. So is it one out of ten? Is it one out of twenty? Is it one out of 100? I don’t know.

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Chapter 16: Financial Stress, Satellite Services, and Changes to MD Anderson Culture