Chapter 29: Changes at MD Anderson Under New President, Ronald DePinho

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Chapter 29: Changes at MD Anderson Under New President, Ronald DePinho

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Dr. Benjamin begins this chapter on change by noting that Dr. John Mendelsohn served as president. He explains that Dr. Mendelsohn brought an emphasis on scientific accomplishments of the faculty, in addition to clinical work and patient care. Next, Dr. Benjamin offers "the perspective of a clinician" on changes that have occurred since Dr. Ronald DePinho took over as the fourth president of the institution. He explains the revenue-generating burdens that have been shifted to physicians to pay for research and a growing administrative structure. He then talks about the deterioration of morale among clinical faculty, who feel they must meet quotas rather than focus on delivering optimal care for patients. Dr. Benjamin next talks about the institution's budget process to explain the broader arena in which the rift between the faculty and administration came from. Dr. Benjamin then gives his view of what the current situation means for MD Anderson's future. He explains that he has "always felt that MD Anderson would succeed despite its leadership," but this depends on a committed faculty. Dr. Benjamin says that he feels his time would be better spent teaching young faculty and gives examples of the training he would provide.

Identifier

BenjaminR_03_20150306_C29

Publication Date

3-6-2015

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Critical Perspectives; Institutional Mission and Values; MD Anderson Culture

Transcript

Tacey Ann Rosolowski, PhD:

Okay. Yeah. Well, I wanted to ask you some questions about institution change, because since 2011, when John Mendelsohn left the institution, and we have a new executive leader, Dr. DePinho came in, who has changed the executive leadership of the institution, MD Anderson has been going through a substantial period of change. So what I’d like is kind of your impression, you know, on what MD Anderson was before that period of transformation and what you see kind of shifting in the institution.

Robert Benjamin, MD:

So I think some of the shifts actually started during the time that Dr. Mendelsohn was the president, and he certainly brought in an emphasis on the scientific accomplishments of the institution as opposed to just the clinical and patient-care accomplishments. When Dr. DePinho came, at least from the point of someone on the clinical side of the street, I think the pendulum swung far towards let’s develop the institution as a world-class basic science institution, and, oh, by the way, there’s a hospital associated with it that can help to pay for this research.The financial strain that’s being placed on the physicians to generate more and more revenue to help support either the research or the burgeoning administration has resulted in a very different atmosphere among the clinical faculty. So rather than working to try to help the patients that they see and optimize the care of every patient that they see, I think they all feel compelled to meet certain quotas of productivity which are defined as dollars. So as a result, I think the quality of care that goes into each patient has gone down. Whether by sacrificing quality a little bit but spreading it over more patients we’re doing more good is debatable, but I think many clinicians feel that it really doesn’t matter how good they are or how well they care for the patients; it simply matters how many patients get billed. So that’s led, I think, to a significant deterioration of morale of the clinical faculty. I can’t speak for the research faculty, but I think many of the research faculty that I’ve heard, the small sample that I see also sort of feel that they’re second-class citizens, because it’s the people brought in by DePinho are given much more in the way of resources and compensation, and some of them are very, very good, but some of those who were there before were also very, very good. But you’d have to talk to them more to feel out what their concerns are. But I think I can reflect the clinical side pretty accurately by saying that there’s a lot of discouragement.

Tacey Ann Rosolowski, PhD:

What do you identify as the sources of the tension? And here I’m asking more like is it communication, is it basic value system? I mean, I’m asking that kind of a question. Where did the break come?

Robert Benjamin, MD:

It’s very hard to answer. I think there has been for a long period of time, not just after Dr. DePinho but before, for several years, the budget process is a top-down-driven system that really doesn’t make logical sense to me. As a department chair, I had very little say on anything related to the budget. I was simply given a small amount of money to divide among the faculty members, said, “Here, you do it. Here’s the amount that you’re going to get as an increase. Figure it out.” We were asked to project how many patients we were going to see, and we would put in a number and say this is what I think we can do, and then we’d get back a request from the division saying, “Well, the division has been given this assignment, and so in order to do your part, these are the numbers that you have to put into your budget.”

Tacey Ann Rosolowski, PhD:

And what you’re referring to is basically the request for clinical hours to general revenue?

Robert Benjamin, MD:

Right. It’s how many new patients are you going to see, and it’s like how many can we see? This is how many we can see. Oh, sorry, the answer is really 50 percent more than you project, because that’s what we need to put into our budget to make the projections work, because we want our budget to be this much more than what our last year’s one was. And somehow they always managed to make what was projected, so they always said, “Okay, well, see, it works. We can do this, so therefore let’s ask for more.” But everybody is thinking that each year it becomes less and less realistic.But at least, again, when I was department chair, I’d do my annual evaluation of the faculty, and faculty would put in how much time they thought they were going to spend clinically and how much research and how much whatever, and it was rare that I would think that I would try to readjust their percentage effort. Now you’re told, “Oh, no, you can’t do this much. You have to be this much clinically, because that’s the only way we can work on justifying generating the numbers that we need to generate,” of whatever.So it’s gotten to the point where several faculty members have just decided that it’s not worth it. They came here to be doing something different from that, and if they can’t do what they had wanted to do here, they’ll try to do it somewhere else. So I haven’t seen this much disquiet among the faculty that I can remember during the time I’ve been here.

Tacey Ann Rosolowski, PhD:

What do you think all this situation now means for MD Anderson as it evolves?

Robert Benjamin, MD:

I don’t know. I’ve always been of the impression that MD Anderson will succeed, despite its leadership, because of the quality of the faculty and the commitment of the faculty. But that requires that the faculty retain their commitment, and so it’s hard to say. I mean, my feeling for myself, for example, is that I would be a lot more effective in spending more time teaching younger members of the faculty some of the things that I’ve learned than in seeing more new patients myself, but I can’t adjust my time to be able to do that unless I retire, and then I can do it because I can voluntarily spend the time. But that’s not the way I think it ought to evolve. It ought to evolve that the department chair should be able to figure out how optimally to divide up the responsibilities of his faculty and not be told, “Oh, no, this is a clinical position. There has to be this much revenue associated with it.” Or not even revenue, because it’s new patients associated with it. So that’s a discouraging situation.

Tacey Ann Rosolowski, PhD:

If you had the time, what is it that you would teach the young faculty?

Robert Benjamin, MD:

Oh, you know, I mean, we see all these patients with weird sarcomas, and a lot of them, you know, will come in and they’ll come to our Center, and it’s one of the few Sarcoma Centers in the world, and they’ll come in with this weird diagnosis, and nobody’s ever seen one. I may have seen a few, but at least I know that much more than the other guy. But there are subtleties in just dealing with how best to manage different clinical situations that you learn over time, and it’s solely to rediscover the wheel.

Tacey Ann Rosolowski, PhD:

Right. Is it something you could give me an example of? I mean, sometimes I know that’s tough, but—

Robert Benjamin, MD:

So a patient came in the other day to see one of our new faculty members who had a—not so new, but young faculty members who had a patient with an epithelioid sarcoma, and the patient had had some treatment before at Sloan-Kettering and treatment somewhere else with her local physician, and came in and basically said, “Well, you know, I really don’t know. I’m not sure there’s anything more to be done for me, and I’m happy to sort of go along but just wanted to check in to see.”We basically said, “Well, we can send you to our Investigational Therapeutics Group and do some testing on your tumor and try to figure out what to do.” But the patient hadn’t had the treatment which is the single most effective treatment for that tumor because nobody knows it exists.

Tacey Ann Rosolowski, PhD:

Oh, my gosh.

Robert Benjamin, MD:

There’s only one publication that even mentions it, and that’s in a small journal, and I only know about it not because of the publication, but because I’ve seen a couple of patients and had some astonishingly good results with one of our regimens that this patient hasn’t had. But I’ve had several cases where that’s what happens.

Tacey Ann Rosolowski, PhD:

So this was a treatment that was perfected here at MD Anderson?

Robert Benjamin, MD:

No, it’s a treatment that other people have used in a number of different situations. It’s just nobody has put two and two together and realized that it’s particularly effective for this unusual subset of patients with sarcomas.

Tacey Ann Rosolowski, PhD:

Wow. Huh.

Robert Benjamin, MD:

So that’s the sort of thing.

Tacey Ann Rosolowski, PhD:

Yeah, yeah. So what’s the lesson for a young faculty member to learn from that situation? I mean, I’m like astonished or amazed, but if I were the young faculty member, what would you want me to take away from that?

Robert Benjamin, MD:

Don’t try to do your own literature search, which will be a waste of time. Ask somebody who has actually seen the disease. There are only a few cases. There are only a few patients I’ve seen.

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Chapter 29: Changes at MD Anderson Under New President, Ronald DePinho

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