Chapter 12: An Offer to Serve as Provost and Executive Vice President

Chapter 12: An Offer to Serve as Provost and Executive Vice President

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Description

In this chapter, Dr. Buchholz explains how he was offered the Provost and EVP position. He describes why it was challenging. He also provides perspective on why the Executive Committee was dysfunctional and the effect that active circulation of rumors had on the institution. He also comments on how MD Anderson culture changed under Ronald DePinho. He explains that Dr. DePinho took MD Anderson "from incrementalism to boldness" with his view of the Moon Shots and his process for making that shift led to the perception that clinicians are less valued than researchers.

Identifier

BuchholzT_02_20180131_C12

Publication Date

1-31-2018

Publisher

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

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Leadership; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Building/Transforming the Institution; Critical Perspectives on MD Anderson; MD Anderson History; MD Anderson Snapshot; Professional Practice; Understanding the Institution; Portraits

Transcript

Thomas Buchholz, MD:

And, then, I think the next Friday I got called, and they said, “Oh, Dr. DePinho is on the schedule to meet with you at 4:00.” And I said, “Oh, no, that’s a mistake. He met with us last week at 4:00. We’ve been trying to arrange a meeting with him at four o’clock on Friday forever.” I said, “We just met last Friday.” And they said, “Oh, no, no, he wants to meet with you in his office at four o’clock on Friday.” And I said, “Okay.” And I didn’t feel threatened at all, because I knew my standing with him was fine. And I was pretty sure he was going to... I was doing a lot of initiatives in our group for transparency, managing faculty expectations, that everybody was clear on what their job description was. And I was trying to suggest in some of our clinical meetings that this should be a standard for every division, because faculty want to know what the expectations are. So I thought he was going to appoint me to a blue ribbon committee to do something like that. Dr. Mendelsohn had appointed me to various things. So I walked in, and Tom Burke [oral history interview] came in, and Leon Leach [oral history interview] came in, and Ron came in, and he said, “Tom, I’d like you to be Provost of MD Anderson.” And I said, “What?” (laughter) And he said, “Yeah, I’d like you to start Monday.” And I said, “Wow.” And he says, “So you want to do it?” (laughter) I was like, “Should I talk to my wife, maybe?” And he says, “Well, we kind of really have to make some decisions.” And I said, “Sure.” (laughter) I walked out, not knowing exactly what that meant. And I got together with Tom Burke over the weekend, and he kind of explained that Ray was moving on, and that it would be okay, and Tom was there to help me. And Tom was my boss, and Ray was my boss, so I had a relationship with Tom, and I knew Leon very well, too, and they all assured that they’d help me. But it was challenging, and my skillset was a little bit stretched, because Ron was in full accelerator mode of recruiting National Academy of Science members, etc., many of whom’s name after leaving his office I’d run back to the Provost Office, and Maureen Cagley and I would Google them, right? Because I had never even heard of them. (laughs) They would say, “Well, we have to recruit X,” and I would go, “Oh, yeah. Yeah, he’s going to be a gamechanger. He’s...” I’d think, “Yeah, that would be... Yeah, okay.” And, “Why don’t you fly out to San Francisco and have breakfast with him, Tom?” And I was like, “Sure, yeah.” (laughter) I think, I’m going to call this person, they’re going to say, “Who are you?” Like, “I’m the Provost of MD Anderson.” They were, of course, really welcoming. And so it was a really eye-opening experience. It was a hard job.

Tacey Ann Rosolowski, PhD:

Why so?

Thomas Buchholz, MD:

Because I didn’t feel... I went from this apolitical thing into the heart of the politics, right? We were just launching the Moon Shot program. I was helping to define what should be the Moon Shot, how are we going to fund the Moon Shot program. I didn’t have much in the way of experience with the whole institutional, financial arrangements of what can we use a Pickens fund for, what can we use this, how does all this work, where is all the... So there were a lot of other initiatives. The Simone Report was just coming out with trying to align administrative efforts, and I was kind of the new person that had relationship with the faculty, and the division, and everything was kind of saying, “Oh, here, Tom, do this.” At the same time, I could perceive what wasn’t going right on the leadership circle. I had the vantage point of the division heads. I had the vantage point of the faculty. I knew what the conversations, what they were in the hallway.

Tacey Ann Rosolowski, PhD:

What wasn’t going right? What were you observing?

Thomas Buchholz, MD:

Oh, I don’t think people feel connected, again. They felt kind of like there were two different cultures. They felt as if some of the institutional resources were frivolously being—that we were contributing, and we weren’t part of where it was going. That “they didn’t pick a Moon Shot for my group, and now we don’t get any resources, and everybody else gets the resources” or so. And that wasn’t necessarily true, again. I think that’s where these rumor mills just took hold, and there was such sources of negativity at the time that, just kind of like in the modern press, in our national—you could take hold of a story and paint it in a very convincing fashion that things are really terrible, and it’s easy to make people feel suspicious. It’s harder to make people feel trusting. There are a lot of people that were threatened by this, or a lot of people, when they say “Raise the bar of science, we’re going to hold tenure renewals to a different level of credibility.” You’re talking about, well, maybe you’re going to lose your job. Maybe I don’t have grant support that I should. And I know that. How am I going to survive in this? Well, one line of defense is to say, “Well, we’re not going that direction,” right? And “We’re going to create pushback.” And so it was challenging. And I thought, again, a little bit naïve, “Well, I could really help this, right? I could be kind of that bridge. I could be someone that people would say, “Well, Tom’s not here to create his own Moon Shot, and we kind of trust him, and if he says that, ‘Oh, I looked under the covers and everything’s okay, that we’re not diverting resources from you, and, in fact, Dr. DePinho’s been so successful in fundraising that we have all the resources we need to do these initiatives without any compromise in our institutional budget...’” That was the reality of it, but there were forces that were pushing back hard against it. And I’m not saying that some of it wasn’t legitimate. I didn’t have an answer to every gripe. Some of the gripes were real, legitimate problems, and legitimate frustrations, and...

Tacey Ann Rosolowski, PhD:

What were some of those legitimate frustrations, did you feel?

Thomas Buchholz, MD:

Inconsistencies, I guess, was one, that kind of everybody wants to be treated fairly and consistently, or we should have policies that... We shouldn’t just do arbitrariness. We shouldn’t just take the make-it-happen type of deal. So some of those things were fair. I think people were feeling like they were frustrated with bureaucracy. They were feeling as if... The usual type of thing, I guess you could read about in the Cancer Letter.

Tacey Ann Rosolowski, PhD:

Did you feel—I mean, so many people were mentioning to me—and I should say I began to interview folks in August of 2011, which was—or actually, maybe it was a little earlier, July—just before Dr. DePinho arrived. I interviewed people all through the honeymoon period, and then heard how the way people spoke about him really changed. And person after person began to say, “There’s just been a real, perceivable change in MD Anderson culture,” among many other things. And I’m just wondering if you felt that that was happening, as well.

Thomas Buchholz, MD:

Yeah.

Tacey Ann Rosolowski, PhD:

And what were the changes that you were seeing?

Thomas Buchholz, MD:

Ron is a transformative figure, and he thinks that MD Anderson has a responsibility to be bold, and to be bold you have to be courageous of making it happen, right? The ends justify the means. And doing that, MD Anderson had been kind of more of an incremental advancing. That’s hard to say with—look at what happened under Dr. Mendelsohn’s leadership, how big we became, and etc. But—

Tacey Ann Rosolowski, PhD:

But it wasn’t such a fundamental, substantive change.

Thomas Buchholz, MD:

Yeah. So Ron’s recruitment style was off-putting to some, because it led to “Are you on the A team or the B team?” And this resource allocation issue became a real perceived issue. I’m not sure that really is a major issue, but this degree of fairness and inconsistency of, well, this is a special circumstance, we’re not going to hold the same level of accountability as we do over here. And then this fear of, well, if we bring in a different caliber of science, is my science going to be good enough to be recognized as part of this community? And I used to be part of this community, and now is my job threatened? Is my livelihood threatened?

Tacey Ann Rosolowski, PhD:

What about distinctions between clinical activity and research activity? A lot of individuals I’ve spoken to have said that there’s just been a subtle shift in the way that patient care is valued, or... I mean, not that the patients aren’t central, but that kind of how patient care factors into the status of a particular individual has changed, and you...

Thomas Buchholz, MD:

I think that was a tenet. I’m not sure that that’s actually true, again.

Tacey Ann Rosolowski, PhD:

Well, what’s your perspective on that?

Thomas Buchholz, MD:

That leaders are defined by what they say. I think if you want to create safety, quality culture, the leader better be up there and saying that out of the first three words out of their mouth. If you want to... So Ron DePinho, I could honestly say, is incredibly impressed and thankful, and defines MD Anderson as the outstanding place for delivering clinical care of cancer patients. And I think his thought was that’s a good piece; what they’re missing is this other piece. And what this other piece is ended up being what was out of his mouth all the time, because that’s where the transformation was going to be. It wasn’t going to be in the clinical arena. But because of that, there was a perception that our whole institutional focus is not about the clinical thing. All we’re talking about is these Moon Shots initiatives. Anything in the press, we’re not celebrating the fact that I just did a 12-hour operation that nobody else in the world could do. We’re talking about we need to bring in more discovery science, and get patents, and drug developments, and invest millions of dollars over here. We’re going to spend $75 million on IACS, and nobody’s going to buy another robot for the operating room. These are the types of things that lead people to have those percep... Like, well, we’re undervalued in the clinical community. I could say with great sincerity I don’t think that Ron ever undervalued it. I think, as a leader, he could have been more—he could’ve articulated that over and over again, and so that it didn’t just become about... When you talked to Ron, it was Moon Shots, big data initiative, this... And there were legit—his wife was involved in all this stuff, too, and obviously you know some of the stories, too. (laughs)

Tacey Ann Rosolowski, PhD:

Yeah, of course. Yeah.

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Chapter 12: An Offer to Serve as Provost and Executive Vice President

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