Chapter 16: MD Anderson in Transition after Ronald DePinho's Resignation: Context


Chapter 16: MD Anderson in Transition after Ronald DePinho's Resignation: Context



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In this chapter, Dr. Buchholz begins to address the transition MD Anderson has been experiencing around Ronald DePinho's resignation only five and a half years after becoming the institution's fourth president. He first addresses the low faculty morale under Dr. DePinho and offers a critical perspective of how the situation was addressed, based on a White Paper prepared by the executive committee of the Faculty Senate at the request of Chancellor McCraven and published in July 2015.

Next, Dr. Buchholz characterizes Dr. DePinho as a boss and talks about the lack of cohesion within the executive leadership team.



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 - Institutional Change; Leadership; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Institutional Processes; Working Environment; Critical Perspectives on MD Anderson; Understanding the Institution


Tacey Ann Rosolowski, PhD:

And remind me when that was published, the White Paper.

Thomas Buchholz, MD:

It was—

Tacey Ann Rosolowski, PhD:

Late 2016, or was that into ’17?

Thomas Buchholz, MD:

No, I remember it was in February of... It must’ve been February of ’15. Oh, wow. Ultimately, Chancellor Cigarroa had come down and met with the Faculty Senate. Chancellor McRaven took over, really wanted to address some of the issues. The faculty morale survey had been out there. There was a great degree of dissatisfaction at that time. They were striking chords across not just a small group of Faculty Senators, across the entire institution, and people were feeling stress about the clinical situation, or feeling stress about some of these implementations that were changing the way that they practice. They were feeling stress about the upcoming Epic go-live. They were feeling a lot was changing at one time, and it was pretty tumultuous. And I think the chancellor wanted people to say, “Okay, write down what are your needs.” And one of the needs was we need more people to help us do our work. That’s not probably the best way to decide expenditures. You need a CFO to start to help make such decisions. So one of the key things that we did in that white paper was we authorized over $10 million personnel expenditures to help with the situation. That has a direct consequence on your operating margin, right? And we eventually got to a point, then, where we weren’t making sufficient revenue to handle the expense structure that we had in place. We had too many employees and not enough revenue generated per employee to make this a sustainable path moving forward. And in part that was contributed because of the inability to have an engaged, meaningful dialogue so that people—I don’t know that people all have to understand it, but they have to trust that we have a well-run organization, with appropriate expertise, that are making intelligent decisions on behalf of the health of the organization. And without that trust, then you think something crazy is going on: “This isn’t really working the way I think it should be working.” And then you can’t have 20,000 CFOs run the institution. You need a CFO who really understands institutional performance metrics, and can give us the institutional discipline, to sometimes not make everybody happy but to do what’s best in the long run for the organization.

Tacey Ann Rosolowski, PhD:

What was your feeling, working on the executive committee at this time, through this turbulence? And, I mean, did you have trust that decisions were being made well, that there were effective conversations?

Thomas Buchholz, MD:

I felt like I had engagement, right or wrong, the way—for the scope of my responsibility, that we tried to create dialogue with the division head community, to a great extent. All of them sat on some organizational structure that ran clinical operations. We had physician administrative partnering down every aspect that would report up into this executive clinical operations team that consisted of the entire division head community. That should be able to represent each of the—each provider in the institution, as long as they’re communicating down to their people, and representing their people. You have to have some sort of hierarchy in a system this size to have efficiency and leadership. You have to have some leadership structure. I think where I felt there was failure is we didn’t have a real cohesive executive leadership team. I... One of my frustrations was we didn’t have the CFO and the provost and the physician-in-chief. For instance, Bob Brigham was our Senior Vice President of Hospital Operations. Bob remains, still, one of the most talented healthcare administrators that I’ve ever met, and it was a true pleasure to work with him. He was kind of my side... He had expertise that I don’t have, and I had the physician component that he didn’t have. And he respected that MD Anderson is a physician-led organization, and he didn’t want to change that for any reason. He thought MD Anderson was fantastic. But I also had deep respect that, wow, he really has administrative training and background and 30 years of experience in doing this that does shape how I’m going to go into this. It’s a complementary skillset. So we tried to formulate that on the clinical side, but Dr. DePinho didn’t like to really have that type of... That wasn’t his style. He was much more comfortable meeting with me one-on-one, and saying, “How’s Epic going? How’s...? How are this? Oh, here’s what I’m hearing from some people.” He was a tremendous boss because I felt like he supported me, he was confident in me, he had my back. If someone... I always felt as he represent—he’d give me credit. I wasn’t seeking credit, but he would speak highly of me. And I could—I felt comfortable talking to him about hard things. And he was very supportive of me. If I called him and I said, “I need you to be here,” he would be there. And he didn’t micromanage me at all, and he wasn’t someone who I wanted to do something, and someone would run around me to the president, and he’d come and say, “Tom, you can’t do it that way.” He respected that, gave me the authority to do this, and stood by me with that. So that was great. I really thought he couldn’t have been a better boss for me as Physician-In-Chief in terms of my responsibilities for my job scope. But secondarily, my responsibility as a member of the executive organization to make this whole culture piece work, to really set kind of... One of my responsibilities is to go downward and do everything that reports up in to me. Another is to be a leader of the organization, a member of the executive team. How are we going to shape this? How are we going to get...? What type of...? Let’s sit around. How are we going to get the division heads onboard and make them really feel connected? How are we going to get the faculty—what are we going to do about this Faculty Senate, right? They’re clearly trying to impeach you, Ron. Who’s going to own this white paper? Is this really the best method that we want? Do we really want this? How come we’re not—how come I’m not contributing to such a conversation as an executive vice president? Because they’re going to say things about clinical. Are you having a dialogue with the chancellor? Why don’t you bring the chancellor down and meet with your executive team? Why don’t we have kind of just an honest, engaged dialogue? Should we really be doing this IBM Watson? Boy, there’s all sorts of things. Do we want to evaluate? Now, you could say, “Well, that’s not really your job description, Tom. You’re the Physician-in-Chief. You’ve got enough going on. You don’t have to...” But ultimately, we are accountable as an executive leadership team, and ultimately I was accountable for those very reasons. I don’t think I lost my position so much because we were working on patient access, or the Epic didn’t go well, or... It was because you’re a member of an executive team that wasn’t really functioning as an executive team.

Tacey Ann Rosolowski, PhD:

Interesting, yeah.

Thomas Buchholz, MD:

And so then we’d get surprises sometimes, and... But I think...

Tacey Ann Rosolowski, PhD:

Can I ask you: did you... Were there other members of the executive team who kind of had that feeling that there could’ve been a more effective culture of executive leadership?

Thomas Buchholz, MD:

I think so, yeah. Yeah. I think I saw through this there would be a tendency for someone to say, “Well, all that choppy water, that’s over here. That’s not me. I’m over in this space. I’m going to just focus on what my work is. And maybe it’s best that I not push for an executive function that brings me into those... I’m just going to sit down and come in every week and do my work,” right? That’s not the best, healthiest of attitude for someone, when you only have three executive vice presidents, to do that. So I think we all got along well. I don’t think there was rivalry between the provost and the physician-in-chief, or competing resources from business to... So I think we got along well. We just... I don’t know. Obviously it didn’t work, right? I think the endgame proves that there was—for whatever reason, it didn’t work. Now, maybe it was unfair, or other things, but there was sufficient that it ended up with a bad outcome, or...

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Chapter 16: MD Anderson in Transition after Ronald DePinho's Resignation: Context