Chapter 11: Financial Processes, Challenges, and a Crisis;

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Chapter 11: Financial Processes, Challenges, and a Crisis;

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In this chapter, Dr. DuBois focuses on financial matters. He notes that as Provost he was required to manage a much larger budget than he had in previous roles. He also explains that Leon Leach [oral history interview], hired by John Mendelsohn, brought a heightened awareness of finances to the institution.He next focuses on the economic downturn of 2008/2009, which required the institution to cut costs dramatically and reduce the workforce by 500. He explains how the Executive Committee worked to anticipate how to weather this challenge and talks about the parameters they used to identify employees to cut. He talks about the stresses of executive leadership.Next, Dr. DuBois talks about building the Division of Academic Affairs. He notes that CPRIT funds were key for this growth and discusses working with CPRIT leadership to keep the MD Anderson community informed of their grant application processes. He talks about the connection between Academic Affairs and the research institutes and how key the former was in recruiting faculty for the institutes.Next, Dr. DuBois discusses issues related to the faculty. He talks about the "Wall of Science and Medicine" he created to bring awareness to the faculty's high profile publications and to stimulate pride and competition among the faculty. He then covers work with the Faculty Senate and the themes of concern. Next, Dr. DuBois talks about the problem of rewarding investigators for their team science efforts, then notes that the Provost's Office was able to set a good tenure process in place.

Identifier

DuBoisR_02_20181114_C11

Publication Date

11-14-2018

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; Building/Transforming the Institution; Institutional Processes; The Business of MD Anderson; The Institution and Finances; Professional Practice; The Professional at Work; MD Anderson Culture; Working Environment; Personal Background

Transcript

Tacey A. Rosolowski, PhD:

Well, I’m not sure if we’ve fully talked about you learning the ropes here, have we? Were there other kind of big learning moments during those first—during that first period?

Raymond DuBois, MD, PhD:

My budget at Vanderbilt was much lower than the budget that we had for all those operations at MD Anderson, and more unwieldy and more distributed out across several different organizational units. So I had to really step up my game on being able to manage those, and that’s where Maureen [Cagley] came in handy, because she knew sort of how things were organized and managed at MD Anderson. She had worked there for several years, and she really helped make sure that all the division and department budgets were on track and stayed in the black. We had two or three meetings per year where we looked at the financial performance, to make sure everybody was not overspending their expense budget and all those kinds of things. Once a year, when we were deciding on the next year’s budget, we had some very intense meetings with all the division heads and went over their budgets in extreme detail, in terms of all the line items: who was going to get a raise and what the plan was for capital equipment. All of those tings got discussed and that took us lots of time and effort, to go through those series of meetings and make sure that we were all on the same page.

Tacey A. Rosolowski, PhD:

In addition to the stated goal of getting the budget on track, did those meetings have another impact, working so closely with the division heads?

Raymond DuBois, MD, PhD:

I think it did help align our goals and objectives because you know, basically you need money, which is the fuel to make things happen. So, which type of faculty were being recruited and who they were planning on bringing onboard for the future and things like that, I think those meetings did help align that and also made sure that they understood that we had to be fiscally responsible. We didn’t want to overspend our budget, we wanted to make sure that we stayed within the boundaries that were allowed, and that we didn’t spend things on frivolous activities or anything like that. I think it did help us, me a lot, to make sure that we were all aligned in the financial predictions and the financial performance.

Tacey A. Rosolowski, PhD:

I remember when I talked to Lean Leach [oral history interview], he was so emphatic about the fact that the institution was moving into, along with every academic medical center, really a new financial era, where you just had to have a level of concern and suspicion that the situation now was going to last a month, because things were changing so rapidly. So I think it sounds like division heads and department chairs were kind of watching this from a different level and not seeing that probably as clearly, because they’re not financial people and they’re attending to their own backyard. So it’s like a culture change, getting people to understand yeah, we’ve kind of come out of the era where resources are very, very liberal, and need to pay much more attention.

Raymond DuBois, MD, PhD:

I think Leon brought a heightened concern about those issues to the institution when he came onboard. I think before Leon took that job, there were some strange accounting practices and other things, and I’m sure he relayed to you about that. But right after I came, it was 2007, and then we had the 2008, 2009 economic downturn, which really, really impacted us. Nobody was expecting that and I can remember some really, really tough meetings where we had to cut our costs dramatically. We were getting a lot less revenue from some of our endowments and other things, and it was just a tough financial time for the whole country, looking back on it. It was the worst downturn since the Great Depression, so we had to lay off over 500 employees. We had to cut costs on travel and other things. We had to cut costs on food and drink that was used for all the meetings, and the team really came together. We identified areas where we could make the most impact and we acted on that pretty quickly. In fact, that year, we had a huge margin, because we had taken all those preventive measures early enough so that the budget didn’t get out of whack before it could be corrected.

Tacey A. Rosolowski, PhD:

How did you communicate this to the institution at large? It’s always a tough one.

Raymond DuBois, MD, PhD:

It’s a tough message, but we were open and transparent and basically communicated via every possibly way. I certainly communicated to all of my reports and all the division chiefs, who cascaded that message down. We had some town halls where we talked about this economic pressure that we were under. It’s still tough to lay off people, but the way we went about it was to really look at people throughout the institution: who was essential, who really was playing very important roles, and patient care was the number one priority. We did have some staff there that were doing things that probably, in the real span of the whole goal, we could do without, and then we also looked at people whose performance had really dipped below what was acceptable, and there some, at that time some low performing individuals, there were employees there that were laid off. I think in the end, it didn’t really have a huge negative impact on our performance.

Tacey A. Rosolowski, PhD:

What were some other kind of key moments for you in those first years, I mean maybe highs and lows. Lows are always learning moments.

Raymond DuBois, MD, PhD:

There were long hours there and for me, my son was finishing up his high school year in Nashville, because he was on the lacrosse team and he was an All State lacrosse player, and I think if I had moved him to Houston, he would have to restart on another team, and he would have lost a lot of momentum. So my wife and I decided they should stay a year, to let him finish out his twelfth year, the twelfth grade, and I think that worked out well. He definitely, you know they went to the—they didn’t win the state title but they were in the playoffs and he really enjoyed doing that and that really meant a lot to him. So, there was a lot of commuting back and forth and that was difficult, because we were in two different cities. Ultimately, he went to Texas A&M and ended up being close to us during his college years, and then took a job in Houston after that, so that was nice. So that was a stress, I think, a family stress, and it was a much better situation after we were all in the same place. The economic downtown, I think was huge, but having the CPRIT funds and all of that was a very positive thing. It enabled us to recruit people from all over the country, because they were in states that didn’t offer that kind of support. What it did was it allowed you to have another sort of grant source that was only for citizens of the state of Texas, so it was a little bit—I wouldn’t say it was not competitive, but it was less competitive than the NIH, because you’re competing with people from all fifty states there. So that was a real positive and I got involved on some CPRIT committees and got to know Al Gilman, and I think that was a very positive interaction. He was quite a character.

Tacey A. Rosolowski, PhD:

And who was Al Gilman?

Raymond DuBois, MD, PhD:

Al became the head of the CPRIT—he was the chief scientific officer, and he was a Nobel Laureate that was at UT Southwestern. He had been their provost and he sort of was leading their research operations there, and he was quite a character, quite a colorful character, I really enjoyed getting a chance to know him. He was in constant communication with us because he wanted to make sure that we were supporting the most competitive research and that we put in place, a screening process to make sure that the best applications moved forward, so that it was an effort to get as much of the CPRIT funding as we could, to MD Anderson.

Tacey A. Rosolowski, PhD:

Can you tell me about the connection between your activities and academic affairs and the growth of the research institutes that John Mendelsohn had put as part of this—or in the executive team and important part of the strategic plan.

Raymond DuBois, MD, PhD:

During my time there, I was intimately involved in that, so with each center director and institute chair, we would discuss key recruits and we would identify resources to support that. We were in pretty much lockstep on doing that and I think it was a positive, good relationship and everybody wanted to get the best potential recruits that we could there.

Tacey A. Rosolowski, PhD:

When did you start seeing immediate results from these efforts?

Raymond DuBois, MD, PhD:

It took about two and a half years to see the increase in the extramural funding bump up, and every year that I was there, it increased over the previous year, and I have those numbers somewhere, I didn’t bring them today.

Tacey A. Rosolowski, PhD:

That’s fine.

Raymond DuBois, MD, PhD:

It led to multi millions of dollars for research funding and support that we had when I started, and so I think it did have an impact. The other thing I did, and I don’t know where I got this idea, but I started this Wall of Science and Medicine. What we would do is we would take a publication from one of the faculty that was published and got a lot of attention in the press, and place it in the provost’s suite and let it hang there for a few months, and then when somebody exceeded that, we put theirs on the wall, and then we would give that to the individual investigator and they were able to put it in their office and sort of brag about what they had done. It became a competitive thing, where people tried to outdo one another, to have a more impactful paper hanging in the provost office. And then whenever I had visitors or donors or board members come in, I would always make sure that they saw examples of some of the work that was being done, and I think everybody—that was a very positive thing, everybody got a lot out of that, and I’ve continued that here. We have a little smaller Wall of Science out in the hallway, where we emulate the high impact publications. When I first started here, only five or six people put in submissions, and now there’s like thirty or forty, so people really enjoy getting some recognition for that.

Tacey A. Rosolowski, PhD:

It may even take time for people to get their heads around what it is and what it means in terms of the institution.

Raymond DuBois, MD, PhD:

There were some major New England Journal of Medicine papers on new treatments for leukemia and other things, and I think people in the whole mix don’t keep up with all these things that are being achieved, and it’s good to have that all in one place, where you can just see the enormity of what’s going on there. Certainly the donors were impressed with that, when they got to see the—we had the picture of the individual and the abstract, and some of the figures in the paper, and what the layman’s conclusion was from what they had done, and it’s very impressive. It’s such a large institution, you know there’s so many things going on, but it collectively has a huge impact.

Tacey A. Rosolowski, PhD:

It does, it does. What about working with Promotion and Tenure, the Faculty Senate?

Raymond DuBois, MD, PhD:

I had regular meetings with the Faculty Senate and like I said earlier, we worked on this exigency plan for the institution and that was a big win-win, both for the institution and for the faculty, and I think we all agreed that accomplishing that was important. I met with Faculty Senate every month and they always had a list of concerns and issues, and I think it’s important to put all of that out on the table and discuss it. Some of those issues, we could resolve and some we couldn’t, and we—and when I couldn’t address some of them, I’d just let them know that there’s not really anything we can do about this particular issue and that’s sort of the answer. You know it’s good to have that dialogue and feedback, so you’re not constantly wondering what the thinking is about this or that. There were some issues that we could address and we put things in place to help solve those problems.

Tacey A. Rosolowski, PhD:

What were some of the themes coming up, both the things that you couldn’t address and the things that you could?

Raymond DuBois, MD, PhD:

Well, some faculty complained about their salaries through the Faculty Senate, or how much support they got for their research operations, or sometimes it was a conflict that needed to be resolved and got identified through that pathway and we were able to have the—usually there’s two individuals involved in the conflict. I would call a meeting and have both sit down and we would really try to hammer that out and come up with some resolution. You just don’t want those burning all the time and a lot of times it had to deal with who got credit as an author on a paper or who was getting money from a grant when the research was shared between two different groups, you know little petty things like that, but they caused a lot of concern and consternation.

Tacey A. Rosolowski, PhD:

I’m just reminded of something that was coming along with translational research, which is the team science context, and obviously there’s a real—as I’ve come to understand, there’s a real gap between what’s needed to get people to practice team science, and then how it’s recognized and rewarded in traditional academic structures. When you mentioned the conflicts about research funding and credit, it kind of reminded me of that. Were you starting to see some of that in 2007, 2008?

Raymond DuBois, MD, PhD:

Yeah, it was emerging, and because MD Anderson is such a large place and we have multiple expertises, there were certain research projects that were better dealt with to have a team of individuals working on it, especially for example, the Institute of Personalized Medicine. There were so many different parts of the puzzle that needed to be done that you know, you did really need a team assembled to do it. I did have conversations with the Promotion and Tenure Committee, to talk about how we could best reward people for team science, and we started looking at where their authorship was placed on a paper and really trying to reward individuals when they contributed to that team, and even to the point where when people would talk about certain research accomplishments in the application for a promotion, they would talk about—we asked them to specifically talk about their role, especially when they were part of a paper that had fifty authors: what was their specific role in making that project work and how did they contribute to the overall success of the team. That really helped, because then that was a tangible accomplishment that they could get credit for, instead of just a blob of authors on a paper. I think getting more detail about what their role was helped out, and so we did start giving more credit for that. And then also, for people who did things that ended up developing new intellectual property, patents and royalties and things like that, we wanted to reward that effort, because a drug or a device doesn’t become useful unless it has some value to the industry, and that’s the way to do it, is to file a patent or do something that indicates it has some value.

Tacey A. Rosolowski, PhD:

Were there some kind of tricky conversations about that, that came up? I don’t mean conflict, but just thinking through the issues, because a lot of these presented new scenarios.

Raymond DuBois, MD, PhD:

Well, no, I think all academic centers are going through this transition and since there are—harder to develop all the support needed from the clinical enterprise, the academic/industry partnerships are becoming more important and more well accepted. At that time, it was still something that you had to make sure that all the Ts were crossed and Is were dotted, but clearly, as long as the conflicts were declared and it was clear that the drug was of value, the only way to get it to the patient was through this industry partnership, and everybody realized that.

Tacey A. Rosolowski, PhD:

Were there issues that were coming up around promotion and tenure, and the process?

Raymond DuBois, MD, PhD:

You know, I thought that we had a fairly good process in place. People took their role on those committees very seriously. I remember right after coming onboard, I talked to—I would have a meeting just with the committee, and they wanted to know what my expectations were and I wanted to answer their questions, so that we were all on the same page. I did say that we would like to increase the bar required for people to get promoted, and make sure that they deserve that promotion, but the criteria I think we all agreed on, in terms of achievements and extramural grants. We also wanted to reward outstanding teachers and contributors in that way. There are basically three criteria for promotion in any academic center. One is research, education, and then clinical service. Dr. Mendelsohn and I were in total agreement that you really needed to be outstanding in one of those, and then have some aspect of another one, to support the promotion. So if you were a pure clinician, as long as you were doing outstanding work in that area and then you did some education or other scholarly activity, that was adequate for a promotion. If you had no—if you don’t excel in any of those, then that really raises a red flag about whether or not you’re on the right career path.

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Chapter 11: Financial Processes, Challenges, and a Crisis;

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