Chapter 15: Institutional Changes and the Decision to Leave MD Anderson

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Chapter 15: Institutional Changes and the Decision to Leave MD Anderson

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In this chapter, Dr. DuBois identifies the institutional changes that prompted him to leave MD Anderson. He first notes that he tried to advise Dr. DePinho about problems emerging among the faculty. He observes that he had been approached by other institutions, but had wanted for professional and personal reasons to finish his career in Texas.

Dr. DuBois lists how he and Dr. DePinho differed in their view of leadership and administration. He notes changes in the leadership structure, and how the individuals from industry that Dr. DePinho had established on South Campus reported directly to Dr. DePinho and Dr. Lynda Chin, rather than following the usual communication chain through the EVPs. He observes how unusual it is to have both a president and his wife in prominent positions in the institution.

Dr. DuBois then discusses explains the controversies around the application that Dr. Lynda Chin made for CPRIT funds, skirting the usual process. Dr. DuBois explains why the application process existed and why not following it was such a problem. He explains the impact of the Chin/DePinho actions on the CPRIT process and MD Anderson.

Next, Dr. DuBois talks about changing attitudes among long-term employees and faculty as well as the Executive Committee as the DePinho presidency evolved. He also notes that in Dr. DePinho was not entirely to blame for the worsening situation at the institution, as he came into his role with no experience running a large, clinically-focused institution.

Identifier

DuBoisR_03_20181115_C15

Publication Date

11-15-2018

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Institutional Change; Leadership; On Leadership; Critical Perspectives on MD Anderson; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; The Business of MD Anderson; The Institution and Finances; MD Anderson History; MD Anderson Snapshot; Ethics; Research; Activities Outside Institution

Transcript

Tacey A. Rosolowski, PhD:

Tell me more about the observations that you were making that kind of led to your decision, because you left in December [2012] and Dr. DePinho arrived September 1st [2011], I guess it was, so it was pretty quick, your decision. Tell me about that whole process.

Raymond DuBois, MD, PhD:

Well you know, I had been approached by other institutions, to look at jobs, and I really had—you know my whole plan was to really finish my career in Texas, because my family lives there and I had such roots there growing up, all undergrad and graduate school and medical school were all in Texas institutions. So the hope I had was that that would be where I could have the most impact. It didn’t work out obviously. So, the president of Arizona State had been calling me a few times, even before Dr. DePinho took over. I had actually been asked to take the job as the director of the Duke Cancer Institute, and I decided I’d rather stay at MD Anderson. I probably shouldn’t say that, because the person there now is wonderful, but I didn’t really get an official offer, but I made it clear that I was going to stay at MD Anderson and try to make things work out there. At one point, I just decided, I just didn’t think it was going to work out, and the main reason was that my view and approach was just really different from Ron’s, in major ways.

Tacey A. Rosolowski, PhD:

How would you pinpoint those differences?

Raymond DuBois, MD, PhD:

Well, like I said, I think that saying things to the faculty like “we’re going to cull the herd,” that to some people is kind of demeaning and it’s just not my style. It’s not a message that I really wanted to propagate. So you know, there were those issues. There were issues of resources we were providing to some of the people that Ron had recruited. We were pretty generous and we decided that in order to recruit the people from industry, we had to give them a higher salary structure than what we normally did with recruits to the cancer center.

Tacey A. Rosolowski, PhD:

What was your concern about that?

Raymond DuBois, MD, PhD:

Well, when you have a two tier system like that, people always perceive that there are haves and have nots, and I think it did cause a lot of consternation and concern, because if you got recruited into one segment there, you got a much higher salary. If you got recruited into let’s say the Preventive Medicine Division, you got a much lower salary and the work, the scope of work was not that different in some cases. It creates a two tier system. Margaret [Kripke, oral history interview] had always shied away from doing that and she was the one that really wanted to make sure everything was transparent and fair and according to some principles, and so I continued that after I took over for her. This sort of changed that paradigm, when you have a two tier system like that, and sometimes it’s hard to justify that with some of the faculty. That was clearly an area of difference.

Tacey A. Rosolowski, PhD:

What were some others?

Raymond DuBois, MD, PhD:

Well, I was a little concerned about going totally into the Moon Shots Program. I just felt like we should do some pilots and try the leukemia one and then see how that goes. But I think Ron was really anxious to get everything going in multiple different areas, and who knows? Maybe he was right and I was wrong, and if you’re going to do something just do it whole hog and get on with it. So we definitely differed in our opinion about how to roll that out and take a little bit more cautious approach, as opposed to multiple Moon Shots all at the same time. Looking back on my career, usually, when I come to a new institution or take on a new role, I try to focus on two or three things and really put all our energy on that to be successful, and you know, we’re going to try to focus on ten or twelve things. I just think it’s so much harder to amass the resources and have enough attention to all the details that need to be done.

Tacey A. Rosolowski, PhD:

There’s also always shockwaves when you make big change. Was that also part—you know what were you seeing with all of these changes, what kind of vibe were you picking up from the faculty, from staff, about the changes?

Raymond DuBois, MD, PhD:

Well, I think there was concern. I think there was excitement at first, because it’s a new leader who had been successful in his career and had really made important discoveries, bringing that expertise. And also, in some academic industry business deals that he had done were very successful. So I think there was excitement about having somebody come in that had a different perspective, a different circle of experience, and bring that to the institution. But just some of the management style and how that rolled out, eventually I think caused concern. MD Anderson, like I said yesterday, has a lot of people who have been dedicated to the institution for twenty or thirty years, so there’s a lot of people that have seen presidents come and go, and so they had experience with the different leadership. I think it was just, for some of those folks, too much of a change too quickly and they weren’t able to deal with it. Then what happens is if you do stumble and the finances don’t end up going in the right direction, then there’s always a lot of finger pointing about that, because we had, even during that great recession, we had had a stable financial system and we had been able to respond to that economic downturn in a way where we still made a margin. We had to cut back on things, but we eventually lifted those restrictions as we came out of that economic downturn and our finances were never in the red, so that was really quite an achievement. And then when—I just know what I read from things in the public, that MD Anderson did experience a pretty significant budget deficit-- and that that creates a lot of negativity, and people who feel like well, maybe this wasn’t the right way to go. Then they do finger pointing and stuff like that and it just sort of builds on itself and makes it difficult.

Tacey A. Rosolowski, PhD:

It was obviously a hugely complicated situation and also, I didn’t say this earlier and should have, that one of the reasons that I wanted to really kind of refract this period, is that obviously, institutions are living things and they’re always changing, but Ronald DePinho’s arrival really did jumpstart a period of change, of real transformation, that the institution is still going through.

Raymond DuBois, MD, PhD:

Right.

Tacey A. Rosolowski, PhD:

And so these interviews that I’m doing with you and with other people who are making these observations, it’s really helping to understand what is that all about, why did that happen. I mean yes, there are personalities involved, but these personalities set in motion, certain kinds of processes that the institution and the people that are managing it have to respond to in a very real way.

Raymond DuBois, MD, PhD:

Right.

Tacey A. Rosolowski, PhD:

So you know, that’s really the source of my questions.

Raymond DuBois, MD, PhD:

I understand. I think that there were big changes made in the organizational structure and the leadership structure.

Tacey A. Rosolowski, PhD:

What was done and how did that have an impact?

Raymond DuBois, MD, PhD:

Well you know, even during my remaining time, we still had the three EVPs in place, and so that was there. I think bringing on the industry group on the South Campus, you know they—I don’t think it was set up directly. They reported a lot of their efforts directly to Ron and Lynda, and so we hadn’t really had organizational units at the institution, from that level of the organization, reporting essentially to the president, so that really changed some of the structure and thinking, so that it was different.

Tacey A. Rosolowski, PhD:

Was there a sense that there was a lack of transparency in that direct relationship?

Raymond DuBois, MD, PhD:

I think sure. I mean, certainly I didn’t know some of the things that were being done or what was happening. I know that there had been some discussions with folks at Rice University, to collaborate on some of those efforts, which obviously it’s a great choice. Rice is fantastic, but neither I, nor some of the other people really knew the details of what was happening. I think you did feel like there were certain things going on over here that had always been out in the open and transparent before, so that was a change.

Tacey A. Rosolowski, PhD:

I mean it also just seems, as provost, who is overseeing all the academic affairs, that that would be within your scope of interest and influence.

Raymond DuBois, MD, PhD:

I always saw it as my job, to try to help facilitate all of that stuff as much as possible. For example, with the Graduate School for Biomedical Sciences, I had always met with Dean Stancel [oral history interview] regularly and talked about ways that we could improve the quality of the students, and recruiting and the reach and all that stuff. Certainly, I had been involved in all the other issues. We had just everybody just openly discuss that, and our opinions were sought out and stuff like that, so that did change, sort of those working relationships. Then it’s a little unusual to have the president and his wife having such prominent positions within the institution at the same time, so that caused some friction in dealing with how resources were distributed and things like that, that probably the faculty felt like there was some lack of transparency there.

Tacey A. Rosolowski, PhD:

People were openly talking about conflict of interest and ethical violations. What was your sense of that at the time?

Raymond DuBois, MD, PhD:

The biggest single issue, I think that really fell on my plate during those concerns, was the application that Ron and Lynda made to get funding support from CPRIT. The way we had set up the CPRIT process was that most—I mean everything sort of flowed through the Provost’s Office, so there was a portal that everybody sent their grants to. What I saw as my goal, was to try to help make sure that those grants were as competitive as possible. So we would pre-review those. We would make sure that all the needed editing and changes were made before we actually put that application forward for review by CPRIT. Like I said yesterday, I had developed a pretty good relationship with Al Gilman, who was the chief scientific officer for CPRIT, and he asked me, on two or three occasions, if I could try to make sure that they just didn’t get hundreds of meaningless applications. I think he talked to each institution in Texas, to try to have some sort of way to make sure that only the really most competitive applications were put forward, because he was asking people from outside the state to review these and that it would be much more efficient if we really just stuck with what we thought the best science was. I talked to Dr. Mendelsohn about that and he agreed. He wanted us to be as competitive as possible and do whatever I needed to make sure that we got those most competitive applications submitted for evaluation. I just remember getting a call one day, from Dr. Gilman, and he was asking me about the grant that Ron and Lynda had sent in. Frankly, I didn’t really know anything about it. I mean I was taken by surprise because he hadn’t discussed it with me. It hadn’t come through the office or whatever, like we usually do with most of those applications and obviously, he was very concerned about that.

Tacey A. Rosolowski, PhD:

And what were the concerns that he expressed?

Raymond DuBois, MD, PhD:

Dr. Gilman was worried because he said that instead of going through whatever the normal CPRIT application process was, that it went directly to one of the individuals by email, to be evaluated for consideration, so that was very unusual.

Tacey A. Rosolowski, PhD:

And this was to a reviewer?

Raymond DuBois, MD, PhD:

Well, to a leader of the review team that looked at those grants. After that, obviously, I did talk to Ron about it and found out that I think they had felt like they had been instructed to send it in that way, and that’s how that came about. It created a lot of consternation in the state and eventually, Dr. Gilman resigned from CPRIT, because of some of the issues that came up after that. So it created some waves and some of the reviewers that were from the outside, reviewing the grants, really got concerned and they resigned from their role on the review team. So it did have a national impact. Eventually, I think the grant was withdrawn and that was the end of it. I don’t know what your understanding of that was.

Tacey A. Rosolowski, PhD:

Well, I just know what I read in the Cancer Letter and with discussions, is that --I mean again, it seems as though there could have been a different response, because the approach was kind of the specialness of this research team, and when it was discovered that this had had as much impact as it did, there could have been a different way of handling the aftermath, is my feeling.

Raymond DuBois, MD, PhD:

Right, right.

Tacey A. Rosolowski, PhD:

To kind of do the impression management after the fact.

Raymond DuBois, MD, PhD:

No, it wasn’t a good time for us, because I think the outside interpreted that as we were trying to get a special favor out of the grant or special consideration. It didn’t go through the portal. It didn’t follow some of the procedures that were in place.

Tacey A. Rosolowski, PhD:

Which throws the whole process in question. I mean it kind of goes beyond MD Anderson and some people had decided to take the bull by the horns.

Raymond DuBois, MD, PhD:

Well, it also led to a stoppage of consideration of any grant, so there was a pause in the CPRIT System for several months, to reevaluate everything. Actually, Margaret Kripke was brought on to follow Dr. Gilman as a chief scientific officer, and I think she helped to really reorganize that so that it was seen as an open and transparent system, and was able to recruit other reviewers to come in and review those grants and then it got back on track. So that was a good outcome but a tough time, when there was so much consternation about what was going on there.

Tacey A. Rosolowski, PhD:

Now you were mentioning the reactions of some of the very long-term faculty and administrators at MD Anderson, and I’m curious what you were hearing from them about what their concerns were in the institution.

Raymond DuBois, MD, PhD:

Well you know, some of them were concerned about lack of transparency and favoritism and nepotism and things like that, and they brought those concerns forward. The potential conflicts of interest of Dr. DePinho and his wife were managed at the UT System level, so as the provost, we were managing all of those issues with regard to the faculty and department chairs and division chiefs, but it’s probably not a good idea to try to manage that for your boss, so I think it made sense for those things to be dealt with at UT System. I think they just had a lot of concerns that they were really being dealt with properly and we really didn’t know what the management plan was, certainly early on, and there definitely was a lot of concern about that and a lot of discussions with faculty about how that could be better dealt with. I certainly relayed all those concerns to Dr. Shine and he wanted to step up the role of the UT System and managing those things, and that sort of evolved as I was leaving and I don’t know exactly how it ended up.

Tacey A. Rosolowski, PhD:

What was happening in the Executive Committee?

Raymond DuBois, MD, PhD:

Well, we were hearing a lot more about what Ron wanted to do and changes he wanted to make in the institution and I think that was an appropriate use of those meetings, because we really didn’t know Ron or exactly what he wanted to do, and it was important for us to understand what our marching orders were going to be and how we’re going to respond to that. I think we were listening and hearing all of these things and trying to come up with how we could actually make those things happen, in a way that was compatible with how MD Anderson worked. I think a lot of the time was spent on that.

Tacey A. Rosolowski, PhD:

I’m just curious, because you had talked about this really good working relationship among these people who really shared a vision for the institution and suddenly, you got a new vision that you have to respond to.

Raymond DuBois, MD, PhD:

Right.

Tacey A. Rosolowski, PhD:

And I’m curious what people’s reactions were and how that affected kind of the working relationships of the Executive Committee.

Raymond DuBois, MD, PhD:

Well, it did change. I mean clearly, Dr. Mendelsohn had his own leadership style and Ron had a different leadership style, so the information flowed a lot more from Ron directly. Like I said, I did try to provide feedback and input, to put my two cents in, in terms of how I think we should do it, but I agreed with Ron when he gave his resignation speech, that he just didn’t listen a lot, to what we had to say. I guess one of my biggest concerns, we were spending money at a significantly higher rate than we normally had ever done before. I think the idea was we were going to raise more money philanthropically than we had done before, so that would offset it, but I think in the long run maybe that didn’t happen and that led to some of the financial strain. Because you know, reengineering all those labs on the South Campus and putting all those hoods in was very expensive, because that wasn’t in the original plans. I think we had to put in seventy high flow hoods down there, and other changes that were being made, to adapt to the new vision were costly and we had now, a two tier system for the salaries of all those individuals brought in from Boston and that added some strain on the budget. And then there were other activities underway, with joint ventures and things like that, that I wasn’t really involved in, but I’m sure that it led to some additional cost. My budget as the provost, per year, was really, it amounted anywhere from $12-17 million for new recruits, so in my mind actually that was a pretty hefty budget, because that would include the startup packages and all the things it took to bring on new faculty. We had recruited a few hundred faculty during my time as provost, but then I think that budget really got much bigger because of some of the recruitment packages that were given to individuals that came on after Ron joined the institution. That also—and I don’t know what those numbers were, but it was much more than the amount that we had usually been investing in that effort.

Tacey A. Rosolowski, PhD:

There’s one word that comes up over and over as people describe kind of the “true” MD Anderson culture, it’s democratic. [laughter]

Raymond DuBois, MD, PhD:

No that’s true. I think we did listen to what the faculty had to say. We wanted to take everybody’s input into account. Obviously, we didn’t always make the decisions that they wanted, but they felt like they were listened to and they had input, and that’s important, to have that give and take.

Tacey A. Rosolowski, PhD:

And they also felt there was a system in place where people were treated pretty much equally, I mean over and over people say that.

Raymond DuBois, MD, PhD:

Yeah, and I have to give Margaret some credit for that, because I think when she came onboard, that was a really important thing for her to accomplish, and she really set up the framework so that that happened. I just walked into what she had already set up and we continued that. Clearly, she wanted everything to be open, transparent, and people clearly understood how decisions were made and I think that did change after Ron took over, just because he had a different style and came from a different system.

Tacey A. Rosolowski, PhD:

Is there anything else you wanted to add about kind of this transitional period and things that were of concern to you?

Raymond DuBois, MD, PhD:

People always point fingers and blame people for certain things, but I don’t really blame Ron per se. I think he had never managed that kind of organization before. He had never been engaged in a complex, multi-thousand employee, fifteen million square feet institution, and so he jumped from managing a fairly small institute and his laboratory people, into a huge CEO like type position. I just don’t think it’s possible to adapt to that overnight.

Tacey A. Rosolowski, PhD:

And he wasn’t really a clinician, so I think much as he may have been committed to the clinical enterprise, it didn’t seem to me he had the detailed knowledge of the inner workings of it, and it wasn’t the most important thing on his kind of driving mission.

Raymond DuBois, MD, PhD:

Yeah, I think it was working well and the clinical enterprise generated a lot of revenue for the institution, so I don’t think he put a lot of thought into that but I’m sure he listened to what Tom Burke and others had to say about things. You know, we did expand the number of ORs and things like that, and so there was still attention to the clinical enterprise.

Tacey A. Rosolowski, PhD:

Right. No, I wasn’t meaning to say that he ignored it but you know, people come in with an experience base, particularly if they were hired, in order to act on that very powerfully, that was his messaging, was really exclusively about that one area.

Raymond DuBois, MD, PhD:

I think that after he finished his clinical training, he pretty much focused on research, whereas even Dr. Mendelsohn and myself, we did have some extensive experience practicing medicine and running—Dr. Mendelsohn ran the Medicine Department at Memorial Sloan-Kettering. At least I ran a Clinical GI Division at Vanderbilt, so you know that we had a different perspective I think.

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Chapter 15: Institutional Changes and the Decision to Leave MD Anderson

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