Chapter 12: Training Laboratory and Clinical Researchers in a Populations Perspective
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Description
In this chapter, Dr. Elting talks about Project 4, a training initiative run by Dr. Carlos Barcenos to inform junior faculty about health policy issues and encourage them to integrate a population-focus into their thinking and research. She gives examples of how they encourage this integration and how the training changes the faculty’s thinking about resource allocation, the cost of care, and what insurance can and cannot accomplish. Dr. Elting explains that the participants will become leaders in their fields and educators of the next generation of oncologists, so this training is key to shift their practice and contributions to how the healthcare system works.
Identifier
EltingL_02_20150305_C12
Publication Date
3-5-2015
City
Houston, Texas
Interview Session
Linda S. Elting, DrPh, Oral History Interview, March 05, 2015
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Education; Research, Care, and Education; Beyond the Institution
Transcript
Tacey A. Rosolowski, PhD:
Okay, okay. Work with Carlos Barcenoshave we talked about that? You haven't mentioned his name, so
Linda S. Elting, DrPh:
He did somehe was a fellow in this researchthis CERCIT project. Project 4I lead Project 4 on the CERCIT project, and that is about supportive care.
Tacey A. Rosolowski, PhD:
Oh, okay.
Linda S. Elting, DrPh:
He had an interest in supportive care of breast cancer patients, and so, although I was not his director mentorSharon Giordano is hiswas his mentor in the program, he was interested in supportive care. And so, he did some studies on that, and helike many others of the junior faculty membersmay not make this area his primary research interest for the rest of his career, but I'm impressed at how much understanding they gain from doingjust going through the motions of doing a single studyhow much better understanding they have of reading this kind of research, and of what the policy implications of their own work are. When we initially started the training program, I was concerned that we wereat UTMB, the people they get seem to me to be people who want to focus on this as their research area full-time, whereas the people we were getting at MD Anderson were clinicians. And they're doingat the same time, they're doing clinical trials, you know, or they're doing laboratory work. And it was not clear to me that those different groups were gonna benefit equally. But I have to say that despite my initial misgivings about the lab guys coming in [laughs] and doing these population-based studies, it's amazing how well they have integrated these concepts into their own thinking, you know?
Tacey A. Rosolowski, PhD:
Howwhat's the way in which you see that impact?
Linda S. Elting, DrPh:
A lot of ways. And it could be that when they speak to me they immediately know what they ought to talk to me about. [laughs] But I hear them saying things likeI don't hear them say anymore, "This is what we do at MD Anderson. This is how we do it." I hear them say things like, "We would like to do this in all our patients at MD Anderson. There are important considerations that cause us not to be able to do this, and one of them is being unable to get reimbursement. Another one is having somebody fifty miles away or 500 miles away, and they can't get here very often. And they're so far, and we need to deal with that distance issue. Or we can't do this, and we're concerned about doing this specific treatment because they're so far away, and they don't have the facilities in theclose by to manage it." And so, they think in terms of allocation of resources and things like that. I've had fellows say to me, "After I have done this, I'm thinking that I want to keep everybody on my studies limited to people who are within a fifty-mile radius, because I've seen how few and far between the emergency facilities are in this part of the state." You know, sand they've learned some geography. [laughs]
Tacey A. Rosolowski, PhD:
Yeah.
Linda S. Elting, DrPh:
Lots of them aren't from Texas. So, I've seen that. I've seen people be very awarebecome more aware of the cost of care, and of how inwhat insurance does and what it doesn't do. I think that a lot of our fellows believedand junior faculty believed that everybody who was too poor to afford insurance could get Medicaid if they would just apply. I don't think they had any idea of how many people are excluded. I don't think they had a good understanding of how few people are covered under Medicaid. And I've had people listen to that lecture that I give to them about who gets it and who doesn't, and they've said, "You mean to tell me if I lose my job and I get cancer I can't get Medicaid?" I say, "That's correct. You're able-bodied, male, under the age of 65. Unless you are declared disabled, there's no Medicaid for you." They say, "But where will I be treated." [laughs] I said, "Well, you're lucky. You live in Harris County. You'll get treated at the Harris County Hospital district. If you don't live in Harris County, you may be out of luck."
Tacey A. Rosolowski, PhD:
Yeah. What do you think the long-term effects of these changes in perspective are gonna be? I mean, it's like you're educatingyou know, it's one of these, you know, pebble-in-a-pool kind of things. It's
Linda S. Elting, DrPh:
Yeah.
Tacey A. Rosolowski, PhD:
gonna ripple out. What do you think the ripple effect will be from this training in these individuals?
Linda S. Elting, DrPh:
Well, you know, when we do this at MD Anderson, the people that are going through this training program will be the leaders in the field in the future. And perhaps even more importantly, they are the educators of the next generation of oncologists. And, you know, I've heardI've had junior faculty fellows say to me, "You know, I had never read the most recent version of the guideline for nausea. And I've changed the way I treat patients because of a study they did with me. And I'm teaching my fellows to do that, too." So, I think that knowunderstanding how the healthcare system works is an important part of being a physician. It's just that nobody ever educates you about it. You have to get bits and pieces of it, and it's kind of trial and error in trying to get your patients cared for. And particularly in institutions like MD Anderson, where so many of the details are handled by departments that are not managed by you, if you're a physician, it's important to understand those bits and pieces.
Tacey A. Rosolowski, PhD:
Well, thank you very much. Really, it was really interesting.
Linda S. Elting, DrPh:
Sure. [laughs]
Tacey A. Rosolowski, PhD:
Yeah, no, I mean, it was a really great
Linda S. Elting, DrPh:
My pleasure.
Tacey A. Rosolowski, PhD:
perspective. And it's three o'clock, so I don't want to
Linda S. Elting, DrPh:
Okay.
Tacey A. Rosolowski, PhD:
abuse your time today. And so, I want to thank you.
Linda S. Elting, DrPh:
Okay.
Tacey A. Rosolowski, PhD:
Thank you for the time today. And I am turning off the recorder at about two minutes after 3:00.
Linda S. Elting, DrPh:
Okay.
Recommended Citation
Elting, Linda E. DPh and Rosolowski, Tacey A. PhD, "Chapter 12: Training Laboratory and Clinical Researchers in a Populations Perspective" (2015). Interview Chapters. 716.
https://openworks.mdanderson.org/mchv_interviewchapters/716
Conditions Governing Access
Open
