Chapter 15: Developing Health Services Research in the Division of Cancer Prevention
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Description
Dr. Elting talks about her role as Chief of the Section of Health Services Research (2001 – 2013) and explains the department affiliation.
She sketches the research focus on the outcomes (including economic and business outcomes) of treatments, not the treatments themselves.
Dr. Elting explains why she was selected to take on this role and how she was asked to head the section and “go find a department to be in and make us famous.” She explains why she identified the Department of Biostatistics and Applied Mathematics as the most likely home.
Dr. Elting then sketches this administrative history of the Departments of Biostatistics and Applied Mathematics. She describes the challenges of finding a way to work with other department members whose perspectives were different and notes a landmark moment of finding common ground for collaboration.
Dr. Elting notes that her appointment to the role of Vice Chair of the Institutional Review Board raised the profile of Health Services Research and further credentialed her and her Section.
Identifier
EltingL_03_20150326_C15
Publication Date
3-26-2015
City
Houston, Texas
Interview Session
Linda S. Elting, DrPh, Oral History Interview, March 26, 2015
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; The Researcher; The Administrator; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; MD Anderson History
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey A. Rosolowski, PhD:
Okay. And so, in 2001, you became Chief of the Section of Health Services Research, and we also have to talk about departments at that point. So, tell me a little bit about that change, going from Director of Research to this chief of this section.
Linda S. Elting, DrPh:
Well, it's kind of an odd story. The institutionthat was a time when it was believed that health services research was going to be really important for the future of healthcare institutions.
Tacey A. Rosolowski, PhD:
Can you give me a definition of what "health services research"is, please?
Linda S. Elting, DrPh:
It's research about the delivery of services, and about the outcomes of health services, rather than specific treatments, and about both their healthcare and economic business outcomes. So[coughs]there was this believe that that was an important area. I was one of the few people doing that kind of research. So, there was a decision made to start a new Department of Health Services Research.
Tacey A. Rosolowski, PhD:
Who made that decision?
Linda S. Elting, DrPh:
Oh, who knows? Someone above my pay grade. [laughs] And it was going to be in the Division of Cancer Prevention, so they started it up and invited me to join the department, along with Scott Cantor, and so we moved to the new department with all our students and people, came with us. And they began a search for a chairman. And they searched, and searched, and searched. And then they realized that there wasn't anybody, so I got a call one morning from the provost, at thatshe wasn't the provowhat was herwhat was Margaret's title, Margaret Kripke? She called me up, and she said, "Well, we can't find a chairman. You're too young. You're going to be a Section. You're in charge. Go find a department to be in."[laughs]
Tacey A. Rosolowski, PhD:
[laughs]
Linda S. Elting, DrPh:
And I said, "Well, am I making this decision for me, or for our whole group?" She says, "The whole group. You're in charge now."
Tacey A. Rosolowski, PhD:
Wow.
Linda S. Elting, DrPh:
So I started interviewing department chairmen, which was odd. And I interviewedI talked to, I guess, three or four or five department chairmen, where it might sort of make sense. And weand I made a decision that we belonged in biostatistics, primarily because what we were doing was very quantitative at that point. They had the best quantitative resources and computer resources in the institution, and everyone else that I talked to was desperately trying to get more resources of that sort. So I felt like that was going to give us the best shot at having the resources that we needed. The chairman, Don Berry, was interested in this kind of work, and in that kind of statistical modeling you might do with this sort of work, and he was real supportive, so that's what happened. And, we were the applied mathematics piece.
Tacey A. Rosolowski, PhD:
So, because it was Biostatistics and Applied Mathematics?
Linda S. Elting, DrPh:
Mm-hmm, mm-hmm.
Tacey A. Rosolowski, PhD:
Okay. Now was "Applied Mathematics"appended to the name once you joined, or was it already part of--
Linda S. Elting, DrPh:
No. Actually, at sort of the same time, although it could have been a year apart, they were consuming the Biomath department. Biostats and biomath originally were together decades and decades ago. And then, biostatistics became its own department. And then, when I waswhen we were joining, biomath was coming back into biostatistics. So--
Tacey A. Rosolowski, PhD:
What was the reasoning for that? I mean, was it another, "who knows?"or[laughs].
Linda S. Elting, DrPh:
I suspect a lot of theI suspect a lot of the issues were political, but one of them was that the Chairman of Biomath, Stu [Stuart] Zimmerman, who had been theI think, the first Chairman of Biomath here. I mean, he had been here as the chairman for forty years or something, or thirty years or something, was getting older, and was beginning to look at retirement. It really made no sense to have two separate departments, since their work, although not the same, was very closely related. And there was good reason to believe that there would be synergy by having them together. So I think it was just the goal to get the people who did a lot of the same kinds of work to be closer to each other, and learn from each other, and I suspect there were lots of skeletons involved in it too, but from the outside, that's kind of what it looked like.
Tacey A. Rosolowski, PhD:
So tell me about your kind ofwhat were your marching orders, as section chief?
Linda S. Elting, DrPh:
You just heard them.
Tacey A. Rosolowski, PhD:
Okay. [laughs]
Linda S. Elting, DrPh:
Find a place to be.
Tacey A. Rosolowski, PhD:
Find a place to be.
Linda S. Elting, DrPh:
And then when I found a place to be, then I was supposed to make us famous.
Tacey A. Rosolowski, PhD:
[laughs] And how did you go about doing that?
Linda S. Elting, DrPh:
[laughs] We did it by writing papers and getting grants, you know? And that was the only way I knew to be famous. I didn't want to be infamous. [laughs] I didn't march, or get arrested or something. So when Iwhen I was told I was a section chief, I can't believe I did this, but in the same conversation, I said, "Can I have a position for an economist?"
Tacey A. Rosolowski, PhD:
Oh wow.
Linda S. Elting, DrPh:
And Margaret said yes.
Tacey A. Rosolowski, PhD:
Now why did you want that position?
Linda S. Elting, DrPh:
Well, I felt likeyou know, health services research departments are usually departments in a school of public health. They're multidisciplinary, and they have lots of different kinds of people. And there are some health services departments, and sort of clinical institutions, they tend to be really focused on clinical outcomes. Although some programs are focused on clinical and patient decision-making and shared decision-making. And I felt that, for us, what we needed was to be a little different; to have something unique to offer. And one thing that no one else had was someone doing healthcare economeconomics, in cancer. I mean, there just wasn't anybody doing that at that point. And so, I felt that that would be a way to distinguish us from other groups, in particular because it was something that really interested me at that point. I was starting to teach myself some economics, starting to look at the cost of care, and you know, because patients often told me it was a real burden for them. So, I asked for a position, and she gave it to me. So, I recruited Tina Shih to come here and start a program in cancer economics. Andand she did that, and did a very fine job of it too.
Tacey A. Rosolowski, PhD:
And her last name is spelled--
Linda S. Elting, DrPh:
Shih, S-H-I-H. And she worked here for aboutI don't know, five years, or seven years or something, and then left to go to the University of Chicago, the mecca for economists. But we just recruited her back, so she's back here.
Tacey A. Rosolowski, PhD:
Oh, interesting.
Linda S. Elting, DrPh:
In this department. So, that was athat was a good recruit.
Tacey A. Rosolowski, PhD:
Yeah, yeah. So, now you held that position until your retirement.
Linda S. Elting, DrPh:
Mm-hmm.
Tacey A. Rosolowski, PhD:
And, tell me--
Linda S. Elting, DrPh:
Well I held that position until we moved from Biostatistics to this new Department of Health Services Research, where I am now.
Tacey A. Rosolowski, PhD:
Okay, and so that position officially ended when, then? So from 2001 until--
Linda S. Elting, DrPh:
Yes, we moved here in 2013?
Tacey A. Rosolowski, PhD:
Okay. Okay, so whatwhat was yourhow did your plan evolve during that time, for how things were to evolve?
Linda S. Elting, DrPh:
We had to fit our program into the biostatistics model, which was awkward.
Tacey A. Rosolowski, PhD:
Why so?
Linda S. Elting, DrPh:
Well weall our research we did as PIs, all of thea lot of what they did, and there are some statisticians who don'taren't PI on anything. You know, they work full-time with other PIs doing the statistics. So there wasn't great infrastructure to support a principal investigator. Nor was there really an understanding of what that infrastructure might be like. And so, we had someit was a very strange marriage of our group to theirs, because we didn't do the same things, in the same way. We had really different issues, but we figured out a way to work together, and we didn't fight much, so I consider it a success. [laughs]
Tacey A. Rosolowski, PhD:
So what were some of the kind of landmarks of evolution?
Linda S. Elting, DrPh:
I guess when we first arrived, Don Berry, I think, had told everybody they had to be nice to us and make us happy. And so for awhile, we got invited to every meeting, and every new project, and every new this. Well after we did that for awhile, they realized we didn't know anything that they needed to know. They were doing other kind of stuff. So for aafter that, there was this long period when we said hello, we saw each other at the elevatorwe would say hello over lunch. And it was a really social relationship that we had with everyone else in the department. And we were never in meetings, or any projects together. Andbut finally, we sort of figured out what they did, and what they were good at, and they figured out the same thing about us, so we actually started to work together to do things, and to do some research, and then it was fun.
Tacey A. Rosolowski, PhD:
So what were the projects you began to collaborate on?
Linda S. Elting, DrPh:
I started asking a statistician to work with me on some of my population-based studies, because I was interested in multi-level modeling, where patients are nested in doctors who are nested in hospital, who are nested in regions of the country, or networks, and that kind of thing. And when we started working together onand that's a very sophisticated statistical model; it's not one I would build myself. I would want a statistician to do it. And when we started working together on that, and we started talking, and going back and forth, I think we all started to realize about how we could collaborate together. Because a lot of what I was doing, was similarvery similar mechanically to what they were doing with gene arrays.
Tacey A. Rosolowski, PhD:
Oh, interesting.
Linda S. Elting, DrPh:
You know, because there areyou know, there are chromosomes, and genes, and they're in regions, and all of that. And once they figured out what my challenge was mathematically, they immediately understood kind of what I was doing, andand so, that's when we started to talk back and forth, and work productively.
Tacey A. Rosolowski, PhD:
What were some other landmark moments? And while you're thinking, I'm going to pause, just for one sec. [Recorder is paused]
Tacey A. Rosolowski, PhD:
Okay, there we go. [laughs]
Linda S. Elting, DrPh:
I guess, the other landmark for me in that department was when I was appointed to be Chair of the Institutional Review Board [IRB], because statisticians deal so much with the IRB. And so, pretty soon I got all of their questions, andand all of their concerns.
Tacey A. Rosolowski, PhD:
And you were appointed as vice-chair in 2003.
Linda S. Elting, DrPh:
Mm-hmm.
Tacey A. Rosolowski, PhD:
Okay.
Linda S. Elting, DrPh:
Vice-chair in 2003?
Tacey A. Rosolowski, PhD:
That's what I have from your CV.
Linda S. Elting, DrPh:
And Chair in 20--
Tacey A. Rosolowski, PhD:
And five.
Linda S. Elting, DrPh:
Five, okay. Okay. Yeah. So, that raised my profile and credibility in the department, as elsewhere. But in particular, that was a place where we could provide some service to them, and so we were all getting along much better then.
Recommended Citation
Elting, Linda E. DPh and Rosolowski, Tacey A. PhD, "Chapter 15: Developing Health Services Research in the Division of Cancer Prevention" (2015). Interview Chapters. 719.
https://openworks.mdanderson.org/mchv_interviewchapters/719
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