Chapter 24 : Overview of MD Anderson Presidents and the Effects of Rapid Growth


Chapter 24 : Overview of MD Anderson Presidents and the Effects of Rapid Growth



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Dr. Elting begins this chapter by sketching the approaches of MD Anderson’s presidents. (She worked under all of them.) She observes that R. Lee Clark was primarily focused on patient care. Dr. LeMaistre [Oral History Interview] was an “ambassador president” who worked well with the University of Texas System. Dr. Mendelsohn [Oral History Interview], she says, brought a research perspective and now Dr. Ronald DePinho [Oral History Interview] is moving MD Anderson into new areas of science.

Dr. Elting states that MD Anderson’s next challenge is to determine how to function as a research institution and deliver care at the same time. She explains how MD Anderson has “seesawed” between these two poles over time. She observes that the negative press the institution is receiving is a function of the institution growing big very rapidly in an environment of financial complexity. She asks, How big is big enough? She observes that the institution has lost its cohesive feel. She compares MD Anderson with the Dana Farber Institute, which has remained small and focused.



Publication Date



Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Institutional Change; Critical Perspectives; Portraits; MD Anderson History; Growth and/or Change; The MD Anderson Brand, Reputation; Institutional Mission and Values; MD Anderson Culture; Understanding the Institution


Tacey A. Rosolowski, PhD:

I wonder if you'd comment on changes that have taken place. We've got a new administration in the past few years and MD Anderson has gone through some shifts in perspective. How do you see those coalescing?

Linda S. Elting, DrPh:

I've seen a lot of those shifts in almost forty years. I've seen a big change in the presidency. I've been here for all of the presidents. Dr. Clark was a patient care guru. That was his highest priority. That's what he pushed. And so the institution was a very different place when he was the president. When Dr. LeMaistre came here, it's hard to characterize his presidency. He was not real engaged in patient care. Nor was he engaged in research. He was a real ambassador president to the legislature, to donors, and he turnedbeing a Houstonian, I grew up hearing if you go to MD Anderson, you go there to die, and they treat you like a lab rat. He transformed this institution from the mad scientist laboratory place to the jewel in the crown for UT. I don't know how he did it exactly. (laughter) Although I think it had to do with a whole lot of time and effort spent with referring physicians throughout the state and developing those relationships. And that took MD Anderson to another level. Although I don't think we need that kind of person again, because he did that hard job to get us from the Frankenstein's lab to a viable place to go for your health care and a facility that the university was proud of. And then when Dr. LeMaistre came, he was really the firstwhen Dr. Mendelsohn came, he was the first president who was a research dude. Highly respected clinician. In fact somebody told me when he was coming here who had been with him at Memorial Sloan Kettering he was the best clinical teacher they'd ever seen. And yet he was sort of the first research dude who took the top job and began the process of transforming this into a highly respected research institution, not just a place with so many patients, they can test any drug and get the clinical trial done, but a place where you do real science, and where real scientists come as a career. And I think that's probably where DePinho is as well, on that upswing of moving MD Anderson into new areas of science. I can't imagine where the next president will go. It's hard to see where the gap will be. But my guess is that we're going to have to figure out a way to be a research institution and deliver health care at the same time, because in this long history there have been times when patient care was carrying research, and there have been times when we cut patient care jobs and the only safe jobs were on grants. There have been times when we were selling ourselves as the research institution of the future, and times when we were saying, "Send us all of your early-stage breast cancer patients." I think we're going to have go figure out at some point how big is big enough, and how do we make both of those things manageable, so that we can do a great job. I think much of what you've seen in the newspapers lately is as much a symptom of being big and growing fast as it is a change in leadership. I think it's quite possible we would have had all the issues in patient care that we have today with any of the final four nominees for president. It's just it's gotten really big really fast. Reimbursement has gone down a lot really fast. And it's hard to know how to run an institution and how to be that nimble. And the bigger we get, the harder the ship is to turn. So I think really the next big question that we face as an institution is how big is big enough, when do we say, "OK, we're not going to do this part of the job anymore, we're going to focus here." That's probably the hardest question I've ever thought of. And I don't think anyone wants to address it (laughter) but most of I think what we're experiencing now is that maybe you can't be all things to all people. And we've gotten so big that we can't almost function. The people here are the same as they were twenty years ago. We still all respect each other. We respect each other, including the people who clean the toilets and wash the floors. Everybody is important in this job of taking care of people with cancer. But there's a point when you just lose control of that whole thing, where there's no longer a cohesive feel. And I think we're past it. I think we've lost that feeling of working together. And we've become a bunch of silos spread over many buildings. And it's becoming more and more difficult to manage the quality of care and ensure the quality of research because we've got so many managers and so many Indians and chiefs. And I think that is a bigger challenge today than the research agenda. I'm probably the only person who thinks that. (laughter) Certainly the research agenda appears to be the highest priority today, along with how to expand our affiliate organizations. But I think a much more important question to who we are and what we are and what we do is what should we be in terms of size, when do we call it quits and say, "We're not going to treat early-stage breast cancer anymore, we made the discoveries, we figured out how to do this, it's done really well in the community, let's encourage people to go there. Let's invest in working on cancer X where we don't know what to do and we don't know how to take care of people." Now I will say that's an opinion left over from many years ago. There was a time when we wouldn't treat our own patients' high blood pressure because we believed our resources should be dedicated to the goal of finding cures. And there was a time when we would routinely tell people, "You just need to have a lumpectomy done in your home city." (laughter) So I think that's the hardest question we face. It's the one we address the least. We don't talk about it as a community here in the institution. We don't talk about it in our departments. We seem towe have the church mentality. Churches say, "If you're not growing you're dying." And that's how we behave. And I'm not sure that's correct. Look at the Farber. The Farber is one of the smallest places in the world. And yet they've done marvelous work. And it's because they're very focused. And so we've tried to be all things to all people. And unfortunately I don't think we can do that. So I consider that our biggest challenge. I think that's the challenge that either this president or the next one needs to take on, or this executive and the next one. And it's the one I think we are least willing to address.

Tacey A. Rosolowski, PhD:

Is there anything else you'd like to add at this point?

Linda S. Elting, DrPh:

I don't think so.

Tacey A. Rosolowski, PhD:

Well, I really want to thank you for our conversations.

Linda S. Elting, DrPh:

Oh, it's been my pleasure.

Tacey A. Rosolowski, PhD:

Yeah, it's been really really interesting. And this will be a real contribution to the whole collection.

Linda S. Elting, DrPh:

Well, thank you very much.

Tacey A. Rosolowski, PhD:

Thank you. So I wanted to close off the interview. If there's nothing left. And I am turning off the recorder at about 37 minutes after 3:00. Thank you.

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Chapter 24 : Overview of MD Anderson Presidents and the Effects of Rapid Growth