Chapter 04: Responsibilities at MD Anderson, the Limits of Leadership Roles, and Working with Other Leaders at MD Anderson
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Description
Dr. Cox talks about his decision to come to MD Anderson, his position as Vice President for Patient Care and Physician-in-Chief, and why that “title was a great title and it was a bad job, for me.” He also discusses being glad to return to being a practicing radiation oncologist, is reflections on MD Anderson President Dr. Charles LeMaistre, and the main differences between being a physician and being an administrator.
Identifier
CoxJD_01_20040319_C04
Publication Date
3-19-2004
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - Overview; Building/Transforming the Institution; Professional Path; Evolution of Career; Joining MD Anderson; Leadership; On Leadership; The Administrator; Character, Values, Beliefs, Talents; Professional Practice; The Professional at Work; Institutional Politics; Understanding the Institution
Transcript
Lesley W. Brunet, CA
Let’s go forward a little bit. I don’t want to skip over this, but I do want to get to your coming down here. I guess when I first started looking at this I thought, why would anyone leave Columbia for Houston?
James D. Cox, MD
There were reasons. One was the attraction, and the other one was that the economic environment in New York City went bad around that time. Columbia Presbyterian Hospital, that had made a commitment—a major commitment—to improve the department, suddenly found that it was losing a couple million dollars a month. They couldn’t do anything, any of the stuff that they said they were going to do and wanted to do, and the picture looked pretty bleak pretty far out. So when this opportunity presented itself, even though I worked incredibly hard for three years at Columbia Presbyterian, I didn’t have very much to show for it.
Lesley W. Brunet, CA
Who first approached you about coming down here?
James D. Cox, MD
Actually, I was on the Board of Chancellors of the College of Radiology, and one of the people who was a chancellor at that time, or maybe somehow he was involved, was Gerald [D.] Dodd, [Jr.], who at that time was the head of Radiology here. Gerry said, “You know, they’ve got a position at MD Anderson for a physician-in-chief.” He said, “I think you’d be good, a good candidate for that. Would you be willing to look at it?” And I said yes. That was in 1987, because I guess I had just become a chancellor. I think I was a chancellor from ’87 to ’93. Anyhow, I was in the leadership of the college somehow. Before that, I’d been on the steering committee of the Council of the College. So Gerry came back, apparently, and talked to people here. I got a call from Dr. [Charles A.] LeMaistre’s [oral history interview] office and I was invited to come and interview. First, he was in New York City. I remember meeting Dr. LeMaistre for the first time at a hotel—I can’t remember the name—in New York City. We had lunch together and talked, and I guess he seemed to be interested after our talk. So I came and visited, and I met with the then division heads of the institution, including John Batsakis and Dodd and Jose [M.] Trujillo and Charles [M.] Balch [oral history interview], Irv [Irwin H.] Krakoff.
Lesley W. Brunet, CA
Pediatrics. Van Eys?
James D. Cox, MD
Jan van Eys. I think that gets all of them. Maybe not. I interviewed with them, and apparently that went all right, so sometime soon after that they made an offer. I said okay, and I said I couldn’t leave too quickly because I was head of the department there and I had to keep my responsibilities to the people for some period of time. Anyhow, I came here, started officially August 1; although, we were working on plans for renovating the office and so on before that. I started on August 1, 1988.
Lesley W. Brunet, CA
There were several things you wanted. As a matter of fact, I have your acceptance letter. I don’t know if you want to look at that.
James D. Cox, MD
[laughs] Oh my.
Lesley W. Brunet, CA
See, the correspondence—it’s always in the correspondence.
James D. Cox, MD
That’s fascinating. Oh, yes.
Lesley W. Brunet, CA
Then I actually have a response to that from LeMaistre. There were several issues that you were concerned about. I’ll give you a few minutes to look that over.
James D. Cox, MD
Wow. [Reads documentation.] I was smarter than I thought. Yes, I said I would plan to spend some portion of my time continuing as chairman of the Radiation Therapy Oncology Group. This would require my traveling to Philadelphia at least once each month, and I would have to go to Bethesda with somewhat regularity for meetings with the chairman of cooperative groups. I asked them to accept the RTOG as a responsibility in the Division of Radiotherapy but more widely. And I was right in spelling that out, although they were wrong, or it turned out that they were very uncomfortable with my being away that much, which was one of the sources of dissatisfaction that evolved.
Lesley W. Brunet, CA
I got the impression they expected you to be on call around the clock.
James D. Cox, MD
All the time. And not only on call for the president, but on call for the division heads, an impossible task. As I’ve told people since—I don’t know if this has been quoted elsewhere—but I said, “It was a great title and a bad job.”
Lesley W. Brunet, CA
Certainly a difficult, difficult job. You mean the title of Physician-in-Chief or the Vice President for Patient Care?
James D. Cox, MD
Vice President for Patient Care and Physician-in-Chief, that whole title was a great title and it was a bad job, for me. In fact, they never really replicated it in that form quite again. David Hohn took it over, and he did a very good job. I mean he was really committed, and he was especially gifted in his interest in facilities and having them evolve. I think almost to a surprise I supported him very strongly in that position, and he was always most appreciative of that, but I was happy he had it, because I didn’t want it. Lesley W. Brunet, CA How soon did you realize you didn’t want it?
James D. Cox, MD
Well, no. I mean, after. Actually, I did my best until ’92, so more or less four years. And two things happened. LeMaistre called me in and said he wanted David Hohn to do this instead of me. Lillian Fuller was scheduled for retirement in the Department of Radiotherapy, and they needed a person to take over from her the very considerable responsibility of the practice for lymphoma. That was sort of my first love, as I indicated, some of the early research that I did, so I was very pleased to do that. So I was happy to go back to being a practicing radiation oncologist and to take care of the lymphoma service and the lymphoma patients and be doing research in that area. And I worked very well with Fernando [F.] Cabanillas. Through the whole thing, I was running the RTOG nationally, which was sort of my anchor and my source in a— [break in audio tape]
Lesley W. Brunet, CA
You were saying that RTOG was your personal—
James D. Cox, MD
It was my professional validation, because I did not get satisfaction from what I was doing day in and day out. But I learned a lesson, you know. As I said, for me that was not a good job, and after I was no longer in that position, I was offered the opportunity to become chancellor, vice chancellor, dean, so on and so forth. And I’d learned my lesson. That was a kind of administration I didn’t want to do and didn’t feel that I was good at. I didn’t find the kinds of gratifications that made me happiest. So I’m very happy being a radiation oncologist practicing here. I came to appreciate the institution far, far more once I was in the trenches, as it were, instead of looking at it from outside or from above, or however you want to characterize it. So I was really very much happier. Then totally to a surprise, when Dr. [Lester] Peters decided to go back to Australia and this position opened up—you know—I thought briefly about whether I should do that. I said, “Well, wait a minute. That’s the kind of administration I’ve always done, I’ve always been good at.” Go back in time. When I was at Walter Reed for two years, the second of those two years all of the regular army therapeutic radiologists had left, so by default I became head of the radiotherapy service at Walter Reed.
Lesley W. Brunet, CA
Pretty good training ground.
James D. Cox, MD
They had recruited one of my commanding officers to become the head of the section of radiotherapy at Georgetown [University Hospital]. He took the job and at the last minute backed out just as I got out of the army, and they offered me that job, so I became the head of the section of radiotherapy at Georgetown. Then I went to the Medical College of Wisconsin as head of the Division of Radiotherapy there and then made it into a department. Then I headed a department at Columbia, the first new department at Columbia University College of Physicians and Surgeons in thirty-two years. So I had done that kind of administration and enjoyed it, was good at it, and so I thought, “Well, if I have an opportunity to do that again, I would like to do it.” And I do, and over the course of the last however many years it’s been, seven years or so, eight years almost. It will be eight years, more than eight, because it was late 1995 when I took over. It’s been the happiest professional time in my life. I love what I do.
Lesley W. Brunet, CA
And the department or the division, it’s—
James D. Cox, MD
It’s flourished.
Lesley W. Brunet, CA
It really has. It’s got quite a reputation. James D. Cox, MD It’s flourished, yes, and I’m very proud of it. I’m proud of what we’ve done with the training program, which was to make it more and more and more academic all the time. The people who are going to start with us in July are phenomenal—our residents in training. The people we just matched with earlier this week who will become our PG-1 trainees and then who will start with us full-time in residency in 2005 are incredible. I mean, they are fantastic scientists, they are outstanding clinicians, they are really wonderful people, and we are just ever more excited about the people that are coming in for training, the research we’ve produced, the productivity of the place. I feel very fortunate to have the opportunity, and I feel very proud with what we’ve been able to accomplish. I’m surrounded by fantastic people. So what can I say?
Lesley W. Brunet, CA
So it’s worked out well.
James D. Cox, MD
It’s worked out well.
Lesley W. Brunet, CA
Do you mind discussing the earlier period just a little while longer?
James D. Cox, MD
No, I don’t mind.
Lesley W. Brunet, CA
One of the things that you talked about or you wrote in your acceptance letter or in the negotiation process was about having a Vice President for Patient Care and then a Vice President for Patient Affairs. What was the issue here?
James D. Cox, MD
The Vice President for Patient Affairs was a physician very close to Dr. LeMaistre, so the degree of access, influence, and balance was always with that person. But Dr. [Charles] McCall, with all due respect, was not a cancer person, didn’t know much about cancer, and so in the context of trying to make a cancer hospital work well, oftentimes was sort of—I don’t want to be unfair—but oftentimes put an emphasis on areas that seemed to me other than what was really best for the cancer patient, best for the faculty. See, my set of priorities from the day I came in—and to this day, as far as that’s concerned—was the most important people in this institution are the people who work here, with one exception; the exception being the patients are even more important. But, I mean, the people are so important and their ability to care for the patients then is so important that in a setting of a cancer hospital, it seemed like that balance wasn’t always a very good one. Now, Dr. LeMaistre himself was not an oncologist, and so I think a perception that was arguably different from Dr. [R. Lee] Clark’s and different from mine was the dominant influence in the institution. It was far more political than it seemed to me was advantageous. Not to say that every institution isn’t political, but it seemed like the emphasis in the decisions and even the representation of the priorities of the institution sometimes got, if not subverted, at least tangential to what I thought were the top priorities in the institution. I think there was and there evolved a disconnect between me and Dr. LeMaistre in that regard, not because of Dr. McCall, but I think the structure of the institution was such that it lent itself to decisions that were governed more by the people who— It was sort of the squeaky wheel gets the grease, and the two squeakiest wheels, naturally, because they had big services, were Dr. Krakoff and Dr. Balch. So Dr. McCall, Krakoff, and Balch had great access to Dr. LeMaistre and great support from him and, I daresay, far greater support than I got from him. Now, that’s candor.
Lesley W. Brunet, CA
This probably comes through in the records.
James D. Cox, MD
Sure.
Lesley W. Brunet, CA
Was there also an issue about who headed up clinical research?
James D. Cox, MD
There was some issue on that, and again, I felt that oversight of clinical research, the design and analysis of clinical trials, the administration of clinical research was one of the skills I was bringing to the institution. I was so passionately committed to that, that it seemed unwise to have that in a different office. Dr. [Frederick F.] Becker [oral history interview], in sort of the Office of Protocol Research, as I recall it, related more to Fred Becker and not very much to the office of the Vice President for Patient Care. So yes, there was some tension there. It was not a huge thing. It didn’t dominate what we did, especially since I was doing what I did in the national scene in clinical research. But, still, it seemed that— And in fact, the institution—and with the support of Lester Peters and the support of the faculty within the Division of Radiotherapy—we became a major player in the Radiation Therapy Oncology Group and are to this day. It becomes a resource for clinical investigations from MD Anderson, because cooperative groups have an ability to do the kinds of clinical research that rarely can be done in a single institution, just because of the numbers of patients involved. So clinical research was something of great interest to me, and I did not want that to be entirely in the hands of somebody else. But that worked out, as far as I’m concerned.
Recommended Citation
Cox, James D. MD and Brunet, Lesley W., "Chapter 04: Responsibilities at MD Anderson, the Limits of Leadership Roles, and Working with Other Leaders at MD Anderson" (2004). Interview Chapters. 756.
https://openworks.mdanderson.org/mchv_interviewchapters/756
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