Chapter 13: General Internal Medicine: From a Section to A Division and Department

Chapter 13: General Internal Medicine: From a Section to A Division and Department

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Description

Dr. Escalante notes evidence that it has taken a relatively long time for internists to be accepted as part of oncology teams. She lists the individuals she recruited to the Department of General Internal Medicine once funding began. She says she is pleased with the progress this young Department has made in the past nine years.

Dr. Escalante sketches the history of the Division and the Department of General Internal Medicine, noting increasing acceptance of generalists. She explains that “we need a team approach to take care of these patients.” She discusses ways in which MD Anderson is far ahead of other institutions in allotting resources to General Internal Medicine and notes the creations of support care teams that provide patients with services not available at other cancer centers.

Identifier

EscalanteCP_02_20140514_C13

Publication Date

5-14-2014

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - An Institutional Unit; The Administrator; Contributions to MD Anderson; MD Anderson History; Discovery and Success; The MD Anderson Brand, Reputation; Building/Transforming the Institution; Growth and/or Change; MD Anderson Impact; Institutional Mission and Values; Multi-disciplinary Approaches

Transcript

Tacey Ann Rosolowski, PhD:

Now, tell me how it happened that you became section chief in ’97, and then you said you were first at-interim chair in 2000 when the division was created, and then in 2005 you became department chair. So tell me about your movement into those administrative positions.

Carmen Escalante, MD:

There was some issues with the section chief at the time that I don’t want to go on record about. But there was a lot of—I guess morale was not good among the—I think back then we probably had five or six faculty. It was a small, fairly small group.

Tacey Ann Rosolowski, PhD:

Just for the record, who was the section chief prior to you?

Carmen Escalante, MD:

Ed Rubenstein.

Tacey Ann Rosolowski, PhD:

Okay, yeah. I remember you mentioned him last time.

Carmen Escalante, MD:

So there was a decision made that he would no longer be section chief, and I was asked to be section chief.

Tacey Ann Rosolowski, PhD:

Why do you think they asked you? What do you think you could bring to that?

Carmen Escalante, MD:

Well, I think I was thought of as probably the most capable of the group. There were issues, and I brought these issues forward to superiors that things were not good. Other faculty had come to me and said, “You know, we need to do something or I’m going to leave too.” You know, people were very unhappy. There was no sense of fairness at the time, or there were some ethical issues. And we were a very small group and it was a difficult time. It was a very difficult time. It was a very difficult time for me. I even contemplated leaving and going somewhere else. No one likes to come to work when there’s a lot of stress and anxiety and morale issues, and so I made a decision and talked with my supervisor. And, again, I need to think about whether we need to hold some of this back.

Tacey Ann Rosolowski, PhD:

Sure. Yeah, and that’s fine. [unclear].

Carmen Escalante, MD:

And he spoke with the next level. So initially I was made section chief and he was left in the section, which created a lot of problems for the next year. I mean, they left him in for a year. He was not happy. He was not happy with me being section chief and him not. There was a lot of animosity there. It was very difficult. Here I had never been in a leadership position.

Tacey Ann Rosolowski, PhD:

I know, I was going to—

Carmen Escalante, MD:

I was junior. I had a section chief that was no longer section chief in the group. It was every day there was an issue. He created issue after issue after issue. And by the end of that year, I said to my superior, “I cannot stay any longer if he continues to be in our group. You know, it’s just too difficult.”

Tacey Ann Rosolowski, PhD:

Can I ask you, during that time, I mean now looking back, what do you feel you learned about leadership from that period?

Carmen Escalante, MD:

I learned a lot about conflict. I probably wasn’t the best at that time because I had—you know, back then we didn’t have training in leadership like they do now. Now, when I was made department chair, we went to a yearlong leadership training. I could have used that back then. I had no real mentor that I could go to and confide in and say, “Hey, this is going on.”I had a thorn in my side, so to speak, from day one, creating all kind of, you know, episodes you can imagine on a regular basis. He did not want me to be in leadership. He did not want it to be smooth. He did not want the group to succeed. He even told me, “You’ll never succeed.” All the group, everything he created he thought would just basically go away and that I would never be successful, and he made this public to whoever would listen to him.

Tacey Ann Rosolowski, PhD:

To what degree was your gender a factor in this, do you think?

Carmen Escalante, MD:

Oh, I think it probably was. I think he had recruited me, and we were predominantly female faculty in that group, and he felt that he could browbeat me and that I would eventually leave, and I think his goal was to make sure I didn’t succeed and the group didn’t succeed, to basically, I think, vindicate him from his demotion. And so—

Tacey Ann Rosolowski, PhD:

Pretty brutal to go to work with that every day.

Carmen Escalante, MD:

Yes. And I did this for a year. He was in our group, continued for a year, so we had reverse—he had been my supervisor. Now I was his supervisor. And, finally, after a year of doing this, I went to my supervisor and said, “You know, something needs to be done. This is not a good place for any of us, and I’m not going to deal with this any longer.” And so they moved him. They moved him to anesthesia to do pre-ops, which affected us because we were doing pre-ops. But the good thing is he didn’t like to work, so he wasn’t seeing that many patients. I said, “He didn’t like patient care.” He’s a very bright man, very, very bright man. Unfortunately, his talents—he didn’t use his talents in the right way.So he was moved, and it helped our group a lot just getting him out of the section, although it didn’t solve the issue completely, because he still would try to stir things up while I was there. But eventually after several years, I think he figured out that no one was listening to him anymore, both from senior management as well as from our group, and his credibility over time just continued to plummet. But, you know, it created a lot of problems, and you couldn’t focus on growing the group because you had to deal with issues from him all the time. And he had a lawyer, and, you know, that was another issue for the institution.So, you know, it was a constant, constant problem, constant hostilities, stress, anxieties, and it was difficult to become a leader, not only a new leader, but to become a leader when you had this going on at the same time. But it made me stronger, I think. It’s not something I’d ever want to go through again. I think there is a lot easier ways to learn leadership than being thrown into such a bad situation, but, you know, I survived.

Tacey Ann Rosolowski, PhD:

How would you describe your own leadership style?

Carmen Escalante, MD:

Well, I like to get input from people, but someone has to make a decision. So I like consensus, but at some point you have to make a decision, and I think no decision is a decision in a way. But I like to bring things to resolution, so getting people to buy in is important, getting thoughts, getting ideas, I think are important. I’ve learned to delegate, which in my early leadership years I felt I had to do everything, you know, no one could do it as well, until finally I was told by my superior, “You’ve got to delegate.” And once I started doing it, I realized, “Wow, this makes my life simpler.” You know, if you delegate to the right people, things can get done, and they can do it just as well as you, and you can focus on things that are more important other than getting caught in all of the daily things. So that was a major step.As we’ve grown, I’ve learned to organize into sections and delegate section chief, and this is a way for them to learn leadership as well and to become leaders, and it’s part of my job in helping them to become effective leaders. And it’s much more manageable because there’s no way as a department chair that I could manage thirty-two people without having sections, not effectively. And so the four section chiefs manage and do the day-to-day supervising and help and do a lot in the recruitment. I value their input, and we together select a leader. Most times they tell me which one they like best, and I don’t think there’s any time that I’ve overruled their priority.And the same with evaluations. They do the first-line evaluations of the faculty in their group. On the other hand, I always leave my door open, so if faculty want to meet with me—and actually I developed what we call kind of touch-base sessions, where I try to meet with all the faculty, and it’s their meeting. They can talk to me about whatever they want. We try to do it usually at least a couple times a year. We kind of go through all of them. And because I meet with the section chiefs on a monthly or bimonthly basis most of the time to sit down and go over things, but with the other faculty, it gives them access to me, and, of course, I tell them anytime any of them want to talk to me about anything, they can. But it works for a large group, and, you know, I’ve become more comfortable with leadership. I was very nervous at the beginning.

Tacey Ann Rosolowski, PhD:

What were you nervous about?

Carmen Escalante, MD:

Failing. Not being able to manage. No one likes to fail.

Tacey Ann Rosolowski, PhD:

Well, it was pretty rotten when you were being told you might, you might fail. (laughs)

Carmen Escalante, MD:

Yeah. No one likes to fail. And I think after you do it, you get more confident. I mean, when you first start—when I first started, I was not very confident because I’d never managed, and I had this person telling me, feeding constantly to not only me but the group that we were going to fail without him and we were not going to amount basically to anything and we needed him, and, you know, that doesn’t help your confidence while you have this going on.But over the years as you get little successes, that builds upon it, and you get your faculty promoted and you start feeling good about it. And once we started getting resources and were able to recruit and develop programs and build on those programs, I mean, you know, you kind of don’t even think about those days anymore, and, you know, it builds your confidence. And that’s what I want to do for my faculty, not only section chiefs, but my faculty, any of them that—some don’t want to be leaders, but others have potential.

Tacey Ann Rosolowski, PhD:

So how do you go about cultivating that?

Carmen Escalante, MD:

Opportunities when things come up, sending them to workshops or seminars on leadership in the institution and out the institution, giving them opportunities if I see potential and I see that they may be interested, and talking to them about “What do you want to do with your career?” And some people may not want that. They want to be totally clinical or education and clinical. Others want a research career. But we have to look forward to building younger leaders so when we move on, there are people behind us that can move up and step into roles, whether here at our institution or at other institutions, you know, if they desire.

Tacey Ann Rosolowski, PhD:

What do you tend to look for in an individual who has leadership potential? How do you identify that?

Carmen Escalante, MD:

Motivation, what I call go-getter attitude, is enthusiastic, excited, committed, that I think enjoys what they do and looks for other opportunities to do more, to do better in whatever they do, that comes through when you give them a project or an opportunity and doesn’t sit on it or never does it, and there’s a spark that you kind of start, once you get to know people. And not everybody may want to be a leader, but everybody can build their career in different ways, and sometimes people don’t realize they have the potential to be a leader until you talk to them. “Well, what do you really want to do?”And so you try to look for opportunities, whether as a center medical director or a potential section chief or a leader of a program or an opportunity to lead a committee. I mean, those are some ways that you can see if that’s what they really want to do, and they can contribute and be promoted and be successful. Everybody wants to be successful, you know. We just are successful in different ways.

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Chapter 13: General Internal Medicine: From a Section to A Division and Department

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