Chapter 21: Changes for Women at MD Anderson

Chapter 21: Changes for Women at MD Anderson

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Description

Dr. Escalante provides an overview of the status of women at MD Anderson.

She begins by talking about what Margaret Kripke, Ph.D. (Oral History Interview) contributed to the institution after her arrival in 1984. She also points out what needs to be done, particularly in seeing women represented in executive leadership, and notes the contributions of Elizabeth Travis, Ph.D. who administers the Office of Women Faculty Programs designed to promote women. Dr. Escalante explains what she believes women bring to leadership.

Next Dr. Escalante notes generational differences in attitudes about family and work/life balance. She talks about her own difficulties in arranging time to address family issues in a Department that was inflexible about scheduling meetings. She cites changes to tenure clock policies as an indication of positive progress and notes that younger women have started a faculty moms’ group.

Identifier

EscalanteCP_03_20140523_C21

Publication Date

5-23-2014

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Diversity Issues; Character, Values, Beliefs, Talents; Experiences Related to Gender, Race, Ethnicity; Obstacles, Challenges; Gender, Race, Ethnicity, Religion; Critical Perspectives on MD Anderson; Critical Perspectives; Women and Minorities at Work; The Life and Dedication of Clinicians and Researchers

Transcript

Tacey Ann Rosolowski, PhD:

]+Well, since we’re talking about changes in the institution, I wonder if we could kind of look a little bit more broadly and talk about what you feel have been some of the big transformational moments for the institution as a whole since you came. I mean, there’s certainly been changes in administration.

Carmen Escalante, MD:

Right.

Tacey Ann Rosolowski, PhD:

There may be other moments that you thought were very, very influential in giving the institution a push to shift in a new direction.

Carmen Escalante, MD:

Well, certainly I was here when Dr. Mendelsohn was hired, and there was a huge shift then and a transformation and, I think, a—

Tacey Ann Rosolowski, PhD:

How would you characterize that?

Carmen Escalante, MD:

I thought it was very positive. I mean, we grew by leaps and bounds, tons of new buildings, you know. He did a lot of good things for MD Anderson.

Tacey Ann Rosolowski, PhD:

With that growth, I mean, a number of people have said that just the growth was kind of difficult to negotiation in terms of it had an impact on culture. Do you agree with that?

Carmen Escalante, MD:

During Mendelsohn’s time? You know, most of that time, I mean, when he came, I was still more junior. I mean, I grew over that time. You know, I think with any change in leadership, there’s a lot of change, which ultimately affects the culture, slowly maybe, but with new leadership, there’s new direction. And, you know, change is often difficult. We don’t like change, and so there’s a getting-used-to period of why are we doing this, is it going to be better in the end, blah, blah, blah. And as a younger faculty member, I guess I just did what I was told back then. You know, you’re still doing a lot of heavy clinical lifting. But I think over time that it changed the direction of the institution. Certainly at that point, I wasn’t a department chair. And that’s what I remember, people leaving, a time of uncertainty until new people were in positions. Kind of what we’re going through now, with a lot of shifting in the senior levels and shifting—I think it might be more painful this time because there’s a bigger switch into the genomic platforms and a total new area where MD Anderson is focusing and building, besides changes just in administrative leadership. And I think it takes a while for people to really understand and feel comfortable with all the changes and really understand exactly what’s happening, and the uncertainty of will it be successful, can it be pulled off, you know, all those unknowns that you have to kind of wait and see.

Tacey Ann Rosolowski, PhD:

]Do you feel uncertain?

Carmen Escalante, MD:

At times.

Tacey Ann Rosolowski, PhD:

And what’s the source of the uncertainty, anxiety, or [unclear]?

Carmen Escalante, MD:

Well, you know, as a department position now, I’m considered a leader. I’m not the executive leadership, but I’m trying to advocate for my department, for my faculty, trying to tell them what’s going on, and sometimes I don’t know what’s going on at that point, you know. How are we going to do this? What is the budget going to expect us to do? With the healthcare changes, what is the administration? How are they looking forward to that? So as I get the information, I try to keep them informed, but sometimes we don’t know. Either the senior administration doesn’t know yet or haven’t come up with a plan, you know, or we haven’t been told yet.So, you know, and I think with any change in leadership, you’re kind of, “Well, how’s that going to affect me? What are they doing? What’s their new plan? They’re bringing in a new person, so then how are they going to change the relationship with the division or the department? What are their new expectations going to be? Are they going to perceive what we’re doing as important?” And you have to rebuild a relationship. And then you have to, as a leader, make sure that your faculty, that you’re giving them correct information so that they calm down and they understand that, “Look, for now nothing’s changing, you know. We’re continuing what we’re doing. I’ll keep you informed,” etc.

Tacey Ann Rosolowski, PhD:

Calming the rumor mill. (laughs)

Carmen Escalante, MD:

Exactly. And there’s always—in these times, there’s always rumor. When there’s change, there’s always rumors going around, and what’s truth and what’s not, and how do you keep everyone calm and focused is the challenge.

Tacey Ann Rosolowski, PhD:

Do you feel that General Internal Medicine is somewhat protected because you are related to kind of quite immediate needs of cancer patients when they come here and their maintenance, and so is the research that you’re doing? And maybe I’m kind of not understanding the terrain, and so even with the shift of the research focus at the institution-wide level to a more genomic cast, do you feel that you are protected and that you will continue to be seen as essential and your work will be seen as relevant?

Carmen Escalante, MD:

Well, I think we all hope that we’re seen as essential and relevant, but, I mean, I think we all wonder, well, we’re not going to cure cancer. You know, I’m not an oncologist. I may help so that they can cure cancer. I’m hopeful that they consider us a relevant part of the team with the oncologist, but me as an individual or my department is not the group that’s going to cure the cancer. We’re going to help, we’re going to be part of the team, and my research is not focused on curing the cancer nor anyone in the department. We’re focused on making it better for the cancer patient and making it more successful so that the oncologist can cure the cancer. So I think it depends on the angle, what’s most important to senior administration, and if they have to refocus or decide some programs are more relevant than others, how will they do that. Well, generally, I mean, I could take the—sorry.[recorder is paused

Carmen Escalante, MD:

So I think it all depends on where you sit. Do I think it’s likely that we would go away? I hope not. I don’t think so. But I don’t think I’m brave enough to say certainly never at this point. I think we’ve done a lot of good things that the institution and our colleagues have recognized, and we’re just kind of multifaceted so we can do a lot of different things as general internists. So hopefully that will help us, but I guess I’m in a cancer institution, I’m a general internist in a cancer institution, and when I first joined, that was a novelty. It’s less so now, but that was a novelty.

Tacey Ann Rosolowski, PhD:

Do you feel that—I mean, I’m trying to think how to ask the question. I mean, part of the reason that General Internal Medicine was established was certainly when the institution was really trying to reformulate itself to address patient needs in a much more multifaceted way. Now, given with this new administration that you feel like, “Well, my fate is not quite so certain as a person in General Internal Medicine,” is there any kind of question about the commitment that—or shall we say the balance that the current administration is placing on research versus patient care? I mean, is that in a place of change right now?

Carmen Escalante, MD:

I think so. I mean, you know, because of healthcare shift, I think clinical care and increased productivity is being pushed. I think that—I don’t think—I know that we’ve been told that we have to be more efficient, that likely we won’t be reimbursed at the same level, and if we want to continue doing all the things we’re doing now, then we have to have more revenue to support the research and everything else that’s not reimbursable. And I think all of the healthcare institutions are probably in the same boat. We may even be better off because we’re healthier. So something’s got to give. You know, people have less time and have to see more patients. They have less time—you know, there’s only so many hours in a day to do research, and the other big issue with research is there are less funding dollars, so it’s much more competitive even for very well-established researchers to get funding. So I think we’re all trying to figure out how is that going to affect us, how are we going to balance this again, and what’s the bottom line. We’re an academic institution. Will less people be able to do research, more people pushed on the clinical side or increasing clinical time? So I think that also produces a lot of uncertainty, how will promotion be handled. So if you’re seeing more patients, then you have less academic time. I think the downstream is you do less academic activities because you’re doing more clinical care. Will that be taken into account when you go to the Promotions Committee? Nobody understands that yet of how all those little shifts can have big impacts on people and their careers, so we’re all trying to figure it out together.

Tacey Ann Rosolowski, PhD:

Definitely sounds like a very uncertain and anxiety-provoking time.

Carmen Escalante, MD:

Yeah, and especially for the more junior faculty that aren’t the professor level, that are still in those assistant, even associate professor levels and are in the clinical side and doing a lot of clinical work and trying to figure out, okay, so now I have to see more patients to meet the goals that the target has, so how am I going to either teach more or write the review paper or write that paper so I can get promoted and keep it—you know, I want to be promoted, but how’s all that going to affect me? And all that makes people very anxious. Especially promotion is tied to increases in salary, bigger increases than annual merits. And so people have families and no one wants to stay stuck in a salary. I mean, everybody likes increasing their salary. So I think those are a lot of things that in the next few years we’ll see how it works out, but certainly will have an impact.

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Chapter 21: Changes for Women at MD Anderson

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