Chapter 16: The Division of Radiation Oncology

Chapter 16: The Division of Radiation Oncology"”Strategic Planning and Growth

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Description

Dr. Cox summarizes the growth of the division between ’97 and 2007, when he retired: from seventeen to fifty full-time faculty and from 240 to 600 patients seen per day. He notes that the Division made a lot of money for the institution and achieved a high level of credibility from good planning. He sketches the yearly strategic planning meetings the Division held each year, noting that the main goal of all planning was to ensure that the Division was the best in all areas. He explains that a second goal was to create a supportive environment for everyone, and believes that they were successful in achieving that. At the end of this segment, Dr. Cox offers reasons for the separation of Departments within the Division of Radiation Oncology.

Identifier

CoxJ_03_20130423_C16

Publication Date

4-23-2013

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - An Institutional Unit; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Institutional Processes; MD Anderson Culture; Leadership

Transcript

James D. Cox, MD:

So, anyhow, we went from seventeen full-time faculty and by the time I—let’s see from ’97 let’s say to 2007 when we split the division department into a separate department and a separate division, and obviously they are not separate, but we had over fifty faculty.

Tacey Ann Rosolowski, PhD:

That’s amazing.

James D. Cox, MD:

We had gone from treating 240 patients a day in ’97 to treating about 600 patients a day now with absolutely advanced technology and still with peer-review.

Tacey Ann Rosolowski, PhD:

What has that represented for the institution?

James D. Cox, MD:

By and large they have been happy. We have made a lot of money for them. They have been supportive, and I think probably I have made—and the people that I’ve hired that have worked with me closely have made reasonable estimates of what we were going to do, let’s say, in planning a budget, and we have been pretty accurate in doing that. So we have maintained a high level of credibility in terms of our planning.

Tacey Ann Rosolowski, PhD:

What kind of revenue stream are we talking about here? What kind of money does the division of radiation (both speaking at once)?

James D. Cox, MD:

Right now I am not entirely sure. I think from the technical side—that is to say that which flows to the institution as opposed to PRS—gosh I don’t know—it’s been so long since I’ve looked at the figures with a high level of interest that I want to say in general the whole portfolio is of the order of—maybe $250 million or more.

Tacey Ann Rosolowski, PhD:

I was asking because in one of the articles that I read for background research the author was saying that you were interested in looking at strategic planning issues with the division. And so I was—

James D. Cox, MD:

We did that regularly.

Tacey Ann Rosolowski, PhD:

So how did that work? And with what result?

James D. Cox, MD:

Well—we got people together once a year, and we set aside a certain amount of time to look at various components that included our educational program that included research, and the research of course included ERO physics as well as the clinical department. In the clinical department there were people doing research that was actually in the laboratory, but they were clinicians doing research in the lab.

Tacey Ann Rosolowski, PhD:

What were the strategic planning goals?

James D. Cox, MD:

They differed each year. I mean we developed—we had a meeting one time in the midst of this where somebody from outside of the institutions challenged—what is your goal? And I said, “It’s to be the best, it’s to have the best division or department of radiation oncology in the world—bar none.” And I think we have done it. So in each area it was how can we enhance what we are doing? Accepting the fact that we are doing really well here, how can we make it better? Don’t rest on your laurels—think about how you can move forward in a more positive direction. Now it is true in every part of the division. There is another piece of it—and I may have mentioned this before in other context—and this is not part of strategic planning, although it underlies strategic planning. We wanted to have a department that is absolutely as supportive as it possibly could be for the people who work within it, so something that I have said frequently is absolutely our top priority in everything we do is the patient. Nothing gets in the way of that. And if you do strategic planning with some goals, the goals have to point in that direction, but second only to the patients is taking care of each other. I have emphasized that over and over again, and I think that has become part of the culture I believe.

Tacey Ann Rosolowski, PhD:

What are some things that you did or fostered to create a supportive environment?

James D. Cox, MD:

I have very little patience for people who are trying to intimidate each other. And that is true among the residents, it is true with the faculty, it is true throughout the entire department, so occasionally there would be people who would sort of—in one way or another—put unnecessary or inappropriate pressures on other people. You might say brow beat them. And I just—I would talk with them and say, “Just don’t do it.” Now I would not do it in public, and so a lot of times they wouldn’t know I had even done it, and the other people wouldn’t know. They might complain to me and say, “Why haven’t you done something about this?” And I would say, “But I have.” And sometimes it was not obvious for a while. So that was one major thing, and it included faculty.

Tacey Ann Rosolowski, PhD:

Well, in general I think the people who are hired at MD Anderson are pretty high intensity independent people.

James D. Cox, MD:

Yeah. They are. Tacey Ann Rosolowsk,i PhD And that must create some unusual challenges of getting people to work together, leaderships—you know—is that something you have found?

James D. Cox, MD:

Well, I think if people enjoy doing what they’re doing, if they are working in a supportive environment, then to be able to transmit that to the components that they are responsible for—you know—the other parts of the department and even within the institution because—I mean—we know many circumstances where people in other divisions were really, really unhappy with the leadership and really unhappy with the way things were done within their section. And sometimes the solutions were really obvious to me, but of course it wasn’t my division so what could I do? On rare, rare occasions I went to John Mendelsohn about it, but not on any kind of routine basis.

Tacey Ann Rosolowski, PhD:

Is there anything else you would like to say about your time as division head?

James D. Cox, MD:

You know there is a publication, and I have forgotten was the occasion is, but Robin Famiglietti—do you know Robin?

Tacey Ann Rosolowski, PhD:

Uh-hunh (negative). I’ll just pause here.

James D. Cox, MD:

Yeah. I think so. So Robin would have the publication. They did—and I cannot remember what the occasion was. I guess maybe it was we started doing an annual report, and I think maybe the first one that was done was more than an annual report. And I suspected this was in—I think it was after we separated the departments, so I think it was probably somewhere between 2007 and 2009. But there was an annual report, and I think it documents what happened over time so that there are numbers put to the things that I have told you about how the division changed.

Tacey Ann Rosolowski, PhD:

I didn’t ask you why the departments were separated in the way that they were.

James D. Cox, MD:

That is a funny story. Well one—the amount of work to be done just got to be too great. At the same time you were trying—needing to do everything in regard to the faculty and to make sure people were doing what they needed to as far as taking care of patients. And then there was the issue of recruiting a new head of experimental radiation oncology and a new head of physics when Dr. [Radhe] Mohan stepped down as chair. So there were a lot of things to be done on the division head side as well as the department chair side. Plus the reality is that there was—in my mind—a natural successor, and that was Tom Buchholz, and he was being recruited away to another institution. And so I decided to separate it at that time, and then they would launch a national search, which they had to do. This was with the blessing of the president of course. They would have a national search with the hope that Dr. Buchholz would be selected, although there was another fine candidate from the outside—or actually who had been here before and who is in another state—they were finalists. And anyhow Buchholz was chosen through the usual search process—not a quick process—it took a year. But he knew he was a candidate, hopes that he could have that job, and he and I have a very close working relationship, and I have tried to be a mentor to him in many ways. And so it was in no small part a way of trying to keep him, and that was sort of decided at the time when he was getting stronger overtures from other institutions. At that same time it was happening in other divisions. They were separating the head of the division from the head of the department whether it was in pathology, diagnostic imaging, medical oncology, so there was ample precedent for it.

Tacey Ann Rosolowski, PhD:

Was there an impact on how resources were allocated? Space? All of that? I’m just curious what effect it had.

James D. Cox, MD:

Not a whole lot. There was not a whole lot of impact there. The impact had to do with sharing decision making, having some resources that previously had come to me as department chair that were already designated in that way by PRS—how PRS funds float. But it was more decision making, but it was also recruitment. He took a major role in recruiting the faculty. So it worked out well, and once he was well-established it made good sense for me to step down from that position, although now he’s got this situation of being department chair and division head, which is not a comfortable situation, but with the sort of economic situation at the moment I don’t think that is going to change right now.

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Chapter 16: The Division of Radiation Oncology

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