Chapter 01: Considering a Job Amid Controversy Over the Division System

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Chapter 01: Considering a Job Amid Controversy Over the Division System

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Description

In this chapter, Dr. Balch and Ms. Sollenberger discuss the controversy over the division system that played out as she was interviewing for the position as Division Administrator of the Division of Surgery. Dr. Balch sketches how a division traditionally worked in medical institutions and explains why Charles LeMaistre [oral history interview] revised the organizational chart in his system to enhance the possibility for shared resources.

Identifier

SollenbergerD_01_20190709_C01

Publication Date

7-9-2019

Publisher

The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Overview; Professional Path; Evolution of Career; Professional Values, Ethics, Purpose; Joining MD Anderson; Definitions, Explanations, Translations; Institutional Processes; MD Anderson Culture; Working Environment; Institutional Politics; Controversy

Transcript

Tacey A. Rosolowski, PhD:

We are recording and I’ll say for the record, it’s five minutes after eleven on July 9, 2019. I’m Tacey Ann Rosolowski and I’m sitting here with Dr. Charles Balch and Donna K. Sollenberger, on the campus of UTMB, University of Texas Medical Branch, in the administrative offices. We are here conducting the interview of

Donna Sollenberger:

for the Division of Surgery Project, “The First 50 Years of Surgery at MD Anderson.” It will be pretty obvious who the voices are but just for the transcription service, good morning Dr. Balch.

Charles Balch, MD:

Good morning, thank you.

Tacey A. Rosolowski, PhD:

Good morning, Ms. Sollenberger.

Donna Sollenberger:

Good morning.  

Tacey A. Rosolowski, PhD:

Well a real pleasure, and we were already talking and chatting, so I wanted to make sure that we continued our conversation. We were starting to ramp-up and strategize what we wanted the scope of this morning’s conversation to be and the formation of the division. The division had been in place since 1986, when Dr. Balch arrived and Charles LeMaistre [oral history interview] asked him to formulate the Department of Surgery into a Division of Surgery, and so you stepped in, in 1991, six years later. Maybe you could give us a bit of the lay of the land. I mean what was the divisional system and the Division of Surgery when you stepped in and what was your mandate, what were you there to accomplish?

Donna Sollenberger:

When I stepped in, in 1991, it was June I think, of 1991, we had --if I recall this correctly and Charles can correct me because he’ll remember the details I’m sure-- but nine surgical departments and a Department of Anesthesiology.

Charles Balch, MD:

Correct, and Dental Oncology.

Donna Sollenberger:

So we had, it was a little different type of aggregation of departments, because anesthesiology you might not see normally. But though it was a good organizational chart because anesthesiology and surgery have to work together to make [perioperative services] work, sometimes the barriers that you would run into from a surgical perspective were that anesthesiology should be doing this, this and this; I can’t be more efficient; I can’t get my cases started on time because of them. And anesthesia would say, well we can’t get them on time because the surgeons come late. This just seemed to me to be the right structure to maybe make a difference.

Tacey A. Rosolowski, PhD:

Maybe I’ll ask you a slightly different question and maybe even a more fundamental question. As we had mentioned before we turned on the recorder, there was a question about the fate of the divisional system. Were you reconsidering taking the position at that point? And I wondered why, because Dr. Balch had handed you a letter in which you were being reassured that there would be something of it intact.

Donna Sollenberger:

I can’t remember when I started interviewing for the position. Maybe January/February of 1991, and I literally was responding to an ad in the Medical Group Management Association newsletter, MGMA. I was the surgery administrator for a Department of Surgery at Southern Illinois University School of Medicine, which was in Springfield, Illinois. I had been doing that position since 1981, no 1976, I’m sorry, with a break of about four years. I had a child and then decided to do some teaching for a while but eventually went back [to the surgery department]. It intrigued me more because of what I was doing. But as I told Charles at the time, it was a bigger stage and we weren’t ever going to, at least in my lifetime, get to that level of prominence in Springfield. So I asked my husband, who is artist, “What would you think if I applied?” And he said, “Yeah, go ahead.” So, it was the first time that I’d ever responded to an ad for a position; and Charles said the first time he’d ever placed an ad for a position like that. Eventually, I was called for an interview with the search committee. I don’t remember everybody on it, but I remember Dan Oldani was on it, Mike [Best?].

Charles Balch, MD:

Yes. There was David Bachrach.

Donna Sollenberger:

Henry. Yes, David Bachrach, Henry Nowe. No, David wasn’t on it. No, it was Henry Nowe from PRS.

Charles Balch, MD:

There was Bob Shaw from Outreach.

Donna Sollenberger:

He wasn’t there yet. Those are just the ones I remember. There were probably some division administrators on it, but I don’t remember which ones. I interviewed, was called back, and I’m trying to remember … I think it was before I made the second trip, I got this call from Jim Cox [oral history interview], who was the VP for Patient Care at the time, I think. Anyway, I had met him and he was calling me. He said, “I know you have indicated your interest in the position and in coming back, but I have decided to eliminate the whole divisional structure, so there will no longer be six division heads reporting to me; instead there will be something like 36 department chairs reporting to me and there is no position for you.” He also had said but he had a position, I remember that. I just said, “Well, I would need to talk to my husband about doing anything differently, but thanks for calling.” And then I called you [Dr. Balch], because I wanted to know what was going on and it was, I think just kind of late breaking news, so you were going to get some more information and call me back. When you did call back, you said there had been a change and that you did want me to come and you had an offer for me and everything. I said well that made me uneasy because basically, my husband is an artist, I supported our family, and by then we had three kids. So I said what we need would be a conversation with the president, Dr. LeMaistre, that indeed, this is the final decision. So you said you would get that done, and within a few days, Dr. LeMaistre called me from an airport and said, “I’m sorry, this has been a little confusing,” but he said you know, I’ve decided we are going to continue the division structure and the division heads will basically report to, continue to report to Dr. Cox? I can’t remember.

Charles Balch, MD:

Yes.

Donna Sollenberger:

So anyway—

Tacey A. Rosolowski, PhD:

Let me just ask Dr. Balch, what were the issues at stake with eradicating this division system?

Charles Balch, MD:

The context here is that for the previous 45 years, the department chairs reported directly to the vice president for Patient Care or directly to Dr. Lee Clark. There was a number of those who thought that they should maintain that direct reporting relationship, and that the division was an interface between them that they really objected to, not just in Surgery but in Medicine as well.

Tacey A. Rosolowski, PhD:

It was perceived by many, wasn’t it, as a kind of loss of authority, loss of a status, not having that direct reporting information.

Charles Balch, MD:

Loss of direct reporting relationship, which they coveted, and that was the older structure but it was when it was smaller. I think “Mickey” [Charles] LeMaistre saw that with the growth of the institution, you can’t have 35 department chairs reporting to one person. You needed some interface, and that it was natural to coordinate some core services at the division level that would serve the departments that the departments couldn’t do themselves. That was the rationale for which I was hired as head of the Division of Surgery, Anesthesia and Dental Oncology, as well as the chair of the Department of General Surgery, which we later reorganized into a Department of Surgical Oncology. Certainly with any change like this in reporting structures, there’s going to be some pushback. A number of the department chairmen had convinced Jim Cox that the division structure wasn’t going to work for them, and Jim, without consultation with any of the division heads, sent out an email that he was going to abandon the division structure and have the department chairs report directly to him. I have no idea whether he got an agreement from Mickey LeMaistre. There was a lot of political pushback both ways in the ensuing two months and finally, Dr. LeMaistre sent out a two-sentence memo to everyone that the discussion about the division structure is concluded, and the division structure will remain in place as originally organized, period. It was a two-sentence letter.

Donna Sollenberger:

I have his letter and I have the one that Jim had sent abolishing it.

Charles Balch, MD:

So the context here is that not only did Dr. LeMaistre call Donna, but Dr. Cox wrote a reassuring letter, with a copy to me, that yes, I acknowledge the division structure, the division will be an important organizational entity and we would like you to come as the chief operations officer for the Division of Surgery. That was in April of 1991, and I will say that the structure really is maintained today, and is even more important today. At that time, we were an organization of about $900 million a year and what, ten or eleven thousand employees, something in that range? Now we’re a budget of $5.4 billion with 31,000 employees, and the division structure in all of the areas has been maintained through those years and I think has found its niche and its value in the organizational structure of MD Anderson, not just in Medicine and Surgery, but in Radiation Oncology, Radiology, Lab Medicine, and so forth.

Tacey A. Rosolowski, PhD:

Did you envision the benefits of the division system when you were contemplating the position?

Donna Sollenberger:

I did. That’s one of the things I thought --as I believe I mentioned-- is that it allowed surgery and anesthesiology coming together to basically be able to solve more problems itself, without having this churn or having to always escalate something up and wait for someone to make the decision or not.

Charles Balch, MD:

We were all at the same table together. One other thing, just in context --and this is part of Mickey LeMaistre’s genius I think-- is in most academic centers, divisions report to departments. In the growth of specialties like ENT, orthopedics and so forth, the professional organizations of those specialties said we should no longer have divisions of orthopedic surgery. There should only be departments, and our members should not accept jobs at the division level. Mickey LeMaistre just flipped the division and department so we could recruit a Department of Neurosurgery chair or a Department of Orthopedics and so forth, and had the departments report to a division. So in that kind of vision to say we can put the politics aside just by flipping the titles, and now people in the outside world will see our specialty surgeons as a chair of head and neck, a chair of neurosurgery and so forth. That actually was very important, was we started recruiting chairs, such as Ray Sawaya in neurosurgery.

Chapter 01: Considering a Job Amid Controversy Over the Division System

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