Where’s Ron-do?

By

Leonard Zwelling

         The video from Big Brother Fontaine said it all. MD Anderson is not making enough money at its core area of expertise—oh, that’s patient care if you were wondering—and it’s spending too much. It is spending so much that Mr. Fontaine is asking everyone at the managerial level to work harder and to get ready to pick up even more work if one of their employees leave. It is likely that employee will not be replaced. (Does this mark the end of bad annual reviews?) People are costing MD Anderson too much. So are buildings, but you can’t fire an edifice once it is built.

         Let’s analyze this.

         First, the revenue part.

         Speaking with my friends who care for patients leads me to believe that the clinicians are all working quite diligently and besides the patient care docs have absolutely no control over their own clinic schedules anyway. They see the patients scheduled for them to see. Period. If there aren’t enough patients to generate sufficient revenue to sustain the unquenchable spending habits of the leadership, whose fault is that? Surely not the clinicians. And surely none of them welcomed EPIC, which is supposed to maximize billing after all. If the EMR is slowing work down, maybe the leadership should have calculated what foregoing full compliance with meaningful use standards would have been had a new EMR NOT been installed. Maybe Clinic Station would have been worth keeping.

         As for the spending side, well who the heck did all that hiring anyway? The faculty? Doubtful. The administrative and managerial ranks are precisely those that have swollen to take Anderson over the 20,000 mark in employees. Fewer than 10% of those people are faculty. I mean really, does the place need that many people? Would anyone have noticed had The Good Ship Mendelsohn Building at mid-campus NOT been built. Only those ensconced in it.

         So while Mr. Fontaine’s message is both accurate and timely, there is a certain disingenuousness and lack of sincerity when he delivers it. He doesn’t generate any revenue. He’s the Executive VP of Costs.

         But my question is a bit larger. Why isn’t Dr. DePinho asserting control over the vital mistakes of the institution he runs? Where’s Ron?

         One explanation is that he is allowing his underlings to take the hit when the news is bad.

         Another is that he is using the time-honored Rose Garden strategy known as hiding.

         The more sinister is that he is now going to go back to Chancellor McRaven and say: “see, I told you. This is what shared governance gets me, a fiscal disaster. When I was running the ship myself, we were in the black. Now look.”

         That would be really clever and I love it!

         Let’s say he’s just sending out the troops to take the heavy in-coming artillery. Dr. Dmitrovsky, Dr. Buchholz and Mr. Fontaine will take the brunt of the firepower and have to face the faculty with all this bad news. Ron stays safe and dry.

         This conspires with the Rose Garden strategy of just being absent. Always a good one.

         But I think it’s the latter plan that has been placed into effect. Now, should he have to, Dr. DePinho can purge the lower ranks of the Executive Suite to preserve his own job by blaming them for mismanagement with the faculty under shared governance and reassert his autocracy.

         Any way it develops, Dr. DePinho’s strategy is working for him. Doesn’t it always?

Leonard Zwelling