Where Are The Surgeons? Where Are The Oncologists?

By

Leonard Zwelling

MD Anderson is in a state of transition. Obviously.

First, a Chief Operating Officer was appointed while the then-president remained in place atop the Pickens Tower of Babel. That COO displaced the Provost, Chief Medical Officer and Chief Financial Officer in the hierarchy of the upper reaches of Pickens. Thus, the crumbling org chart.

The choice of COO was an unusual one, the relatively newly arrived Head of the Division of Radiotherapy, Steve Hahn. It was a good one, from what I can tell. Steve has gained the trust of the faculty on the Shared Governance Committee who represent the most critical constituency of the leadership of MD Anderson—the faculty. This was a fact the then-president never figured out.

Then, the then-president quit. I detect a seismic wobble in the Tower.

Now, in his place is another one of the Division Heads, the Head of the Division of Diagnostic Imaging. I guess you have to be facile with electromagnetic radiation to be an ad interim leader at MD Anderson. What you clearly do not have to be is a surgical or medical oncologist, although Dr. Hahn is fully clinically trained in patient care and Dr. Hicks can pass a catheter just about anywhere.

It does strike me as odd, however, that the usual sources of leadership in times of stress were by-passed by the Chancellor. That would normally be the Head of Surgery and the Head of Medicine. What happened?

I am going to let others answer that question, but when you consider who the previous people in those positions were, you have little doubt that under the current distress of financial problems and leadership absence, Drs. Hong and Pollock would have been drafted into service. Not so much now with their replacements. The trust that is required to be manifest between the leadership of Medicine or Surgery and the faculty they lead is probably missing and the institution cannot risk any more poor decisions by people incapable of making good ones. That the people in those jobs were awfully close to the then-president may also have precluded them as logical stand-ins.

This is a clear indication of the problems around the Division Heads table.

Under ordinary circumstances, the leaders of Medicine and Surgery are the first among equals—especially at a cancer center. That has not been the case for many years at MD Anderson. And if it ever was going to be the case, the overly close relationship between the past president (#3) and Dr. Hong (“your serve”), made the natural oppositional relationship impossible. Then came the new then-president (#4) and Dr. Hong wisely found the door.

The past Head of Surgery tried to stand up for what was right in patient care and he was fired on Yom Kippur. Nice gesture, Ron!

Well, you get the drift. The big dogs were followed by lap dogs and when the Chancellor needed help, he had to look elsewhere in the kennel.

MD Anderson is lucky to have the H and H boys ready to go. Hicks and Hahn (sounds like a vaudeville team) should be able to keep the ship on an even keel as the Chancellor and the Regents search for a permanent successor (#5). Whether either of them wish to be considered is up to them and then to the search committee. Perhaps they will earn their way to the big chair.

As a medical oncologist who was once pressed into service as a vice president by a surgeon despite me having few if any credentials in the area I was to oversee, I am used to having internists and surgeons step up when the going gets tough. That this did not occur this time says volumes to me about the leadership in these areas at MD Anderson.

We shall see shortly if the Tower wobbles some more, but perhaps it should. There are a few layers in the org chart that could use demolition.

Leonard Zwelling