If MD Anderson’s Leadership Is So Bad, Why Is It Still Number One In Cancer Care? Hint: It’s Not About The Leadership

If MD Anderson’s Leadership Is So Bad, Why Is It Still Number One In Cancer Care? Hint: It’s Not About The Leadership

By

Leonard Zwelling

Careful readers of this blog might have noticed over the years that the blog is not critical of the patient care delivered by the clinical faculty or the research performed by the basic scientists at MD Anderson. I am a grateful beneficiary of the clinical care and a former performer of said research.

The blog is focused on the poor leadership for the past 25 or so years through three presidential administrations and the current disastrous guidance coming from Austin.

So, let’s break it down.

In the main, although there are many data that go into MD Anderson’s annual designation as the number one place for cancer care, it is, in my opinion, largely based on the impressions of the committee members who make the annual US News and World Report rankings.

One critical criterion in the rankings is the available technology at any given cancer center. MD Anderson is not short on any technology other than having an inadequate effort in AI. MD Anderson has more than enough nurses and ancillary care-givers. Every conceivable cancer has been seen by the faculty. “Nothing is rare” at Anderson. All true.

But, as this blog has said many times, the true assets of MD Anderson are its name and its faculty. Its name is based on the many accomplishments of previous clinical and research faculty. This asset cannot be changed easily, but it must be nurtured all the time. MD Anderson is perceived to be great by the world and the public relations people do everything in their power to promote this impression. In fact they do, “whatever it takes.” So, one factor in maintaining the number one ranking is good PR based on a storied history. It is the legend of MD Anderson. Remember what was said at the end of The Man Who Shot Liberty Valance: “When the legend becomes fact, print the legend.”

Second, is the current faculty. I still believe in the quality of the care provided by this faculty and especially in the fact that so many know so much about so little. What I mean is where else can an entire clinical practice let alone a career be based on the treatment of a single type of cancer? Who else can afford it? I have been stunned for over forty years at how much any given faculty member knows about his or her specialty. Bring that to bear on any single patient, and the quality of care is likely to be world-class. So, it is the very design of the clinical practice and the multidisciplinary nature of the care that keeps MD Anderson number one. No one else can do it.

Finally, I have been astonished by how little the leadership matters in delivering the critical product of MD Anderson—patient care. Through five presidents it has been superb. The very first president set the tone when he, R. Lee Clark, invented a free-standing cancer hospital at the edge of Houston. Nothing anything additional presidents could do altered the dedication of the clinical faculty to patient care. A Vice President of Patient Care was even shot at his desk. That affected nothing.

Presidents come and presidents go. The same is true of vice presidents, Division Heads, and department chairs. I should know. I was one of those vice presidents who came, tried to make a difference, and then, was gone. But I always knew that all I could do was facilitate the work of the faculty that was the essence of MD Anderson’s ranking. I hope I never fooled myself into thinking I was anything but overhead.

Sure, leaders can guide, direct, mentor, manage, and even strike a vision. Some, like J Freireich, Ki Hong, or Josh Fidler can change the practice of medicine and science, but it is the rank-and-file faculty member who remains the most important asset to assuring MD Anderson stays number one.

Finally, a story. Recently I have had the occasion to assist someone in becoming an Anderson patient. The care this person was getting in the patient’s local community was just wrong. This is common. The real reason MD Anderson is number one besides its name and its faculty is that everyone else giving cancer care is so much worse. I know this is a harsh judgment. Prove me wrong.