The Faculty Needs To Re-engage
By
Leonard Zwelling
This op-ed from The New York Times on September 2 by Skye Perryman urges average Americans to get politically active if they want to stop the country’s progression toward autocracy and the disintegration of democracy that has characterized the second term of Donald Trump. I want to argue that this is exactly what needs to happen at MD Anderson and the retirement of the current president is the perfect moment to reactivate the faculty’s insistence on shared governance between the administration of the UT cancer center and its faculty.
This was always a high mountain to climb in the president-centric UT System and it is a higher mountain than ever today. When the Texas State Legislature eliminated Faculty Senates as they were traditionally constituted, the major organ to effect shared governance at MD Anderson disappeared. Then, despite the Legislature allowing a new way to constitute a faculty representative body, the exiting president of MD Anderson chose not to activate this mechanism. Thus, there is no standing group of democratically selected faculty members that can represent the interests of the physicians and scientists who are the backbone of the institution as a new president comes on board, surely in the next twelve months.
Rather than bemoan its current state of powerlessness, the faculty needs to find a path toward reconstituting a Faculty Senate or something like it using a process that is consistent with the constraints imposed by the Legislature. This needs to happen now.
There are still members of the leadership of the past Faculty Senate on the MD Anderson faculty. Perhaps they can serve as the nidus for proposals to the current academic leadership and the ad interim president to ask for the implementation of a process, totally within the guidelines of the state, to develop a new representative body of the faculty that can speak for the faculty in a democratic fashion.
No one has to explain to me that MD Anderson was never supposed to be a democracy. All MD Anderson’s five presidents have been autocrats by definition. That was always the plan. However, the successful presidents among the five have developed ways to listen to faculty concerns, implement suggestions and fixes, and explain when such faculty needs and desires cannot be met. In the past, that mechanism for faculty input was the Faculty Senate. The last two presidents never cared about shared governance and frankly turned their noses up at the Faculty Senate’s suggestions and concerns. Now is the time for the faculty to make it clear to the ad interim leadership and whoever is the new permanent president that this will no longer be acceptable.
Now the question arises, what will happen if the new guy or gal uses the presidency in an autocratic fashion as did DePinho and Pisters and not constitute some sort of representative group to provide faculty feedback to the leadership? After all, autocracy is the default mode of campus governance in the UT System.
Please do not write any memos. Do not phone Austin. No emails, and I think we can agree that my blog is not moving the needle toward meaningful shared governance. There is only one recourse the faculty has when it comes to overcoming presidential indifference. That is to turn Wednesday into Sunday in the clinics. Pick a Wednesday a month away. Clear the templates of patients. Care for the acutely ill and hospitalized only, just like on Sunday. No clinic visits. The goal is to deprive the institutional leadership a whole lot of money. Money has been the major goal of the last two MD Anderson presidents. In their eyes, clinical faculty were there to generate income. Research faculty were tolerated.
If the clinical faculty will not go this far, the only hope the faculty have in getting a voice in institutional governance is the beneficence of the new leader. Lately, that’s been a bad bet.
I am a retired faculty member who never saw a whole lot of patients in my 29 years on the faculty. I was mostly a lab jock and vice president. The only faculty members with real heft are the clinicians when it comes to political and financial power. If the faculty want a voice, it will be the clinicians who create that voice.
These are the realities. Now, it’s up to the faculty to request and then demand a role in the operations and policies governing MD Anderson. The wise president will embrace this input. Clearly, the last two presidents have been unwise. But, as the attached op ed suggests, waiting for a wise man, a savior, is not the route to a better future. Individual and collective action is.
I believe that it was Jock Ewing on an episode of Dallas many years ago who said to his son Bobby, “real power is not something you are given. It is something you take.”
Still true in Texas.
5 thoughts on “The Faculty Needs To Re-engage”
Anyone associated with MD Anderson (faculty, employees, Board of Visitors, donors, patients) should demand greater transparency about the financial operations of the institution from the next administration.
MDACC is a $7 billion+/year operation, and it is not always clear where money goes, particularly with the $10B+ capital projects. Dr. Pisters celebrated when the Board of Regents (BOR) approved capital expenditures, but he failed to say that it was being paid for by clinical revenue (thank you faculty, thank you patients). MDACC spent a pretty penny on experiential consultants to plan for the downtown Austin hospital, but all for naught.
The former CFO, Ben Melson, did a good job at explaining the finances, including capital expenditures. The current CFO, Omer Sultan hired by Dr. Pisters, not so much!
Furthermore, it is unclear about the return on investment in the many institutes that Dr. Pisters touted: James P. Allison Institute, Institute for Data Science in Oncology, Institute for Cell Therapy Discovery & Innovation, Institute for Applied Cancer Science, “award-winning” Leadership Institute, and others. Nowhere to be found is a pro forma for any of these initiatives. They are all used for marketing and philanthropy, but otherwise they seem to be money pits.
It would be good to see a report on how $100 million invested in venture capital (VC) funds is going. When the institution failed to reach a top tier for faculty bonuses last year (short by $11M), it still found a way to put $50 million in a second venture capital fund. Since VC takes precedent over human capital, what’s been the return on investment?
Dr. Pisters replaced the shared governance committee with his President’s Advisory Council (PAC). PAC meetings contained useful information that would enlighten faculty and employees, but that information never trickled down to the rank-and-file. If PACS meetings continue, they should be open to all employees, or at least have a recording available for review like is done with other institutional meetings. If necessary, PAC meetings can go into executive session to discuss confidential matters, but otherwise, those meetings should be open to all with a means to provide faculty/employee feedback without fear of retaliation!
You seem rather knowledgeable. Do you share your insights with your departmental leadership, divisional leadership? It seems to me that PAC members ought to be taking what they learn to the faculty, but this channel of communication was always fraught.
All of your concerns would be solved by something like the Faculty Senate constituted under the new state rules. Pisters could have done that two years ago, but chose not to. I don’t believe anything short a complete overhaul of the institution will fix these problems. That is exactly what John Mendelsohn did within his first year. It needs to happen again. All VPs, and Division Heads need to move on.
I was also unaware that MD Anderson itself could invest in anything without it going through Austin. Perhaps poor ROI is what got Pisters fired?
Dr. Pisters received Board of Regents approval to invest clinical revenue in the venture funds, but that was at the same time he was telling us that we were going to fall short in our operating margin and had to work Saturdays last summer to make up the shortfall, but even that could not close the deficit. The operating budget may not have been designed for it to be met.
Department and Division leadership? The closer that one gets to the top, the more apt they are more apt they are to practice “see no evil, hear no evil, speak no evil” for fear of losing one’s position and exorbitant salary!
Correct. It’s about the money.
I am not sure how they calculate or present the budget numbers now. It should be very simple. This much came in; this much went out. My recollection of the system they use is the of opacity and sleight of hand.
I really cannot believe that MD Anderson is losing money, BUT, if so, how about cutting those executive salaries? Also, does the work force really need to be 22,000+? Doubtful.
It would be nice if the next president really understood how to manage a large organization, do so in a constructive manner, and understand that the engine of the organization’s financial well-being is the faculty.
MD Anderson is NOT losing money – it’s generating over $2B+ in annual profit that is going towards capital expenditures and whatever pleases the President. The arbitrary operating margin fell short, as you said, due to opaque and slight-of-hand accounting. The most recent head count is over 27,000, up from 20,000 in 2017 when DePinho had to exercise a reduction in force. Many of the extra hires now work remotely and don’t live in the state of Texas!
There should also be transparency about the Pickens Fund which at one point had over $850M controlled by Pisters. It was established to support research, but over the years it is uncertain what has become of it, but certainly it has not been used exclusively for research.
One thing certain about MDACC is that the administration, Board of Regents, and state leaders will do everything in their power to protect the almighty brand, and if Pisters did anything egregious that would warrant his dismissal, the leadership will not breathe a word for fear of tarnishing the brand!
PS. I’m still waiting to get my invite to Pisters’ retirement party. I would not expect anything less for an outgoing CEO recently named in Becker’s Hospital Review as one of the top academic medical center CEO’s to know in 2026!