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Emperors, gladiators and handmaidens
These are interesting times in the world of cancer center directors.
The role has become the modern-day equivalent of the old medical school dean.
In the olden days, deans often were highly successful department chairs — triple threats able to run academic and educational enterprises while fostering clinical practices and maintaining a healthy bottom line. These individuals had extraordinary power, particularly if successful.
Thus, they came to have targets on their backs, with willing archers drawn from the ranks of university presidents anxious about a rival powerbase, other deans and even their own aspiring faculty leaders. It was uncommon for their roles to be held for more than 5 to 10 years, with the time-honored phrase “It is with mixed emotions ...” as the harbinger of the announcement of the oft-anticipated professional demise.
Over the years, the imperatives of medical school deans have been eroded, and many of these posts have become even less attractive, if that is possible. Many deans today have little money and less power, and they essentially function as the whipping boy for any constituent with power or a short fuse. Little wonder that the cadre of deans has lost some luster, not unlike the constituency that occupies the beltway. Who would want that role given the ambient circumstances?
Role of the director
The past few years indicate that cancer center presidents may have joined the list of unstable occupations.
Having held this role myself for more than a decade, I have had the opportunity to reflect upon its strengths and limitations.
The benefits are pretty clear — the ability to influence cancer research and treatment on a large scale (and sometimes a broad stage); the opportunity to shape an institution, recruit superstars, and create treatment and prevention models that are new and creative; supporting research agendas that reflect one’s interests and the community imperatives; and sometimes creating physical edifices that are startling, and which meet the needs of patients, families and staff at an increasing level of sophistication.
However, there are some downsides.
It is very common for the cancer center leader — who often has one of the most robust bottom lines in the medical school or health system — to acquire the same targets that used to adorn medical school deans. So often, everyone wants a piece of the action.
I can remember, without great joy, having constant battles at an institution that employed me with the chair of medicine, who viewed the oncology team as the gladiators and handmaidens of his empire, with their role being to provide kudos, sustenance, and salary or research support for any initiatives that he commanded.
The more enterprising cancer center directors have managed to create their organizational charts to ensure parity with departmental chairs with direct reporting to deans, system CEOs or a lay board of directors, the latter similar to a conventional business model for a CEO. Although this avoids the problems of dealing with a peer who hasn’t enough enterprise or energy to create his own sources of supply, it does place the cancer center leader in apposition — not opposition — to folks with a lot more power and often much more diverse experience, especially in the sociopolitical domain and in the corridors of power.
‘Power-shifting shenanigans’
There have been some interesting power-shifting shenanigans in some of our most productive and august cancer centers.
For a while, the most celebrated saga involved the president of The University of Texas MD Anderson Cancer Center, who seemed to be under attack from above and below for much of his tenure in the role.
He attracted the interest of the educated medical and lay press, his woes widely circulated on a regular basis, often representing highly sophisticated, leaked information from insiders in the know. That represented a sad example in which a gifted scientist moved into a role with huge sociopolitical demands. The result, though not astonishing, represented serious loss on both sides of the equation.
Less chronicled was the quiet exit from one of America’s oldest cancer centers of an internationally respected triple threat a couple of years ago — to the complete surprise of his external advisory board — shortly after rebuilding the institution, successfully recompeting for NCI designation with a great score and a long period of funding, and saving U.S. taxpayers a great deal of money by piloting the process of review without an onsite visit.
I viewed him as a superstar, but he left within months, at the discretion of his board and its chair. Who knows why? A quiet man, he doesn’t speak of it.
But these episodes pale by comparison to the extraordinary tale of Mary Beckerle, PhD, widely regarded as an outstanding cancer center leader.
Beckerle resurrected Huntsman Cancer Institute at University of Utah some years ago and, with active and constant support from the Huntsman family, managed to build it to its pinnacle, with strong clinical, translational and basic research, geographically balanced in a deft yin and yang with the highly productive Intermountain Healthcare system. I was surprised to hear that she had been terminated, reportedly by email — a particularly egregious lapse of decorum and common sense!
I have no idea of the unpublished circumstances that led up to this. The usual local clamor and speculation occurred, but this time was different. The scion of the Huntsman clan — a steadfast supporter of the institute and of Beckerle — took advantage of his role in the fourth estate, lambasting the university for its actions, and many of the university and cancer center faculty joined in this protest.
For once, the gladiators had a win. A few days later, Beckerle reclaimed her role, and those who had created the fuss started looking for other opportunities.
Advice for future leaders
So, what have we learned?
Running a cancer center is more complex than is recognized by many, and can be fraught with unexpected hazards.
For those of you who consider offering yourselves for this role, I offer only the following words of counsel:
- Never forget the maxims so wisely summarized by Joseph V. Simone, MD, many years ago — including, my personal favorite, “Institutions don’t love you back;”
- Try to avoid allowing hubris or circumstance to sever the connection between the trench workers and you;
- When the board or a dean have sociopolitical imperatives that may be bad for your cancer center, they often have enough clout to move you out, even if your thinking is correct. Not all arguments need to be won; and
- It sometimes helps to have a benefactor with clout, and to keep that person close and in the loop.
I am glad Mary Beckerle reassumed her role. It was the right thing to do, and it will probably be good for her institution and her cancer center. I do not know enough of the circumstances to have an opinion about the reasons underlying her transient departure, but I do think that — if the news reports are accurate — firing by email is grossly inappropriate.
With the harbingers coming from Washington, D.C., for 2018, maintaining an active cancer research and treatment entity will become harder and harder. I hope the people who run universities and health systems pay attention and understand that working to get the occupants of the beltway to do their jobs better will be more productive than playing musical chairs with their cancer center leaders.
Fortunately, I work in a successful system that is driven by data and outcomes, with a CEO who appreciates reinvestment in a successful service line. I think I will have the chance to relocate or to retire when I’m ready, rather than reading an announcement that talks about mixed emotions.
Reference:
Simone JV. Clin Cancer Res. 1999;5:2281-2285.
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare System. He can be reached at derek.raghavan@carolinashealthcare.org.
Disclosure: Raghavan reports no relevant financial disclosures.