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Three interview sessions: 11 March 2014,18 March 2014, 29 April 2014
Total approximate duration, five hours.
Interviewer: Tacey A. Rosolowski, PhD
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About the Interview Subject:
Dr. Thomas Burke (b., 8 May 1953, Pittsburg, Pennsylvania) joined MD Anderson in 1988 as a faculty member of the Department of Gynecologic Oncology and Reproductive Medicine. In the eighties and nineties, Dr. Burke became known for developing combination-treatment alternatives to radical surgery for uterine and vulvar cancers. His administrative career began with his role as Medical Director of the Gynecologic Oncology Center in the Department of Gynecologic Oncology and Reproductive Medicine from 1989−1998. In 1998 he also began to serve as Vice President of Medical Affairs, rising through several leadership roles until he became Executive Vice President and Physician-in-Chief, a role her served from 2005−2013, when he was appointed Vice President of the MD Anderson Cancer Care Network.
Major Topics Covered:
Personal and educational background
A portrait of a clinician with an “entrepreneurial spirit”
Research: combination therapies for gynecologic cancers
Gynecologic Oncology at MD Anderson and multi-disciplinary care
Development of multi-disciplinary care at MD Anderson
Roles as Physician-in-Chief
Developing MD Anderson support services
Developing networks to serve MD Anderson
MD Anderson culture: changes and continuities amid growth
MD Anderson’s financial challenges and strategies to navigate them
A note on transcription and the transcript:
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One:
Taking Opportunities and Integrating Talents Drawn From Many People
Chapter 1 / Educational Path
Developing A Surgical Perspective and Style, Passing it on Through Mentoring
Chapter 2 / Educational Path
College at a Tumultuous Time and the Benefits of an Army-Subsidized Medical Education
Chapter 3 / Educational Path
On the Importance of Relationships in Medicine and Medical Care
Chapter 4 / Professional Path
Coming to MD Anderson to For Surgical Innovation: Serving as “The Last Resort Guy”
Chapter 5 / The Clinical Provider
The Late Eighties: Clinical Services in Gynecologic Oncology and Reproductive Medicine
Chapter 6 / MD Anderson History
An Overview of the Gynecologic Oncology CliniOffering Multi-Disciplinary Care Before it Was the Norm at MD Anderson
Chapter 7 / The Administrator
Developing Multi-Disciplinary Care Within the Department and in the Institution
Chapter 8 / Building the Institution
Bringing Experience With Surgery and National Trials to MD Anderson; Research on Endometrial Cancer
Chapter 9 / The Researcher
Research on Gynecologic Cancers; the Impact of Research on How a SPORE is Administered
Chapter 10 / The Researcher
Interview Session Two:
Maintaining MD Anderson Culture Despite Growth and Financial Challenges in Healthcare
Chapter 11 / Institutional Change
Medical Director of the Gynecologic Oncology Center: Developing Processes and Faculty Talent
Chapter 12 / The Administrator
Serving as MD Anderson’s Chief Medical Officer and Physician in Chief
Chapter 13 / The Administrator
As Physician in Chief: Addressing Needs in Pharmacy, Nursing, and Quality and Safety
Chapter 14 / Building the Institution
Building a Highly Skilled Nursing Service
Chapter 15 / Building the Institution
As Physician in Chief: Building the Survivorship Program and Pharmacy Support
Chapter 16 / The Administrator
Interview Session Three:
Comprehensive Approaches to Faculty Burnout in a Complex, Growing Institution
Chapter 17 / Building the Institution
The Institute for Cancer Care and the Challenge of Value-Based Care
Chapter 18 / An Institutional Unit
Financial Realities in Healthcare: The Need for Investment in Healthy Behavior; Treatments Near the End of Life; the Affordable Care Act.
Chapter 19 / The Finances and Business of MD Anderson
Financial Realities in Healthcare: The Affordable Care Act
Chapter 20 / The Finances and Business of MD Anderson
The MD Anderson Network
Chapter 21 / Building the Institution
The MD Anderson Network: Building Partnerships Based on Shared Mission
Chapter 22 / Building the Institution
Building the MD Anderson Cancer Network
Chapter 23 / Building the Institution
Significant Research Initiatives
Chapter 24 / The Researcher
Interview Session One: (listen/read)
Interview Identifier (listen/read)
Dr. Burke sketches his family background and early influences that left him open to taking new opportunities. He explains that he knew he wanted to be a physician when he was five years old. He notes that he still has a photo that appeared in the newspaper in which a little neighbor girl has brought him a “sick” doll and he is listening to the doll’s heart.
Dr. Burke explains his interest in the sciences, particularly the “interactive” parts of science: anatomy, dissection and comparative biology. He mentions his mother’s love of animals as an influence and notes that his mentors in surgery were enormously important.
Chapter 2 (Educational Path)
Developing A Surgical Perspective and Style, Passing it on Through Mentoring (listen/read)
Dr. Burke begins by describing the unique qualities of the operating room environment where, he notes, a surgeon’s interactive style may be more important than his technical skills He explains his philosophy of “de-stressing” the surgery environment to in order that a patient is not put at risk.
Dr. Burke talks about his surgery training. He observes that the environment that a surgeon created in the operating rooms influences how they were able to attract people to their specialties, a fact he has integrated into his own surgical practice and environment.
Dr. Burke tells a story of acquiring a cadaver during his clinical fellowship to redo anatomy from the perspective of surgeons. Dr. Burke explains what he learned from this and how the experience has helped him in his work at MD Anderson.
Chapter 3 (Educational Path)
College at a Tumultuous Time and the Benefits of an Army-Subsidized Medical Education (listen/read)
Dr. Burke talks about his experiences at Tulane University in the 1970s (BS Biology, 1974; MD ’78). He explains his concern about the draft (and his plans to avoid being drafted) and his decision to join the ROTC (1975) so the Army would pay for his medical education.
Next Dr. Burke talks about the benefits of receiving an Army Military Scholarship for medical school, including a summer program that took him to Hawaii, as state he loves. He recalls a memorable experience of visiting the leper colony on the island of Molokai.
Dr. Burke reflects on what he learned from his time in the military: responsibility, teamwork, the ability to predict how people will behave, how to handle stressful experiences.
Dr. Burke next talks about meeting his wife, Cathy. He describes their first date and a key shared interest: the art of David Lee.
Chapter 4 (Professional Path)
On the Importance of Relationships in Medicine and Medical Care (listen/read)
Dr. Burke explains why he specialized in Gynecologic Surgery, which he saw as bringing together his love of surgery with birth, a happy time where a physician develops and sustains a relationship with a patient over time. He goes on to explain how an oncologist and a patient are partners in risk, care and outcome, and how this is for him a very rewarding personal experience. He talks about his ability to deal with life and death situations without being weighed down by them. Since MD Anderson people can do this, they do not abandon people who will not survive their treatment
Dr. Burke next talks about the challenge of attracting cancer nurses to oncology specialties and recalls a program he established (early in his administrative career) to bring nursing students to MD Anderson. He notes that this program was successful in introducing students to careers in oncology nursing.
Chapter 5 (The Clinical Provider)
Coming to MD Anderson to For Surgical Innovation: Serving as “The Last Resort Guy” (listen/read)
Dr. Burke explains how he came to join MD Anderson. He first explains that a surgeon’s style develops as an amalgamation of those who have trained him/her, but the question is, How does a great surgeon move beyond this training? Next he explains how he came to MD Anderson from Fort Leavenworth (and sketches his positions prior to that). He explains that he had done all the routine procedures, but he wanted to become more innovative and be in a place where he could “attempt what was not possible.” Dr. Burke recalls that he was the first person in Gynecologic Oncology who had not been trained at MD Anderson. He describes the atmosphere and his recruitment process.
Chapter 6 (MD Anderson History)
The Late Eighties: Clinical Services in Gynecologic Oncology and Reproductive Medicine (listen/read)
In this chapter, Dr. Burke describes the clinical situation when he arrivepatients came to the place, rather than to a particular surgeon, and so assigning cases was an issue.
He describes how a clinician develops a practice at MD Anderson and explains that he decided to take cases that no one else wanted, offering “a unique service to patients, families, and to the referring MDs.”
Dr. Burke talks about how experiences in the military prepared him for this kind of situation. He also notes that critical situations in the military were great preparation for critical care in oncology. He gives an example of creative problem solving from an ob/gyn service in Kansas. He uses the example of two- and three-team surgeries to illustrate how MD Anderson provides innovative care to patients.
Dr. Burke notes that multi-team surgery was very limited when he arrived but increased quickly, with patient recovery improved as a result.
Chapter 7 (The Administrator)
An Overview of the Gynecologic Oncology CliniOffering Multi-Disciplinary Care Before it Was an MD Anderson Norm (listen/read)
Dr. Burke explains how he came to his first administrative position as Medical Director of the Gynecologic Oncology Clinic, or Station 82, when the institution was transitioning its organization from one focused on specialization to multi-disciplinary clinics based on disease site. He notes that Gynecologic Oncology always operated that way, beginning with the founders of gynecologic practice at MD Anderson and their early recruitments.
He talks about the rudimentary situation of the clinics in the early nineties, the early record keeping practices (see example from a PowerPoint presentation, available from the Archivist, Research Medical Library). he developed on the history of the Clinic, which includes information about these practices).
Chapter 8 (Building the Institution)
Developing Multi-Disciplinary Care Within the Department and in the Institution (listen/read)
Dr. Burke talks about his work in the early nineties on a planning group to develop multi-disciplinary care and more patient-centered care throughout the institution. (They had patients wore pedometers to see how far they had to walk for appointments.) He notes the speed at which the transition was made and the shock it could create.
Dr. Burke explains how the move to multi-disciplinary among faculty also created a situation in which all support services were also disease linked, with resulting increases in their specialization and expertise. He notes that this has been a “recipe for MD Anderson success.”
Dr. Burke notes that Gynecologic Oncology operated in a multi-disciplinary fashion from the start. He notes that MD Anderson was the first cancer center to restructure care around disease sites.
Chapter 9 (The Researcher)
Bringing Experience With Surgery and National Trials to MD Anderson; Research on Endometrial Cancer (listen/read)
In this chapter, Dr. Burke sketches the evolution of his research career and the specific perspective that made him attractive to MD Anderson. He explains that he started this career while he was a Fellow at the Walter Reed Hospital in the late seventies. He notes the strange situation in which the Army was at the forefront of research in ob/gyn cancers. He then notes that, when he came to MD Anderson, there were many unanswered questions and he brought the institution his experience with national trials and his strong surgical background, and broad network of connections. He briefly explains his leadership philosophy with regards to junior faculty and research: allow them to choose different disease area interests so they don’t get in each other’s way.
Chapter 10 (The Researcher)
Research on Gynecologic Cancers; the Impact of Research on How a SPORE is Administered (listen/read)
Dr. Burke sketches his study of endometrial cancer that involved a decade-long project of looking at techniques to reduce the radical surgery needed. His model has radically changed the management of the disease. Dr. Burke describes a uterine SPORE he worked on with Dr. George Stancel and two junior faculty members, resulting in many new discoveries and new investigators attracted to the field.
He also explains an important outgrowth of this project: inclusion of patient advocates on the research team.
18 March 2014 (listen/read)
Interview Identifier (listen/read)
Chapter 11 (Institutional Change)
Maintaining MD Anderson Culture Despite Growth and Financial Challenges in Healthcare (listen/read)
Dr. Burke begins this Chapter by describing how the culture of MD Anderson has changed since 1988 when faculty easily had face-to-face relationships. He notes that many institutional values have been formalized as the institution shifted to multi-disciplinary care models and translational research.
He talks about the advantage of the MD Anderson system in which physicians are not compensated per procedure: this has been maintained a “clean way of providing care.”
He next talks about the “financial clarity” that Dr. Leon Leach [Oral History Interview] brought to the institution under Dr. John Mendelsohn.
He next talks about what makes MD Anderson unique: keeping the mission areas in balance has been part of institutional strategy.
Chapter 12 (The Administrator)
Medical Director of the Gynecologic Oncology Center: Developing Processes and Faculty Talent (listen/read)
Dr. Burke begins by describing how he resolved inefficiencies in the Gynecologic Oncology Center when he took over. He describes a quality control program he set in place and sketches increases in the Clinic’s patient traffic and faculty numbers.
Dr. Burke next comments on positions that can serve as training ground for mid-career physicians who will rise in the administration. He explains how his leadership skills grew and talks about his roles on the Credentials Committee and the Medical Staff Committee. Dr. Burke notes how important it is that a hospital’s leadership has this broad perspective: he looks for young faculty who will be open to these opportunities and to future leadership. Dr. Burke talks about how he looks for faculty with potential and gives them chances to develop themselves.
Chapter 13 (The Administrator)
Serving as MD Anderson’s Chief Medical Officer and Physician in Chief (listen/read)
Dr. Burke first explains how he came to serve 50% of his time as Chief Medical Officer in 1998. He notes the scope of this role and how it affected his clinical practice. He next notes that when John Mendelsohn became president, he was asked to come full time into administration. He explains his decision to shift into administrative work.
Next he explains the scope of his responsibilities as Physician in Chief and stresses that clinical operations should be led by a physician. He talks about the complexity of MD Anderson search processes
Chapter 14 (Building the Institution)
As Physician in Chief: Addressing Needs in Pharmacy, Nursing, and Quality and Safety (listen/read)
He talks about pharmaceutical needs. He next explains how he built his support team by seeking out people.
He describes the Quality and Safety program focused on patient safety, explaining the related Clinical Safety and Effectiveness Program first developed for industry, buty adapted for MD Anderson and other health care institutions. He talks about the influence of this Quality and Safety program.
Dr. Burke explains how changes innovated by the Clinical Safety and Effectiveness Programmed were first received when introduced. He notes resistance and that the Program encouraged individuals to innovate their own improvements to process and gave prizes for the best solutions to process problems. He gives examples of innovations.
Chapter 15 (Building the Institution)
Building a Highly Skilled Nursing Service (listen/read)
Dr. Burke describes how he addressed the need for an increasingly skilled staff of oncology nurses.
He talks about partnering with Dr. Barbara Summers [Oral History Interview], Head of Nursing, to create a program to attract young nurses to the field. He explains that oncology nursing is not a “happy area” and has had difficulty attracting students. They also created programs to help nurses develop their skills and expertise with additional training and degree programs.
Dr. Burke gives an overview of changes in the field of nursing that have broadened the scope of nursing to management, administration, and advanced practice nursing. He notes that Advanced Practice Nurses have expertise and serve as preceptors to their teams and those under them, increasing the quality of care.
Chapter 16 (The Administrator)
As Physician in Chief: Building the Survivorship Program and Pharmacy Support (listen/read)
In this chapter, Dr. Burke first explains that he hired Alma Rodriquez to head the Survivorship Program and gave her a mandate to build that program. One of the first projects undertaken was information gathering to discover what issues and needs patients had as they entered survivorship and long-term survivorship. Dr. Burke describes the feedback from patients and how the Program went about addressing those needs. He notes that today the Survivorship Clinics see thousands of patients. He explains his hope that a freestanding survivorship clinic will be built someday (the institution was close twice).
Next, Dr. Burke explains the complexity of pharmacy needs at MD Anderson, how these have been addressed, and how his office is currently building a training program in cancer related pharmacy.
Interview Identifier (listen/read)
Chapter 17 (Building the Institution)
Comprehensive Approaches to Faculty Burnout in a Complex, Growing Institution (listen/read)
In this chapter, Dr. Burke talks about the reality and sources of faculty burnout and the support for those who experience it. He explains that faculty who are deeply connected to the institution’s mission create their own mechanisms to cope with stress and burnout and those who cannot, leave MD Anderson.
Next, Dr. Burke talks about the mechanisms in place to help faculty with stress. He explains that mentoring can help young faculty find balance and also a research niche, which will help with their career stress, and gives examples from his department. He mentions MD Anderson’s counseling services.
Dr. Burke talks about his personal experience with burnout.
Dr. Burke says that burnout is an ongoing issue that will not go away. He advocates that faculty work in teams and that these teams care for one another. He also mentions efforts in 2010 and after to rid the institution of dysfunctional behavior. The mentoring program and safety and quality programs arose from this effort.
Chapter 18 (An Institutional Unit)
The Institute for Cancer Care and the Challenge of Value-Based Care (listen/read)
In this chapter, Dr. Burke talks about the creation of the Institute for Cancer Care Excellence in 2008 and its role in defining value-based care. He sets this in the context of the current focus on the financial side of healthcare and the huge effort underway to map processes of care, attach cost to those processes, and determine ultimate value. He first gives context, explaining that MD Anderson wanted to be in the forefront of thinking about value based care and he and others began to make connections with the “quality movement” (e.g. Brent James). One of the first aims was to publish papers on “value propositions in health care.” Dr. Burke gives some context, explaining that quality, safety and cost lead to a notion of value.
Dr. Burke explains the viewpoint that MD Anderson took on quality --different from the prevailing viewpoint in the nation. The Institute served as the focal point to bring together all information about this ongoing conversation.
Dr. Burke explains the challenges in assembling data that support the view of quality advocated by MD Anderson.
Chapter 19 (The Finances and Business of MD Anderson)
Financial Realities in Healthcare: The Need for Investment in Healthy Behavior; Treatments Near the End of Life; the Affordable Care Act (listen/read)
In this chapter, Dr. Burke talks about the fiscal realities that MD Anderson is confronting now and in the immediate future. He first observes that there has been no effort at the national level to make an investment in healthy behaviors, though he sees some change in that recently. He mentions where the resistance has been to such investment and observes that MD Anderson has advocated for these changes, but that no single institution can influence national priorities.
Dr. Burke next talks about the difficult financial decisions tied up with establishing care protocols at the end of a patient’s life. He talks about studies in progress to determine which efforts near the end of live have value (in that they improve a patient’s survival). He then discusses the realities of the conversations that physicians must have with patients, the decisions that patients and families must make.
Chapter 20 (The Finances and Business of MD Anderson)
Financial Realities in Healthcare: The Affordable Care Act (listen/read)
In this chapter, Dr. Burke talks about the Affordable Care Act. Though creating access to care is a critical benefit, Dr. Burke explains via examples that the Act has created challenges because the payment system it relies on will not survive the Value-Based Care movement. He also gives examples of how the current system pays an institution for “doing things wrong.”
Chapter 21 (Building the Institution)
The MD Anderson Network (listen/read)
In this chapter, Dr. Burke talks about becoming Vice President of the MD Anderson Cancer Network, established early in 2014.
He gives background on how the Network began.
Next he explains why he was appointed to the position and his personal reasons for taking the position.
Dr. Burke sketches why the MD Anderson Cancer Network offers “a huge delivery” on the institution’s mission.
He comments on the dissolution of MD Anderson’s partnership with Orlando Health and the lessons.
Chapter 22 (Building the Institution)
The MD Anderson Network: Building Partnerships Based on Shared Mission (listen/read)
In this chapter, Dr. Burke explains that his current assignment as Vice President of the MD Anderson Network is to establish partnerships with institutions whose missions link with MD Anderson’s.
He talks about a Network goals of increasing MD Anderson trained physicians and researchers. He gives examples of an innovative program to accomplish this. Dr. Burke notes the importance of this program given that the nation is confronting a shortage of oncology professionals.
Next he mentions the Network’s role in expanding access to MD Anderson’s clinical trials, lists the features of a good partner institution, and talks about how he is going about bringing MD Anderson’s outside connections under one umbrella. He notes that these partnerships represent revenue streams for MD Anderson.
Chapter 23 (Building the Institution)
Building the MD Anderson Cancer Network (listen/read)
Dr. Burke begins this chapter on his strategies for building the MD Anderson Cancer Network with a discussion of the major challenges that this initiative must face.
He talks about the importance of “profiling” the patient populations at each partner institution in order to select the right clinical trials for their involvement and gives an example.
He discusses the financial projections for the Network’s operation (in the 60 – 80 million range) and how that revenue will be used.
Dr. Burke explains his philosophy and goals. By bringing all partner institutions under a single umbrella, the Network can to touch as large a percentage of the United States population as possible.
Chapter 24 (The Researcher)
Significant Research Initiatives (listen/read)
In this chapter, Dr. Burke talks about the significant research he conducted prior to devoting most of his time to administration. He was involved in early projects defining the respective roles of radiation and chemotherapy. He talks about the challenges of large-scale clinical trials, particularly with rare cancers. He sketches his work defining the surgical staging for uterine cancer in the eighties and nineties and his work training individuals in robotic and laproscopic techniques.
Dr. Burke next explains why vulvar cancers were “a great niche” for him to take on in the sixties and seventies and describes an additional study.
At the end of this Chapter –and the interview—Dr. Burke talks about how satisfied he has been to work at an institution that enabled him to reinvent himself. He is content to know that he has trained many people and put together many teams that have launched all kinds of services.
This interview with Dr. Thomas Burke (b., 8 May 1953, Pittsburg, Pennsylvania) takes place over three sessions in spring of 2014 (approximate total duration, five hours). Dr. Burke joined MD Anderson in 1988 as a faculty member of the Department of Gynecologic Oncology and Reproductive Medicine. For many years Dr. Burke served as Executive Vice President and Physician-in-Chief. In 2013 he appointed the Executive VP overseeing the MD Anderson Cancer Care Network. This interview takes place in Dr. Burke’s office in the Mid-Main Building of MD Anderson. Tacey A. Rosolowski, Ph.D. is the interviewer.
Dr. Burke received his Bachelors of Science in biology from Tulane University in New Orleans in 1974 and continued at that institution for his M.D., conferred in 1978. He did his Clinical Fellowship in Gynecologic Oncology at the Walter Reed Army Medical Center in Bethesda (1984-6/1986) and then went to the Tripler Army Medical Center in Honolulu Hawaii for his Clinical Residency and Clinical Internship in Obstetrics and Gynecology (7/1979-6/1982 and 7/1978-6/1979, respectively. Dr. Burke was an Instructor in Obstetrics and Gynecology, first at the University of Kansas Medical Center in Kansas City, KS from 1982 to 1984 and then at the Uniformed Services University of the Health Sciences in Bethesda, MD, 1984−1986. He then joined the faculty and served as an Assistant Professor until 1987, when he became a Clinical Assistant Professor in Obstetrics and Gynecology at The University of Texas Health Science
Center at San Antonio, San Antonio, Texas. In 1988 Dr. Burke joined the faculty of MD Anderson as an Assistant Professor and Assistant Gynecologist in the Department of Gynecologic Oncology and Reproductive Medicine.
In the eighties and nineties, Dr. Burke became known for developing combination-treatment alternatives to radical surgery for uterine and vulvar cancers. His administrative career began with his role as Medical Director of the Gynecologic Oncology Center in the Department of Gynecologic Oncology and Reproductive Medicine from 1989−1998. In 1998 he also began to serve as Vice President of Medical Affairs, rising through several leadership roles until he became Executive Vice President and Physician-in-Chief, a role her served from 2005−2013, when he was appointed Vice President of the MD Anderson Cancer Care Network.
In this interview, Dr. Burke provides a portrait of a clinician with a self-described “entrepreneurial spirit” and a tendency to “remake himself.” He discusses his research and discusses the evolution of combination therapies for gynecologic cancers. He also discusses how Gynecologic Oncology at MD Anderson was practicing multi-disciplinary care before it was an institution-wide protocol and commitment. These sessions also bring out Dr. Burke’s capacity to develop and leverage networks for the benefit of MD Anderson and its mission. In the process of describing his administrative roles, he provides insight into the context of financial challenge and change that MD Anderson is now confronting, and details initiatives that the institution has in place to navigate this stressful time.