Skip to main content

Raber (Martin), MD, Oral History Interview: Home

Interview Navigation Materials

Interview Navigation Material

 

Interview Profile

 

Submitted: 30 July 2014

Interview Information:

Four interview sessions: 26 September 2013, 1 October 2013, 17 October 2013, 24 October 2013
Total approximate duration: 6 hours and 9 minutes
Interviewer: Tacey A. Rosolowski, Ph.D.

 

For supplementary materials:

Please contact, the Historical Resources Center, Research Medical Library:

Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Medical oncologist Martin Raber, M.D. (b. 1947, Rockway, Long Island, NY) came to MD Anderson in 1978 to take up a fellowship in the Department of Developmental Therapeutics.  After time away from the institution, he joined the faculty as an Associate Professor of Medicine and Chief of the Section of Medical Oncology in 1985.  His research has focused on tumors of unknown origin.

He served in many administrative roles, including Associate Vice President for Patient Care (1992 -1994), as Physician in Chief (1994 – 1996) and Vice President of Managed Care and Outreach Programs (1996 -1998)., Dr. Raber quickly advanced into leadership roles that allowed the institution to take advantage of his interest in healthcare delivery systems.  He was influential in crafting responses to the managed care crisis in the late 1980s.  His career was greatly influenced by the cancer diagnosis he received in 1995.  He retired on 15 January 2011.  Today Dr. Raber is a Clinical Professor of Medicine in the Department of Gastrointestinal Medical Oncology.  He also serves in special advisor roles to the Division of Cancer and to the Physician in Chief.  Dr. Raber has been a patient at MD Anderson.

 

Major Topics Covered:

Personal and educational background

Research: tumors of unknown origin

Views on the doctor-patient bond; evolution of views after cancer diagnosis

Patient experiences (diagnosed 1996)

Evolution of administrative skills and leadership perspectives

Cancer Manager

Developing the Emergency Center

The Physicians’ Network

MD Anderson Sister Institutions: early development, lessons learned

MD Anderson and changing economics of healthcare; the managed care crisis; the Affordable Care Act;

Evolution of multi-disciplinary care at MD Anderson

The Oncology Fellowship Program

Changes to MD Anderson budgeting and financial practices in the 1990s; communication between faculty and financial offices

Developing MD Anderson’s Core Values

MD Anderson culture and institutional power systems

MD Anderson’s culture of care and research

 

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.


 

Table of Contents

 

Interview Session One: 26 September 2013

 

A View of Oncology, Changing Paradigms of Cancer Research, and the Oncologist’s Mindset
Chapter 01 / Overview

 

Rising Through MD Anderson’s Administration During Institutional Reorganization
Chapter 02 / Professional Path

 

The Impact of a Cancer Diagnosis
Chapter 03 / The Patient

 

The Impact of Attending Medical School in Belgium
Chapter 04 / Educational Path

 

Study Abroad Builds Clinical and Administrative Skills: A Talent for Seeing
the Big Picture as a Physician and an Administrator

Chapter 05 / Professional Path

 

A Theory of the Doctor-Patient Bond: Doctor and Patient Against a Mortal Disease
Chapter 06 / The Patient

 

Diagnosis, Treatment, and a Spiritual Crisis
Chapter 07 / The Patient

 

Learning to Communicate Differently with Patients
Chapter 08 / The Patient

 

A Physician’s Patient Experiences Influence His Administrative Initiatives:
Developing MD Anderson’s Core Values

Chapter 09 / The Patient

 

MD Anderson Presidents Handle the Managed Care Crisis
Chapter 10 / The Finances and Business of MD Anderson

 

Interview Session Two: 1 October 2013

 

Building Projects in the Nineties and their Impact on Multi-disciplinary Care
Chapter 11 / Building the Institution

 

An Overview of Contributions to Research and the Institution
Chapter 12 / View on Career and Accomplishments

 

The Oncology Fellowship Program: A Struggle to Free Fellows from Patient Care
Chapter 13 / Building the Institution

 

Tumors of Unknown Origin: Research and Patient Care
Chapter 14 / The Researcher

 

As Physician-in-Chief: Creating Cancer Manager to Address Managed Care
Chapter 15 / Institutional Processes

 

Bringing Internists into the Emergency Center
Chapter 16 / Building the Institution

 

The Physicians Network
Chapter 17 / Building the Institution

 

Sister Institutions and Lessons from MD Anderson Espana and Banner, Arizona
Chapter 18 / Building the Institution

 

Finding a Clinical Home in GI Medical Oncology
Chapter 19 / The Clinical Provider

 

Interview Session Three: 17 October 2013

 

John Mendelsohn’s Appointment; He Taps the Financial Wisdom of the Board of Visitors
Chapter 20 / The Finances and Business of MD Anderson

 

Hiring Leon Leach and a New Financial System for MD Anderson
Chapter 21 / The Finances and Business of MD Anderson

 

Financial People and Faculty Find Common Ground in the Nineties: It’s about Research
 and the Patients

Chapter 22 / MD Anderson Culture

 

A Unique Rewards System to Motivate MD Anderson Faculty
Chapter 23 / The Finances and Business of MD Anderson

 

Identifying with Patient Experiences
Chapter 24 / The Clinical Provider

 

Interview Session Four: 24 October 2013

 

A View on the Affordable Care Act and Its Possible Impact
Chapter 25 / The Finances and Business of MD Anderson

 

An Administrator Who Understands the Faculty and Can Promote Initiatives and Individual Success
Chapter 26 / B: MD Anderson Culture

 

What Makes MD Anderson Unique: An Institution that Can Make Miracles Happen
Segment 27 / B: MD Anderson Culture

 


 

Chapter Summaries

 

 

Interview Session One: 26 September 2013 (listen/read)

 

Chapter 00A
Interview Identifier (listen/read)

 

Chapter 01 (Overview)
A View of Oncology, Changing Paradigms of Cancer Research, and the Oncologist’s Mindset (listen/read)

 

Topics Covered

  • Personal Background
  • Professional Path
  • Understanding Cancer, the History of Science, Cancer Research  about 9 min.
  • On Research and Researchers
  • Discovery, Creativity and Innovation
  • Formative Experiences
  • Overview
  • Definitions, Explanations, Translations
  • The Clinician
  • Evolution of Career
  • Professional Practice
  • The Professional at Work
  • Cancer and Disease
  • Professional Values, Ethics, Purpose
  • Institutional Mission and Values 
  • Research, Care, and Education         
  • On Care

In this Chapter Dr. Raber sketches the development of his career, highlighting some factors that influenced the direction of his work.  He first notes that his experience working in Canada from 1974 –‘789 gave him the opportunity to see a government-run medical system (which he advocates).  He then explains that he came to Houston in 1978 to be an oncologist, a time when there were very few in that specialty.  Dr. Raber defines medical oncology and talks about what was happening in the sciences, particularly in the treatment and understanding of leukemia, that allowed medical oncology to evolve.  He also explains how advances in the sciences influenced the political scene, resulting in the 1972 National Cancer Act. 

Dr. Raber describes the scientific scene in the early Seventies, sketching what was available for treatment and describing it as the “moment of the great national groups such as the Southwestern Oncology Group and the Eastern Oncology Group.”  He characterizes the (ultimately failed) paradigm used at the time to move toward curing cancer: “combine all the drugs available in every possible way for each disease and we will cure cancer.”  Dr. Raber then observes that since that time, there have been successive waves of excitement for immunotherapy, pharmacodynamics, and other approaches, including the discovery of oncogenes in the early eighties, a time in when people waited for their journals to see what new discoveries were reported. 

Dr. Raber notes that he came to MD Anderson to work with Dr. Emil J Freireich and then ran an oncology program at the UT Medical School.  He served as Director of Resident Training from ’81 to ’85, when he came back to MD Anderson to run a drug study program.

“Cancer is smart,” Dr. Raber says.  He explains how the discovery of oncogenes opened up a new world for oncology, but failed to result in cures.  He explains that we are in a new era of personalized medicine and defines this approach.

Dr. Raber notes that he is happier now than at any other time in his career.  Dr. Raber describes working with patients, some of whom die of their disease.  He observes that “oncologists are hard on themselves” and that there is a lot of burnout because oncologists see each patient who dies as a personal failure.

 

Chapter 02 (Professional Path)
Rising Through MD Anderson’s Administration During Institutional Reorganization (listen/read)

 

Topics Covered

  • Professional Path
  • The Administrator
  • Portraits
  • MD Anderson History
  • MD Anderson Past
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • Understanding the Institution

Dr. Raber notes that when he returned to MD Anderson in ’85, Dr. R. Lee Clark had just retired and Dr. LeMaistre has begun his presidency.  Dr. Raber explains Dr. Clark’s leadership strategy of hiring “the greats” and telling them to create a home for themselves, giving the example of his hiring of Emil Frei and Emil J Freireich.  He compares Dr. LeMaistre’s goal to reorganize the institution in an academic hierarchy, a process that resulted in smoother operations, but “a lot of pain.”  The institution was also in a dramatic growth phase as the institution reconfigured itself to provide patients with multi-disciplinary care.  Dr. Raber explains the respective contributions that Drs. Clark and LeMaistre made to MD Anderson.

Dr. Raber then notes that from ’85 to ’95 he rose through the administration.  He lists his roles and notes his goal of remodeling how care was delivered under the managed care insurance system. 

 

Chapter 03 (The Patient)
The Impact of a Cancer Diagnosis (listen/read)

 

Topics Covered

  • Personal Background
  • The Patient
  • Cancer and Disease
  • Evolution of Career
  • Formative Experiences
  • Patients
  • Patients, Treatment, Survivors

In this Chapter, Dr. Raber sketches his own cancer diagnosis and treatment and its effect of reorienting his career: after his illness, he no longer wanted to serve as a Vice President.  He describes the way cancer stripped him of his professional identity, forcing him to examine the essentials, which he realized were “doctor and teacher,” roles he focused on between 2002 and 2011, when he retired. 

 

Chapter 04 (Educational Path)
The Impact of Attending Medical School in Belgium (listen/read)

                                                                  

Topics Covered

  • Personal Background
  • Professional Path
  • Overview
  • Influences from People and Life Experiences
  • Formative Experiences
  • Character, Values, Beliefs, Talents

Dr. Raber explains that he has no idea why he wanted to be a doctor (though he has observed this is common among physicians).  His grades in science in college were not strong, so he applied to medical school in Louvain, Belgium.  He compares the American and European systems of education, the latter requiring students to work independently –a good system for him.   The program at the Catholic University of Louvain was theoretical, with students entering the clinic in their fourth year.  He explains how the education and intercultural experience had an impact on his attitudes toward the delivery of health care, the responsibilities of doctors, and his ability to work with different groups of individuals.

 

Chapter 05 (Professional Path)
Study Abroad Builds Clinical and Administrative Skills: A Talent for Seeing the Big Picture as a Physician and an Administrator (listen/read)

 

Topics Covered

  • Personal Background
  • Professional Path
  • Overview
  • Influences from People and Life Experiences
  • The Leader
  • Leadership
  • The Clinician
  • Formative Experiences
  • Character, Values, Beliefs, Talents
  • The Healthcare Industry
  • Cultural/Social Influences
  • Global Issues –Cancer, Health, Medicine 

Dr. Raber mentions administrative lessons learned from Dr. Tom Andrioli when he was running the residency program at the University of Texas Medical School.  He then talks about his own style of approaching problems and decision-making.

Dr. Raber explains that he needs to think about an issue in its entirety and how it will evolve over time: what is a good decision for today and in the context of what might happen in the future.  He gives the example of how to plot a strategy for colon cancer.   He then observes that most doctors and administrators focus on today, but he is really strong at thinking about consequences and at getting other people to also see the bigger picture as they make decisions.

Dr. Raber next explains why he left Belgium to go to Dalhousie, Canada for his internship.  He explains why his experience gave him strong skills in physical examination.  He also explains the benefits of the Canadian system for delivering medical care as well as elements of Canadian culture and mentality that are necessary for that system to work.  (It could not be adopted in the U.S.)

 

Chapter 06 (The Patient)
A Theory of the Doctor-Patient Bond: Doctor and Patient Against a Mortal Disease (listen/read)

 

Topics Covered

  • The Clinician              
  • On Care
  • The History of Health Care, Patient Care
  • On Research and Researchers
  • Understanding Cancer, the History of Science, Cancer Research
  • Institutional Mission and Values
  • Character and Personal Philosophy
  • The Professional at Work
  • Offering Care, Compassion, Help
  • Patients, Treatment, Survivors           

In this Chapter Dr. Raber explains that he became a cancer doctor because the disease was intellectually interesting and he felt he could do something about it.   Next he explains that, in the seventies, there were many discussions about how to conceptualize the relationship between the doctor, patient, and illness in a triangular model, with each occupying its own point.  Dr. Raber says that, in contrast, he sees the doctor and patient on the same side of a line, with cancer on the opposite side.  This model emphasizes how overwhelming cancer is: the patient is in mortal danger.

 

Chapter 07 (The Patient)
Diagnosis, Treatment, and a Spiritual Crisis (listen/read)

 

Topics Covered

  • The Patient                 
  • Cancer and Disease
  • Patients
  • Patients, Treatment, Survivors
  • Formative Experiences
  • Faith
  • Personal Background
  • Human Stories
  • Faith, Values, Beliefs

In this Chapter, Dr. Raber talks about his own experience with cancer.  His diagnosis of lymphoma in ’96 came as a complete surprise as did his relapse two years after treatment.  Dr. Raber explains that his relapse forced him to think about the possibility of dying of his disease.  He began to feel “unhooked” and to ground himself visualized himself in a boat on calm water with the disease looming like a storm in the distance.  He concluded that you can’t control the storm, but you can control the boat. Dr. Raber explains that he next asked, “Where is God in this?”  He asked about one hundred people he know (not patients) how they would answer this question, but also had to understand it himself.  He read a great deal about religious philosophy and decided, “God is in the boat with me.”

Dr. Raber notes that he read the works of Franz Rosensweig, an Austrian religious philosopher, and tells a story from the book, Understanding the Sick and the Healthy.  He explains that a patient must have “a working construct of how the world works with respect to you and your disease.”  He next explains that he went back to work setting up MD Anderson Espana and contracted pneumonia on a trip to Spain in 2000.  This illness resulted in his near death, yet he was able to say to himself “I am going to be better tomorrow, because I am going to get better or I am going home to God.”  Dr. Raber notes that he considers himself a theist, but not a religious person.

 

Chapter 08 (The Patient)
Learning to Communicate Differently with Patients 
(listen/read)

 

Topics Covered

  • The Clinician
  • The Patient     
  • The Administrator       
  • Cancer and Disease
  • Patients
  • Patients, Treatment, Survivors
  • Formative Experiences
  • Personal Background
  • Human Stories
  • Offering Care, Compassion, Help
  • Education
  • MD Anderson Culture

Dr. Raber explains how his experience with cancer affected his work.  He was not a better doctor, he says, but a different doctor in how he related to patients and understood where they are in the spectrum of the disease.  He notes the problem patients have communicating with their doctors.  He had the same problem and he gives an example of describing energy levels.  As a result, he questions patients differently about their symptoms and lifestyle, asking more about context.  He also asks if they have a church or religious community. 

 

Chapter 09 (The Patient)
A Physician’s Patient Experiences Influence His Administrative Initiatives: Developing MD Anderson’s Core Values (listen/read)

           

Topics Covered

  • The Patient     
  • The Administrator
  • Institutional Mission and Values
  • MD Anderson Culture
  • MD Anderson History
  • Growth and/or Change
  • Understanding the Institution

In this Chapter, Dr. Raber explains how his patient experience changed his thinking about hospital administration.  Dr. Raber explains that he noticed examples of inappropriate behavior on the part of the staff while he was a patient, so he created programs to change how patients interact with patients.  He gives several examples and describes how healthcare workers are always “on stage” when they are in front of the public.  He explains that the shift in the concept of caring was designed to include employees as well, so each employee extends care to patients and to “the person next to you” at work.  Dr. Raber was on the Senior Leadership Team at the time and the discussion about formally identifying integrity, discovery, and caring as core values occurred early in John Mendelsohn’s administration.  He explains why there was controversy over this.

 

Chapter 10 (The Finances and Business of MD Anderson)
MD Anderson Presidents Handle the Managed Care Crisis (listen/read)

 

Topics Covered

  • MD Anderson History
  • Portraits
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • MD Anderson and Government
  • Fiscal Realities in Healthcare
  • The Healthcare Industry

Dr. Raber begins this Chapter by comparing how Dr. Charles LeMaistre and Dr. John Mendelsohn addressed the threat of managed care in the nineties, calling Dr. LeMaistre “the monarch” and Dr. Mendelsohn “the wizard” (of system manipulation).  He notes that Dr. LeMaistre responded to the healthcare crisis as a political problem needing a political solution, an approach leading to the crafting of legislation allowing self-referral, addressing the problem of indigent care, and changing MD Anderson’s place in the structure of the State.  Dr. Raber explains why elements of the legislation were so important.  He offers the opinion that Dr. LeMaistre wanted to force out some senior individuals in the leadership via early retirement to demonstrate to the State Legislature that the healthcare situation was very serious.  He then describes how he and other leaders convinced legislators to back the bill.  Dr. Raber then points out that John Mendelsohn inherited the institution after the legislation had been passed.

 

Interview Session Two: 1 October 2013 (listen/read)

 

Chapter 00B
Interview Identifier (listen/read)

 

Chapter 11 (Building the Institution)
Building Projects in the Nineties and their Impact on Multi-disciplinary Care (listen/read)

 

Topics Covered

  • Portraits
  • Growth and/or Change 
  • MD Anderson History
  • MD Anderson Snapshot
  • Leadership
  • Multi-disciplinary Approaches
  • MD Anderson History
  • Institutional Mission and Values
  • Institutional Politics
  • Controversy

Dr. Raber begins this Chapter by describing how CFO David Bachrach has the wisdom to acquire all the land he could, planning for MD Anderson’s needs for the next 100 years.  He notes that Dr. John Mendelsohn built on all of that land in ten years, then describes the relationship between the form of buildings (and their layout) and the way that medicine is practiced.  He begins with the R. Lee Clark Building (the Clark Clinic Building) then discusses the Alkek Hospital building project, which was suffering, he observes, until David Hohn took over as the project’s driving force.  He gives a sketch of Dr. Hohn’s career then describes the evolution of Main Campus, beginning with the Clark Clinic Building in 1978.  He explains that when the Charles LeMaistre building was the first structured for multi-disciplinary care.

Dr. Raber then talks about Dr. Andrew von Eschenbach’s decision to build a building for the faculty (primarily to open more clinic space in the LeMaistre Building).  He talks about faculty reactions to the plan also sketches the Texas State formulas for allocating space in academic buildings.  Next he explains how the decision was made to build the Mays Clinic (the Ambulatory Clinic Building), a project taken over by Dr. David Callender.  With the Mays Clinic, the institution had enough space to practice multi-disciplinary care.  Dr. Raber notes that the space and the organizational principles of multi-disciplinary care do not fit into an academic structure.

 

Chapter 12 (View on Career and Accomplishments)
An Overview of Contributions to Research and the Institution (listen/read)

 

Topics Covered

  • The Researcher
  • The Administrator
  • Career and Accomplishments
  • Character, Values, Beliefs, Talents
  • Professional Path
  • Portraits
  • On Research and Researchers
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care

Dr. Raber notes that he has spent particular time with young faculty and fellows in medical oncology.  He also cites his role in building programs that are efficient and deliver better care.  Dr. Raber also notes his attention to employees and his desire to help them reach their potential through mentoring that “looks at what that person can be.”  He offers his mentoring philosophy. 

Next Dr. Raber explains that he came to MD Anderson to work with Dr. J Freireich [Oral History Interview]: at the time Dr. Raber was conducting research based on flow cytometry.   While directing the residency program at the UT Medical School he was a principle investigator on a drug study when Dr. Irwin Krakoff gave him the option to come to work at MD Anderson studying natural chemical products.  He also notes that he had very good administrative skills and talks about how those evolved.  He notes that he studied a number of new drugs in the Station 19, the clinic he ran.

 

Chapter 13 (Building the Institution)
The Oncology Fellowship Program: A Struggle to Free Fellows from Patient Care (listen/read)

 

Topics Covered

  • The Administrator
  • Education
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • Research, Care, and Education
  • Critical Perspectives
  • The Business of MD Anderson

In this Chapter, Dr. Raber explains how he built up the educational component of the Oncology Fellowship program, which was losing fellows in the early nineties.  He explains that he decided to put the program on hold for a year while he developed a system in which the fellow was not necessary to the delivery of patient care.  This system would free the fellows’ time for more study.  (His goal and slogan was “Fellow Free in ’93.”)He met with colleagues to determine how care could be given by nurse practitioners and clinical nurse specialists.  He observes that this was a very new approach, as nurse practitioners were just coming onto the scene.  He explains why his view of the fellows’ role was controversial among faculty and nurses, then sketches the compromises reached to place the fellows in a primarily educational role with more academic instruction and less intensive clinical experience.  He then sketches the educational program: three years with eighteen-month clinical rotations. 

Dr. Raber also observes that this restructuring took place right after the legislation was passed that allowed counties to negotiate with providers for the delivery of care services.  He lists the problems with indigent care that Harris County faced and how this provided a solution for the clinical training of fellows.  MD Anderson made a deal with Harris County to use fellows and physicians to provide MD Anderson standard of care for indigent patients at LBJ Hospital.  All specialty cases would come to MD Anderson.  This program still exists and he describes the operation of the three clinics held per week.  These cases present fellows with the opportunity to be medical decision makers.  Dr. Raber notes that this program, run by Alyssa Rieber (a former Fellow) has won awards.

 

Chapter 14 (The Researcher)
Tumors of Unknown Origin: Research and Patient Care (listen/read)

 

Topics Covered

  • The Researcher
  • Patients
  • Institutional Processes
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • MD Anderson Culture
  • Devices, Drugs, Procedures
  • Understanding the Institution

Dr. Raber explains that, in the mid-eighties, patients would come to MD Anderson with no definitive diagnosis identifying their cancer.  He talks about the practical problems this created for patients and the institution.  To solve the problem, Dr. Raber said, “see them in Station 87.”  Dr. Jim Abruzzi from the GI department was also there and interested in patients with unknown primary tumors.   Dr. Raber sketches the types of studies he and Dr. Abruzzi conductenatural history of tumors, combination therapies, and imaging studies.  He notes that the natural history studies have been influential.

 

Chapter 15 (Institutional Processes)
As Physician-in-Chief: Creating Cancer Manager to Address Managed Care (listen/read)

 

Topics Covered

  • The Administrator
  • MD Anderson History
  • Overview
  • Definitions, Explanations, Translations
  • The Business of MD Anderson
  • The MD Anderson Brand, Reputation
  • Fiscal Realities in Healthcare
  • The Healthcare Industry
  • Controversy
  • Professional Practice
  • The Professional at Work
  • Beyond the Institution
  • The History of Health Care, Patient Care
  • Critical Perspectives

Dr. Raber explains how he became Physician-In-Chief (in 1994), why he wanted to move into a new role, and who took over his clinical trials and program responsibilities.  He notes his growing interest in health care delivery systems: he was able negotiate new relationships with insurance companies.  Dr. Raber reviews the old arguments made against sending patients to MD Anderson because of expense.  He notes that he had the idea to tell insurance companies, “We’ll take the risk.  We will give you a lump sum per month to cover care because we know we do it better and we are not more expensive.  This lump sum approach was the rationale for Cancer Manager.  Dr. Raber explains that effective cancer care depends on the experience of the treating physician.  He explains the Cancer Manager system he and others worked out with insurers: how they determined the amount that MD Anderson would risk.  He notes that this system involved collaboration with physicians in the community and long negotiations to determine the respective responsibilities of community and MD Anderson physicians.  He notes that Cancer Manager operated for two years and made money for the institution.  It was also determined that MD Anderson cost 10-15% less than other cancer centers.  He discusses why the program only lasted two years, largely as a result of demands to roll back managed care.  He lists the positive and negative outcomes of the program, noting in particular the drawback of capitation: if you deny care you make money.

 

Chapter 16 (Building the Institution)
Bringing Internists into the Emergency Center (listen/read)

 

Topics Covered

  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • MD Anderson Culture
  • The History of Health Care, Patient Care
  • Growth and/or Change
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy

Dr. Raber first notes that in the late eighties and early nineties, the Emergency Center began to run inefficiently because there was no emergency room staff.  He made the decision to staff the Emergency Center with general internists.  He also hired Edward Rubenstein to run the internist program at the time.  He explains why staffing with general internists was controversial at the time. 

 

Chapter 17 (Building the Institution)
The Physicians Network (listen/read)

 

Topics Covered

  • The Administrator
  • Beyond the Institution
  • The History of Health Care, Patient Care
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • MD Anderson Culture
  • The Business of MD Anderson
  • The MD Anderson Brand, Reputation
  • Institutional Mission and Values
  • Institutional Processes

Dr. Raber begins this Chapter by noting that the idea for the Physicians Network came about because of his increasing interest in health care delivery systems.  The Physicians Network was a new ideto create a 5013c company that would enable MD Anderson to operate in the community and around the world.  He explains why the 5013c status was important and notes that the idea resulted in two companies.  The MD Anderson Outreach Corporation (now called the Services Corporation) can make contracts with other corporations.  The MD Anderson Physicians Network can hire physicians.  He notes that Leon Leach and Dan Fontaine were involved in setting this structure in place, and gives his view of why this was necessary to “get great cancer center care out into the world.”  He notes that the poor quality of cancer care is an “enduring disappointment” to him.    He also affirms that MD Anderson levels of care are “transferable” and that anywhere that MD Anderson goes, it has a positive impact on care. 

[The recorder is paused for about 7 minutes]

Dr. Raber explains that the Physicians Network began with a network in Texas, later spreading.  He also notes how difficult it is to control what a physician does and says outside of MD Anderson itself.  He acknowledges that some individuals and institutions were interested in improving care, others merely in using the MD Anderson name. 

 

Chapter 18 (Building the Institution)
Sister Institutions and Lessons from MD Anderson Espana and Banner, Arizona (listen/read)

 

Topics Covered

  • The Administrator
  • Beyond the Institution
  • Understanding the Institution
  • Institutional Mission and Values
  • MD Anderson Culture
  • The Business of MD Anderson
  • The MD Anderson Brand, Reputation
  • MD Anderson History
  • Cultural/Social Influences
  • Global Issues –Cancer, Health, Medicine 
  • Building/Transforming the Institution
  • Institutional Politics
  • Controversy

Dr. Raber explains that MD Anderson Espana represented an effort to extend MD Anderson care in a system where the institution would have more control.  He describes some cultural challenges that the Spanish system presented, preventing this model from living up to its potential.  Next Dr. Raber talks about MD Anderson Banner, Arizona and how lessons learned from the experience in Spain helped create a smoother project.  Dr. Raber notes that best affiliations are those driven by the faculty.  He also notes that the sister institutions created in the MD Anderson orbit (in China, Korea, and Chile) were seen from a marketing perspective, but difficulties with local politics made that difficult.  Dr. Raber explains that experience with sister institutions taught the administration how important it is to allow the faculty to drive initiatives.  He notes how passionate the faculty are about MD Anderson’s good name and gives several examples.

Dr. Raber notes that the connection with MD Anderson Banner was driven by institutional leadership and the drive to export the MD Anderson way of providing care.  He then talks about the regional cancer centers and how the create an MD Anderson model of community practice.  He reflects on comments from naysayers who believed patients would prefer to stay with their own physicians.  In fact, the communities were “hungry” for great cancer care. 

Next Dr. Raber talks about the evolution of the Physicians Network into a new model in which physicians offer a defined set of services to patients via a hospital.  He explains how this works and also reflects on why outreach of this kind is seen as threatening.

 

Chapter 19 (The Clinical Provider)
Finding a Clinical Home in GI Medical Oncology (listen/read)

 

Topics Covered

  • Professional Path
  • The Researcher
  • Post Retirement Activities

Dr. Raber explains that he came to be attached to the Gastrointestinal Medical Oncology Department.  He notes colleagues who covered for him in the clinic during his illness.  In 2005 he went back to seeing patients with tumors of unknown origins and restarted the clinic.  He has stopped seeing patients now that he has retired, but still works tangentially on unknown primary tumors.

 

Interview Session Three: 17 October 2013 (listen/read)

 

Chapter 00C
Interview identifier (listen/read)

 

Chapter 20 (The Finances and Business of MD Anderson)
John Mendelsohn’s Appointment; He Taps the Financial Wisdom of the Board of Visitors (listen/read)

Topics Covered

  • Portraits
  • MD Anderson Past
  • MD Anderson History
  • Institutional Processes
  • Growth and/or Change
  • Institutional Politics
  • Controversy
  • The Business of MD Anderson
  • Understanding the Institution
  • The Institution and Finances

Dr. Raber begins this Chapter by sketching the issues shaping MD Anderson finances prior to Dr. John Mendelsohn’s tenure as president.  He notes the members of Dr. Charles LeMaistre’s team that left the institution when Dr. Mendelsohn arrived and explains his approach to financial issues.  He asked for advice and, in this spirit, tapped the financial expertise of members of the Board of Visitors for his own financial decisions and prospective hires.  Dr. Raber says that for almost all of John Mendelsohn’s tenure, ideas had to be explained to the Board of Visitors before they would be approved.

 

Chapter 21 (The Finances and Business of MD Anderson)
Hiring Leon Leach and a New Financial System for MD Anderson (listen/read)

 

In this Chapter, Dr. Raber talks about Dr. Leon Leach [Oral History Interview], who was hired as Executive Vice President and Chief Financial Officer in 1997.  Dr. Raber reviews Dr. Leach’s background and explains that after visiting departments and divisions, Dr. Leach said, “There is no business in America that runs this way.”  Dr. Leach designed a modern accounting and budgeting system for the institution.  Dr. Raber explains how the new budget system works.  He also explains how Dr. Leach changed the institution’s approach to borrowing money, “unlocking the financial value of MD Anderson” to permit growth.  Dr. Raber also says that the budgeting process can be “perverted” because of assumptions about productivity that have not been formalized and he refers to the process as “Kabuki drama.”  He ends this Chapter with the observation that Leon Leach is a deep person educated in finance and possessing strong religious views.

 

Chapter 22 (MD Anderson Culture)
Financial People and Faculty Find Common Ground in the Nineties: It’s about Research and the Patients (listen/read)

Topics Covered

  • Growth and/or Change
  • MD Anderson History
  • MD Anderson Snapshot
  • Understanding the Institution
  • Institutional Processes
  • Institutional Politics
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Institutional Mission and Values

In this Chapter, Dr. Raber first explains that the faculty understood that the institution had to undergo changes in the nineties to operate efficiently.  Thus the new budget process instituted under Dr. John Mendelsohn was “painful but not controversial.”    Dr. Raber explains a dimension of institutional politics: the power of the Vice Presidents and the Division Heads fluctuates, with one group holding more power as the other group’s wanes.  This is largely due to personalities, he observes.

Dr. Raber next explains the communication process that had to take place as the “money people” and faculty discussed proposals.  He observes that the faculty at MD Anderson might have an easier time with this because so many of them have connections with pharmaceutical companies. 

Dr. Raber explains that the financial people at MD Anderson learned to frame ideas in terms that the faculty would respond to, primarily addressing whether an idea would be “good for our patients.”  He explains that the MD Anderson faculty are good at thinking this way because they deal with one patient population.  Staying focused on patient related issues comes easily.

 

Chapter 23 (The Finances and Business of MD Anderson)
A Unique Rewards System to Motivate MD Anderson Faculty (listen/read)

Topics Covered

  • MD Anderson Culture
  • The Life and Dedication of Clinicians and Researchers
  • Understanding the Institution
  • The Institution and Finances
  • Institutional Processes
  • The Business of MD Anderson

In this Chapter, Dr. Raber observes that “normal rewards” used in business don’t work if one wants to motivate MD Anderson faculty.   He explains the reasoning behind the saying that “MD Anderson is as close to socialism as you can get.”  Physicians’ salaries are not influenced if a patient decides to take chemo rather than have surgery.  The egalitarian quality of MD Anderson is “central to our lives,” Dr. Raber says.  He ends this Chapter by observing that Dr. Mendelsohn has a fundamental impact on the institution.

 

Chapter 24 (The Clinical Provider)
Identifying with Patient Experiences (listen/read)

Topics Covered

  • The Patient
  • Patients
  • Patients, Treatment, Survivors
  • Cancer and Disease
  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Understanding the Institution
  • Critical Perspectives

In response to a question about serving in advisory roles after his illness, Dr. Raber explains that he doesn’t demarcate between his roles.  (He jokes that his father never understood what he does.)  Throughout his career, he has explored many ways of making an impact on a patient’s life, including making huge changes by working with health care delivery systems.

Dr. Raber next says that he likes to walk through MD Anderson as an unknown to experience it from a patient’s perspective.  He next tells a story about a young woman from Florida who had a devastating disease and explains why she insisted on having her chemotherapy at MD Anderson.  Dr. Raber goes on to talk more about his concern for patients who experience long wait times, for example.  He also talks about an area of radiology where patients had to sit in full view of passersby while drinking barium prior to a scan.  He spoke out about this many times and is pleased to see that with renovations to the clinic, radiology has increased the privacy for people prepping for these exams.  Dr. Raber recalls participating in a panel discussion of the play “Wit” (a play about a breast cancer patient).  He notes that he was the only participant sensitive to the way that the hospital setting and caregivers robbed the patient of privacy.

[Note: the recorder cuts off abruptly.]

 

Interview Session Four: 24 October 2013 (listen/read)

 

Chapter 00D (listen/read)
Interview Identifier

 

Chapter 25 (The Finances and Business of MD Anderson)
A View on the Affordable Care Act and Its Possible Impact (listen/read)

 

Topics Covered

  • Institutional Processes
  • Devices, Drugs, Procedures
  • The Business of MD Anderson
  • The MD Anderson Brand, Reputation
  • Building/Transforming the Institution
  • Technology and R&D 
  • The Healthcare Industry
  • Understanding the Institution
  • The Institution and Finances

In this Chapter, Dr. Raber outlines some of the challenges and opportunities he sees coming as a result of the Affordable Care Act.  He comments on why U.S. healthcare is so expensive and notes that the care MD Anderson offers is very economical over the course of an illness.  He also explains that the ACA could encourage MD Anderson to reinvent its delivery of care, changing a system that is very labor intensive for physicians.  He gives an example of video-conferencing from Kaiser Health Care in California and also comments on the challenges that provider experience when they are offering new kinds of services for which there is no reimbursement schedule.  He also observes that MD Anderson can take advantage of efficiencies and potential for cost control because of the breadth of ownership it enjoys over facilities.

 

Chapter 26 (MD Anderson Culture)
An Administrator Who Understands the Faculty and Can Promote Initiatives and Individual Success (listen/read)

 

Topics Covered

  • MD Anderson Culture
  • The Administrator
  • The Educator
  • Mentoring
  • The Educator
  • Mentoring
  • On Research and Researchers
  • Understanding the Institution 

Dr. Raber observes that he made the unusual decision early in his career to focus on hospital administration and institutional politics.  Dr. Raber talks about the advice he gives to young faculty who want to move ahead in their research and clinical careers.   Dr. Raber notes that he chose to work at the institutional level where he had significant impact on the delivery of care and on cultivated the success of many people who work at MD Anderson.  Dr. Raber talks about how important luck is in jumpstarting a promising research career, but also gives examples of individuals who pushed through early research disappointments and achieved success later in their career.  He explains that he had early administrative success, which helped focus him on this activity.  Dr. Raber next comments on why it is important for physicians to join the ranks of executive leadership, bringing their intellect and understanding of clinical practice and research.

 

Chapter 27 (MD Anderson Culture)
What Makes MD Anderson Unique: An Institution that Can Make Miracles Happen (listen/read)

 

Topics Covered

  • MD Anderson Culture
  • Institutional Mission and Values
  • The MD Anderson Ethos
  • Dedication to MD Anderson, to Patients, to Faculty/Staff
  • Cancer and Disease
  • Healing, Hope, and the Promise of Research
  • Career and Accomplishments
  • The MD Anderson Brand, Reputation

In this Chapter, Dr. Raber explores several facets of MD Anderson that contribute to its unique character.  He talks about the continuity of leadership.

Next Dr. Raber describes the “intense sense of mission” shared by all employees at MD Anderson, a mission so strong it is “almost like a religion.”  He notes that this is missing in most medical institutions.  He then notes that cancer is not like other diseases and creates a unique bond between the patient and the cancer provider.  He explains that patients “work hard” to get to MD Anderson and are very motivated.

Dr. Raber explains that MD Anderson brings together a mission-driven faculty and staff, an egalitarian system for rewarding physicians, and motivated patient population.  As a result, he says, “miracles are popping up all over.”  He defines a “miracle” as patient receiving a new drug that will stop his/her cancer.  Bringing together patients and physicians at the right place and the right time for cure can result in a “dynasty,” he observes.

Dr. Raber emphasizes that, at MD Anderson, “We actually believe we deliver the best cancer care.”  He then talks about the attitudes of patients who skimp on their cancer care or choose not to see a cancer specialist.  He notes that “not every doctor is the same.”

Dr. Raber also comments on the tendency to judge a clinician by how she or he treats patients and the intense peer pressure to perform well in this regard, with less value placed on performing well in the “external” world of professional conferences and papers.  He next comments on the process of assimilation that young faculty trained at other institutions must undergo to perform effectively at MD Anderson.  He notes that some don’t grasp the essentials of MD Anderson culture and eventually leave.  He describes some of the dimensions of that culture: dress, standards for interacting with others.  He then observes that each hospital sends a message to patients, and MD Anderson sends a message of competence. 

Dr. Raber says that working at MD Anderson gave him the opportunity to work with high performers in a place where things are happening.  It was like working “with the Yankees.”

Original Profile

Interview Profile #41: Martin Raber, M.D.
Submitted by: Tacey A. Rosolowski, Ph.D.
Date revised: 30 July 2014

 

This interview with medical oncologist Martin Raber, M.D. (b. 1947, Rockway, Long Island, NY) takes place in four sessions conducted in September and October of 2013 (approximately 6 hours and 9 minutes total duration).   Dr. Raber first came to MD Anderson in 1978 to take up a fellowship in the Department of Developmental Therapeutics.  After time away from the institution, he joined the faculty as an Associate Professor of Medicine and Chief of the Section of Medical Oncology in 1985.  In addition to conducting research on tumors of unknown origin, Dr. Raber quickly advanced into leadership roles that allowed the institution to take advantage of his interest in healthcare delivery systems.  He was influential in crafting responses to the managed care crisis in the late 1980s.  His career was greatly influenced by the cancer diagnosis he received in 1995.  He retired on 15 January 2011.  Today Dr. Raber is a Clinical Professor of Medicine in the Department of Gastrointestinal Medical Oncology.  He also serves in special advisor roles to the Division of Cancer and to the Physician in Chief. 

This interview takes place in Dr. Raber’s office in the Department of Gastrointestinal Medical Oncology in the Faculty Center Building on the Main Campus of MD Anderson.  Tacey A. Rosolowski, Ph.D. is the interviewer.

Dr. Raber received his B.A. in Biology from Washington University in St. Louis, Missouri in 1968 then continued for his M.D. at the Catholic University of Louvain in Louvain, Belgium (degree conferred in 1975).  He did his internship with the Faculty of Medicine at Dalhousie University, in Halifax Nova Scotia in 1974 – 1975 and continued at the same institution for his residency in the Department of Internal Medicine from 1975 – 1978.  (He served as  Chief Medical Resident, ’76 – ’77.)  From 1978 – 1980 Dr. Raber was a Fellow in the Department of Developmental Therapeutics at MD Anderson.  In 1980 he joined the faculty of the The University of Texas Medical School, Houston, TX  as an Assistant Professor of Medicine in the Department of Internal Medicine.  In 1984 he advanced to Associate Professor of Medicine in the Department of Internal Medicine, Division of Hematology.  In 1985 he joined the faculty of MD Anderson as an Associate Professor of Medicine in the Division of Medicine.  He served in many administrative roles, including Associate Vice President for Patient Care (1992 -1994), as Physician in Chief (1994 – 1996) and Vice President of Managed Care and Outreach Programs (1996 -1998).

In this interview, Dr. Raber traces the evolution of his administrative skills and career and provides a detailed view of MD Anderson’s response to the changing economics of healthcare from the nineties onward.  He is keenly sensitive to cultural and political issues (a sense he attributes to the years he spent in Belgium earning his M.D.) and provides many insights into the working of MD Anderson culture and institutional power systems.   In addition, Dr. Raber was diagnosed with lymphoma (Waldenstrom’s macroglobulinemia) in 1995 and struggled with the disease for many years.  In this interview he speaks candidly about experiences as a patient and how they provided him with insights that enhanced his clinical and administrative practices.  Dr. Raber is also is a passionate clinician and faculty member of MD Anderson and he speaks from that perspective when he describes the characteristics of MD Anderson and the efforts he and others made during critical years to improve the institution’s health care and delivery systems.