About Us
2008 State of the Institution Address
October 29, 2008
Introduction
When I began preparing this report on the state of The University of Texas M. D. Anderson Cancer Center last summer, little did I know that many of the ambitious goals and plans I will be discussing today would become not just desirable, but truly essential for our continued success.
We have made steady progress each year toward achieving the seven goals in M. D. Anderson’s Strategic Vision, which we outlined together in 2000 and updated in 2005 (chart 1). Today, we face a level of turmoil in the worldwide economy which creates serious challenges and poses financial threats that impact us individually, and as an institution. We can use these strategic goals to prepare and position ourselves for these challenging times.
Briefly, what are the financial threats we must be prepared to meet?
- We can anticipate increased demand for the uncompensated charity care we provide for indigent Texans with cancer.
- We also anticipate increased numbers of underinsured and uninsured patients and more bad debt, due to job loss and the recession.
- Because we are an aging population, a greater pecentage of cancer patients will be using Medicare, which does not pay adequately for the costs of providing care and probably will be cut further in 2009.
- A challenging capital market may delay the construction of new facilities.
- Philanthropic gifts may be postponed or reduced.
- National Institutes of Health and the National Cancer Institute budgets that fund research are likely to remain flat, and may continue to be reduced.
Sounds daunting, doesn’t it? But I remind you that we enter these difficult times with more resources than most medical
institutions. And we are buoyed by a single, well-understood mission we all share, and an incredible amount of respect and support in the community and worldwide for the important work that goes on at M. D. Anderson. These are some very strong assets.
The executive leadership team has begun to plan responses that target the potential threats to our bottom line. I will outline some of these plans today, along with plans that continue to advance our agenda for Making Cancer History®.
At a minimum we must move quickly to improve efficiency, streamline processes and optimize our use of human, physical and financial resources. Of necessity, there will be some changes in the way we do things, including increased standardization of operations, closer tracking of productivity, and adoption of best practices. While change can be difficult, I am confident 
that by working together we will be successful in identifying the right priorities, managing the challenges we face, and sustaining our outstanding record of achievement. We did well in weathering Hurricane Ike, based on careful preparation and a spirit of dedication and teamwork when the storm arrived. It is with this same spirit that we will come through the adverse circumstances the nation now faces as a result of the current economic storm.
We all know M. D. Anderson as a collegial and mission-driven academic institution, where people from many disciplines work together to better understand cancer and treat our patients. Our growth and accomplishments have been truly phenomenal.
There are many objective measures of these successes: the increasing lead in our number one ranking among hospitals in cancer care in the U.S. News & World Report survey, “off the chart” scores in our externally administered patient satisfaction surveys, the ever-increasing numbers of patients who seek our services, the outstanding peer review score awarded to our NCI Cancer Center Support Grant renewal, the record levels of generous philanthropy that have contributed over $170 million during each of the past two years, the steady record of elected national leadership positions and outstanding recognition awards for which our people are selected, the overtures from many nations to M. D. Anderson to participate in creating new cancer centers and enhancing existing programs, and many more. I share your pride in these great accomplishments.
We are a giant enterprise composed of many interlocking units, pursuing our mission in more than 10 million square feet of space spread out far beyond the boundaries of the Texas Medical Center proper. We must maintain an infrastructure and ways of doing things that connect us together and continue to support our values of caring, integrity and discovery and the collaborative, “can do” culture of which we are so justly proud. We must maintain an intellectual environment that supports pursuit of quality and efficiency in our patient care services and in our academic activities, and a nurturing and mentoring environment that supports the personal growth of everyone at M. D. Anderson. And we must maintain and preserve the financial resources required to support growth and continued excellence in the investigation and treatment of cancer.
It is a rapidly evolving, highly competitive and unpredictable national and world environment in which we live. Our responsibility at M. D. Anderson is to keep abreast of challenges and opportunities, to remain out in front in innovation, and to be a flexible and adaptable organization. We shall meet this responsibility.
Let’s look at some of the challenges and opportunities.
Our Clinical Mission
Our outstanding reputation for delivering the very best care for our patients is well deserved. If we want to remain leaders in cutting edge, research-driven cancer care we must continue to generate new ideas and respond effectively to external challenges and expectations.
The most prevalent trend in cancer treatment is “targeted therapy,” an area in which we already provide strong leadership. In the past five years we have introduced into clinical trials 17 new cancer treatments
developed at M. D. Anderson that target specific genes and molecules, and six others are submitted for regulatory approval to initiate trials. A number of earlier therapeutic inventions by M. D. Anderson investigators are nearing consideration for final approval by the FDA, including two gene therapies and two vaccines. These discovery efforts are expanding in our new Center for Targeted Therapy.
Individualized therapy has been introduced in lung and breast cancer clinical trials involving prospective selection of appropriate targeted cancer treatments, based on real-time measurements in a patient’s tumor biopsy of protein expression and of gene mutation, copy number and expression. Similar trials for other types of cancer are on the drawing boards. We are gearing up to create a state of the art translational pathology laboratory which can expedite genetic and molecular assays on cancer biopsies that eventually will enable selection of optimal drug treatments for each patient.
Targeted therapy is a theme that permeates all approaches to cancer treatment today, not just chemotherapy. In radiation oncology we are taking the lead in investigating the use of proton beam therapy, which can deliver higher energy to the tumor with reduced damage to normal tissues. In surgery, targeting the tumor and reducing injury to normal tissues is being accomplished through robotic technology and minimally invasive techniques. Research in diagnostic imaging is poised to enable us to detect and target molecular abnormalities in primary cancers and metastases, using innovative nuclear and optical technologies. Research in anesthesia is targeting pathways and receptors that influence the efficacy of medications which control pain. Our epidemiologists are identifying gene abnormalities that increase the risk of cancer, which can be targeted for screening or for preventive therapeutic interventions.
All of these approaches are being applied to both adults and children. The Children’s Cancer Hospital at M. D. Anderson is carrying out targeted clinical research programs that, in part, draw upon and contribute to discoveries made by colleagues in the adult multidisciplinary cancer programs.
Of course, the ultimate goal will be collaborative selection of combinations of therapies in each of our multidisciplinary care centers, based on the anatomic locations of the patient’s cancer and the collection of genetic and molecular abnormalities in each individual cancer. The clinical division heads are preparing research agendas for this enterprise, which will be developed within our new Institute for Personalized Cancer Therapy. Targeting of diagnostic tests and therapeutic interventions must be integrated into all three phases of the cancer care cycle, including prevention, diagnosis and treatment, and survivorship (see chart 2).
There is increasing emphasis on prevention and survivorship in the cancer care community and the public. M. D. Anderson has taken a leading role in cancer prevention over the past decade. Looking forward, a major goal will be to formulate plans for expanding clinical services and research in a new Institute for Cancer Prevention and Risk Assessment (see chart 2), with support provided from a generous $35 million gift made by the Duncan Family Foundation.
Charts 3-5 list goals for this year, and relate them to one or more of the seven strategic goals in M. D. Anderson’s Strategic Vision.
We are committed to developing comprehensive approaches to managing care for cancer survivors, after active therapy has been completed. After extensive planning that involved teams from across the institution, three pilot programs are implementing unique clinical services and research opportunities targeting cancer survivors. It is a challenge for both patients and their physicians to transition from treatment of the cancer and its sequallae to more observational and prevention-oriented long-term care. Which physicians will be taking over these responsibilities? Where should these patients be seen? Provision of appropriate diagnostic imaging and laboratory medicine services, as well as consultative medical and behavioral subspecialty services, must be fully integrated into the care provided for cancer survivors. We will increase research on the prevention and management of long-term medical complications that result from the treatments we administer to combat cancer. Robust research programs in both prevention and survivorship will involve all clinical divisions and multidisciplinary care centers.
This year, building upon our experience with the pilot programs, we will be deciding what new elements we will bring to survivorship programs and how they will be organized. This will enable us to determine the space and other resources required for providing services to our cancer survivors — some in existing clinics, many more in a planned new facility on the main campus, and others through web-based communication with their local physicians.
The trend to incorporating integrative medicine into cancer care is growing nationally, and M. D. Anderson’s program is making substantial research-based contributions. This program will have applications in prevention and survivorship, which have yet to be explored. A goal during this new academic year will be to assess the role and the needs of our integrative medicine program in all three phases of the cancer care cycle.
Survivorship as a discipline started with specialists in pediatric cancer, where it was known for years as “long-term follow-up.” Our pediatric cancer program has grown in size and stature during the past few years. Original research in pediatric cancers is starting to flourish here, and an outstanding new faculty has been recruited for the Children’s Cancer Hospital, as it is now known. Our goal is to provide the resources and support it needs to grow even stronger. This will include dedicating the ninth floor of Alkek Hospital entirely to inpatient and ambulatory pediatrics.
A trend which has gained attention in the federal government and in the news media is the increasing demand for greater accountability from physicians and clinical investigators, as well as the accountability of academic medical centers. Accountability is a huge topic, which can be viewed through many different lenses. From the point of view of the government and the public, accountability includes:
- Full disclosure of financial ties that could impact, or could be perceived as impacting, delivery of clinical care and performance of clinical research.
- Proper allocation by faculty of contractually committed time and effort to research projects and clinical activities for which the government is providing salary support.
- Provision of improved value (better clinical outcomes, reduced costs) by physicians and groups who deliver care for which the government, the private sector, or patients themselves provide payment.
- Provision of appropriate levels of non-reimbursed charity care and care for the uninsured and underinsured, by medical centers which benefit from tax-exempt status.
These issues present practical and ethical challenges for the day-to-day activities of most employees at M. D. Anderson and for the institution.
The level of government scrutiny is increasing, and will be even greater during the next administration, because of the broad consensus that the nations’ health care system is too expensive and inefficient, and desperately needs fixing. A major goal during this academic year will be determining operating metrics that provide accurate data on clinical outcomes and costs of care. Supporting our efforts to improve outcomes and reduce costs will be our new Institute for Cancer Care Excellence (see chart 2), which involves both academic research and the testing of best and most cost-effective practices in our clinical operations. Our goal during the new academic year includes beginning to make important contributions to health services research as applied to oncology, and to improve the value of the care we deliver as measured by improved outcomes and reduced costs.
We also will need to determine the appropriate commitment of M. D. Anderson’s human and financial resources to unreimbursed patient care for indigent Texans and those without adequate insurance. Here, we must balance our desire to provide financial assistance to as many of those who seek our care as possible with our obligation to use our resources to maintain excellence and growth in all four of our mission areas. As a major goal for this academic year, the institution’s leaders are assessing the clinical and financial implications of ways we can address our responsibility and our accountability with regard to the financial challenges faced by patients who have inadequate health care insurance. For indigent Texans whose family income is less than 185% of the federal poverty limit we offer free care, and for less than 250% we offer a 50% discount. A particularly trying challenge is management of uninsured and underinsured patients who are not indigent, and who seek our care.
One way of increasing our delivery of care to indigent, underinsured and uninsured residents of Harris County is to expand the services we currently provide, at our expense, for cancer patients treated at the LBJ County Hospital. These activities will nearly double during the next few years, and will include supervision of their radiation therapy unit by our faculty — all at no cost to Harris County.
I know we all agree that our first and primary accountability at M. D. Anderson is to the patients we serve. Our shared commitment to providing the highest quality, safe, research-driven patient care accounts for our success in achieving leadership status in clinical oncology. The comments I receive from dozens of patients are that once they are seen for diagnosis and treatment in one of our multidisciplinary clinics, the care is outstanding. However getting in the door for that first appointment remains a challenge for far too many who seek our care.
The average waiting time for a new appointment in FY08 increased to 14 working days (nearly three weeks), which is simply unacceptable. I’ve set a goal of reducing the average wait time for new appointments as close as possible to seven working days. Of course, wait time will vary for different types of cancer and for individual patients.
We must fix our patient scheduling processes, which continue to be inefficient and wasteful of human and physical resources. This will require the collaborative efforts of department chairs, practicing physicians, clinic administrators and nurses, patient access specialists, patient advocates, business representatives who screen patient financial assets, information technology specialists with expertise in scheduling systems, and all leaders who oversee clinic activities. Until we can create or purchase an effective electronic patient scheduling system for our clinics, we will have to use old-fashioned human, industrial engineering approaches.
Everyone involved also will have to review our operating procedures and find ways to simplify and standardize our processes. For example, in some clinics customization of new patient appointment slots to accommodate individual physician preferences reduces flexibility and contributes to excessive wait times.
Underutilization of our human and physical resources is simply not an option today. This includes faculty, clinics and operating rooms, imaging capacity, and much more. Just visit some of our underutilized clinics on Friday afternoon, or consider that some of our operating rooms operate at only two-thirds capacity by national standards. Everyone involved will have to chip in.
There is another factor that must be addressed in considering patient access, namely the critical role of the activities of individual clinical faculty. The number of new patients and new consults seen per clinical faculty member has gradually declined by 10% compared with five years ago. Providing care to new patients is critical to our patient care and clinical research missions, and also it is the major source of increased revenues that support our overall growth in all four mission areas. We have two choices: to increase the number of new patients and consults we see, or curtail our growth substantially. All department chairs and division heads want to grow their programs, so the choice is obvious and their accountability for maintaining new patient and consult visits is clear.
The point is that to support our growth in research, education and prevention and, of course, our growth in clinical activities, we must sustain a parallel growth in hospital and clinic revenues that support our operating margin. These clinical revenues provide the bulk of our funds for numerous clinical and non-clinical activities, including, for example: unbilled care for indigent Texans; margins that fund our capital plan for facilities, major equipment and IT projects; 70% salary support for our laboratory investigators; overhead costs for research that are not covered by grants, contracts and philanthropy; and funds for recruitments, centers and internally peer-reviewed innovative research projects. In 2007, the institutional expenditure for unreimbursed indigent care was $73.2 million and for unreimbursed Medicare was $89 million; the commitment to research was $238.7 million, and support for educational activities amounted to $81.5 million.
Since income from the clinical care we provide is critical for supporting activities in all four of our mission areas, as well as their growth, addressing this issue is a critical goal for the new academic year. If the average number of new patients seen per physician was restored to the level of five years ago, the problem would be solved. It is critical that this 10% deficit be recaptured during FY09. We all favor an individualized approach in assigning responsibility for the increase. Some clinical faculty can contribute optimally to our mission by seeing additional new patients and consults, others by focusing more on their research, and many are making major contributions to activities such as education and participation on committees like our five Institutional Review Boards. It will be up to each department chair to work out a division of labor with his or her faculty to achieve the overall goal of providing the department’s services to increasing numbers of new patients and consults, and carrying out high-priority research, education and prevention projects. This year’s budgets and clinical targets for each department were designed to accomplish the 10% recovery in new patients served. Our physician-in-chief and our provost are providing data to guide department chairs in setting appropriate new patient targets for physicians and monitoring their activity monthly. Department chairs will be held accountable for meeting commitments.
In summary, at this time of financial and economic stress, we have a responsibility to our patients and to those who support us to improve our use of our precious resources: our people, our space and our funds. To accomplish this, we also need to improve the efficiency and effectiveness of the processes we depend upon, when we team up together to deliver our special brand of multidisciplinary patient care.
Our Research Mission
Complexity, sophistication, specialization and collaboration — all of these are themes that come to the forefront in cancer research today. While the individual laboratory researcher or clinical investigator, working on his or her personal interests and goals, remains key to scientific discovery, research has become more and more a group enterprise that requires expertise, technical resources and time beyond the capacity of most individual investigators to provide.
“Team science” that crosses multiple disciplines is further necessitated by the national emphasis on speeding up the process of translating scientific discoveries into diagnostic tests and new therapies that will directly benefit people. M. D. Anderson excels in this type of research. We are committed to doing everything in our power to keep our leadership position in translational and clinical research, while continuing to strengthen the basic science investigation that feeds this pipeline.
Our investigators also increasingly need access to disciplines like physics, chemistry, engineering, computer science and informatics to effectively explore fundamental, mechanistic biological science, and to implement clinical applications of their discoveries. This means broadening the expertise and areas of interest of individuals we recruit to our faculty, together with an increasing emphasis on the strong collaborations we are building — both with the seven academic institutions in greater Houston and with investigators throughout the country and worldwide.
Our formal collaborations with the seven Gulf Coast Consortia institutions currently involve 10 funded education and training programs and 12 research consortia, clusters and centers. Additional collaborations between individual investigators and academic colleagues in Houston and at other U.S. institutions are too numerous to count, and involve the majority of our faculty. Globally, just within the sister institution network we have created, the past two years has seen exchanges of 87 trainees at many levels, and initiation of 86 collaborative research projects.
A major goal for the new academic year will be to encourage and embrace continued expansion of collaborations that leverage research capabilities and increase the impact of our research accomplishments.
In recognition of the increasing collaborative nature of research within the institution and to focus on topics that the faculty have selected as most relevant and opportune for exploration at M. D. Anderson, we have created new Centers of Excellence with memberships that are cross-departmental. Each center is charged with developing successful, internationally recognized research programs.
This began six years ago with the six translational research centers in the McCombs Institute for the Early Detection and Treatment of Cancer (See chart 2).
Based on the success of the McCombs Institute model, the centers initiative is expanding to include new Centers of Excellence in the basic sciences and in prevention and population research, and to expand disease-targeted research in our multidisciplinary care centers, which have already captured 11 Specialized Programs of Research Excellence grants from the NCI. We will continue to work out the details of organizing and resourcing research in these centers during the new academic year. And we will need to raise the philanthropy, grants and state funds to support them. Each Center of Excellence will be rolled out as resources become available and plans become finalized.
In planning the strategy for basic research, the faculty selected six new Centers of Excellence to be grouped along with our basic science departments in an Institute for Basic Science (see chart 2). These include new centers that will explore: biological pathways; cancer epigenetics; environmental and molecular carcinogenesis; immunology, inflammation and cancer; structure, chemistry and function of macromolecules; and genetics and genomics. The strategy is to build on expertise already represented on our faculty, and expand research through recruitment, new core resources and collaborations.
In the area of clinical investigation, M. D. Anderson faculty and research nurses already excel in collaborative, interdisciplinary research. However, some of the multidisciplinary care centers could benefit from stronger interdepartmental collaboration. As noted earlier, we are developing ambitious plans for an Institute for Personalized Cancer Therapy (see chart 2), which will support the clinical research programs of each multidisciplinary care center, our Phase I clinical trials program, and our targeted therapy initiatives. Among the new Institutes we are planning, this is the largest and most challenging. It will require coordination and collaboration involving all of our clinical divisions as well as many faculty in quantitative sciences and translational and basic research.
The continued increase in the number and complexity of clinical trials, the increasing number of trials requiring Investigational New Drug support, and the increase in regulatory oversight have created strains on the clinical research infrastructure, and the human resources and funds that support our trials. We need to provide adequate funding for these mission-critical activities through grants and contracts, philanthropy and institutional sources. At the same time, we will need to bring together all stakeholders to increase prioritization of new trials, reduce ordering tests and collecting data that are not essential, and enhance the value contributed by each individual involved in clinical investigation. We have said this many times and we are making progress, but today’s economic challenges force us to accelerate this process.
The Division of Quantitative Sciences, with its new Department of Bioinformatics and Computational Biology, is the major focus for our growth in bioinformatics, computer science and computational biology, each of which directly impact research in all of our Institutes (see chart 2).
To expand our research we will need new facilities. Two more are under consideration on the South Campus, in addition to the new buildings housing the Center for Advanced Biomedical Imaging Research (opening early 2010) and the Center for Targeted Therapy and other research programs (opening in 2011). One under consideration is a large commercially funded building targeted to attract biotechnology companies, in which we would temporarily rent substantial laboratory space and animal facilities for a decade.
On the Main Campus, at a site or sites to be determined, new academic facilities under consideration include a second Basic Science Research Building, expansion of translational research laboratories for the Division of Pathology and Laboratory Medicine, and a new home for our School for Health Professions.
Finalizing plans for future research buildings is a high priority goal for the new academic year. The timeline for construction may be delayed, depending on philanthropy, the level of state support, and access to capital funds which currently is in a state of uncertainty. And, as I mentioned earlier, all of these plans are contingent on our strong clinical volumes and the resulting operating margin. In the meantime we must increase our efforts to make optimal use of the research space in our existing facilities.
Finalizing plans for future research buildings is a high priority goal for the new academic year. The timeline for construction may be delayed, depending on philanthropy, the level of state support, and access to capital funds that currently is in a state of uncertainty. And, as I mentioned earlier, all of these plans are contingent on our strong clinical volumes and the resulting operating margin. In the meantime we must increase our efforts to make optimal use of the research space in our existing facilities.
The trend to build open rather than enclosed laboratories, initiated with the Mitchell and Immunology Buildings, has become standard practice for most research, along with a major expansion of space for shared instruments and core facilities. Our extensive shared resources are partially supported as cores in our Cancer Center Support Grant, and in our SPOREs and program projects, but also they require charge-backs to grants awarded to individual investigators, philanthropy and substantial institutional funding, averaging $8.5 million per year over the past five years.
Setting up a system for prioritizing and allocating these resources, utilizing internal peer review, is a goal for the new academic year, because preservation of valuable shared resource services is imperative in the face of today’s funding climate.
We have only begun to exploit the opportunities for research collaborations with our sister institutions outside of the U.S., each of which is a successful and recognized cancer center. Especially promising are collaborations involving epidemiological studies and investigation of genetic and molecular abnormalities in specific variants of cancer prevalent in one part of the world or another. The limiting factor is financial support. In a few cases, such as the Middle East, financial resources likely are to be available for collaborative research. We will seek philanthropic support for collaborative international research, exploring new sources such as expatriates and foreign nationals.
For the past two years less than 50% of our research expenditures have been funded by the federal government. This is a major change from previous years. In FY07, federal grants and contracts accounted for 43% of research funds. Hospital margins contributed the bulk of the remainder, followed by philanthropy, contracts with pharmaceutical companies and appropriations from the state of Texas at 7%. State funding could increase substantially if we achieve our goal of competing successfully for grants from the new Cancer Prevention and Research Institute of Texas (CPRIT), which should become available in 2009 or 2010.
Accountability for spending our substantial research funds wisely is expected by the federal government and by each of our other sources. Federal grants and contracts undergo rigorous peer review, and awards from CPRIT will be reviewed by external experts. Our commercial contracts (e.g., for clinical trials) are developed in close collaboration with pharmaceutical and biotech companies, which review them carefully. Accountability for wise expenditure of philanthropy and our clinical margins allocated for research is provided, in many cases, by internal reviews performed by committees and academic leaders; in other cases, written reports from individual recipients of unrestricted philanthropic gifts or institutional funds are the only reviewed records of how the research funds were used. As we further expand research support from philanthropy and clinical income, we anticipate an expansion of internal review. Our Board of Visitors, which is well into a commitment to raise $1 billion for M. D. Anderson over a six-year period, has stressed this need. Board members are working with our executive leaders to develop a “report card” with metrics measuring the quality of our philanthropy-supported research, for distribution to potential new major donors. In addition to many widely used metrics such as publications and grant dollars, the Board is interested in documenting accomplishments that produce major scientific advances, or new diagnostic tests and treatments that directly impact patient care. It is critical that we give them a very strong report and an action plan for using these metrics.
The Laboratory Space Committee of the Research Council has established metrics and carried out internal peer review of the research productivity of our laboratory scientists, and the Clinical Research Impact Committee has assessed the productivity of our clinical investigators. These data plus the reports from departmental reviews provide assessments of research productivity. The faculty have expressed strong sentiment that the institution should make a greater effort to selectively reward those who are making the strongest research achievements with increased resources and support, including space and protected time for research. And conservation of precious resources to support the strongest research becomes critical at a time when funds from so many sources are less secure than previously. It is a major goal of the new academic year to put in place such a reward system, with the clear understanding that rewards for excellence, such as increased research space, will mean that for others resources such as laboratory space will shrink — all based on peer review. Of course, many factors must be taken into account in deciding on resource allocation, including support for new Centers of Excellence, bridge funding for meritorious grant-supported research, and research start-up packages for new faculty. I believe we have done this fairly and well, but I also believe we can and must do it even better and more selectively, as we continue to grow and our NIH funding continues to remain flat, at best, for a while. Each faculty member has excellent and valuable skills to contribute to our collective mission, and for some it may be primarily in patient care, education or clinical prevention, rather than in research. We must recognize and reward, appropriately, faculty who make contributions to each of our four mission areas.
Our Educational Mission
I want to turn now to another vital mission area, education.
More than 5,000 people received formal training at M. D. Anderson during the past year. More than a third were full-time trainees, primarily clinical fellows and residents, postdoctoral fellows, graduate students, undergraduate students in the supporting professions, and a growing number of nurses. The remainder, from the U.S. and abroad, rotate at M. D. Anderson for periods of weeks to many months, receiving training in areas of special interest. They range from students working toward degrees to practicing cancer physicians seeking competence in specialized areas of clinical care.
A committee of interested faculty has worked hard to create an agenda championing changes in our Graduate School of Biomedical Sciences to increase the quality of both student performance and faculty teaching. Many, but not all, of their recommendations have been adopted. We are proud of our GSBS, and our goal is to enable it to achieve a higher rank and attract even stronger students.
Our newly renamed School of Health Professions, which provides training leading to degrees or professional certificates for laboratory technicians and clinical support personnel, is increasing from a one-year to a two-year program and also will double in class size, resulting in a net four-fold increase in the number of active students. Increased classroom space has opened, and the school will eventually be located within a new facility. Technical personnel with training such as we provide are in extremely short supply, and the job opportunities for our graduates are outstanding.
We are proud that a new academic Department of Nursing has been established to support the educational and research activities of professional nurses with doctoral degrees, and to provide them with the opportunity for faculty appointments. This new department is advancing our efforts to create an environment that promotes excellence in nursing practice, research and education, as well as to encourage collaboration among interdisciplinary colleagues in pursuit of the mission of the institution.
The largest number of trainees at M. D. Anderson are receiving education as postdoctoral fellows in clinical subspecialties and in laboratory research. The clinical training programs, which include clinical care and research experiences, have become among the strongest in the country and acceptance is highly competitive. Plans are under way to expand the research training of selected clinical fellows, to include in-depth laboratory research experience for a number of years. This will prepare these physician, scientists for careers focused primarily on innovative and clinically impactful laboratory investigation.
Our provost is developing plans to enhance mentoring programs for advanced fellows and new faculty, especially those who enter at the assistant professor level. This must be personalized, depending on the career goals of each individual. For example, a physician in a clinical department who plans a career in laboratory research will need mentoring from a strong laboratory scientist, while a future clinical investigator should be mentored by an expert in clinical trials. Some faculty and advanced fellows will benefit from both types of mentors. A month ago we held our first mentoring day symposium, which was very well attended.
The demand for training of international physicians at M. D. Anderson is increasing, as a result of the activities of our Center for Global Oncology. Many of our formally affiliated institutions and our nearly two dozen sister institutions around the world want to send some of their best physicians for periods of intensive subspecialty training. Most of these physicians, who will return home, should not compete for the limited available positions that lead to U.S. board certification, and can receive certificates attesting to their experience at M. D. Anderson. Through this mechanism, our goal is to share best practices in clinical care and clinical research with colleagues worldwide, and the creation of our Center for Global Oncology will enable us to better organize this program.
There is no doubt that the next U.S. president and Congress will have to redesign health care delivery, to deal with access for those currently uninsured and underinsured, to address escalating costs, and to design a payment system that rewards outcomes rather than performance of tests and procedures. Due to our institution’s position as a leader in cancer care and research and our faculty’s leadership roles in numerous cancer subspecialty organizations, we can contribute to these deliberations and should be prepared to do so with thoughtfully considered positions. This is a challenge that I, the executive vice presidents, the clinical division heads, department chairs and senior administrative leaders need to address as a goal during this academic year.
Being an Employer of Choice
Our goal for all employees is for M. D. Anderson to be an employer of choice during the development of their careers. Educational programs provided by our Division of Human Resources and a number of hospital departments enable employees to gain the skills needed for advancement and for transfer into new activities. Our prevention and health screening programs for employees have earned M. D. Anderson the CEO Gold Standard award given to major national companies. We will continue to expand prevention and screening, tobacco cessation and instruction on lifestyle changes, including a new exercise program at the gym in the Pickens Academic Tower.
Another major goal will be to address some issues raised in our third employee opinion survey, which demonstrated substantial improvements compared with the survey two-and-a-half years ago, but suggested the need for further attention to dealing effectively with poor performers, ensuring that employees feel it is safe to speak up, and reducing bureaucracy. Improvement in these areas will directly impact the value of the services we provide and everyone’s job satisfaction. Last year, we undertook our first-ever volunteer opinion survey, as well, so that we could learn more about the factors that motivate our wonderful hospital volunteers, as well as those factors that discourage them or occasionally drive them away. An action plan is in place to build an even stronger volunteer program. Their service is more vital than ever, and I believe that our volunteers deserve major credit for the levels of patient satisfaction we have achieved.
I have identified a number of goals for us to address during the new academic year. The list is extensive, but by no means exclusive. They affect all of our mission areas, and they target the seven institutional goals in our Strategic Vision. The executive leaders of M. D. Anderson encourage suggestions and criticisms from all employees, on how to achieve our vision of continuing to be the premier cancer center in the world based on the excellence of our people, our patient care and our science.
We are fortunate to have skilled and experienced leaders. I rely heavily on the advice and decisions of our three executive vice presidents, who, in turn, rely upon the teams they direct. The executive vice presidents and I have worked together in formulating the goals I have presented.
The optimal solutions to the challenges we face today often will come from skilled employees who are on the front lines and those who carry out our challenging administrative and business functions every day. Our leaders need to listen to their advice. By working together, we will achieve our goals.
Our spirit of mission-focused collaboration and collegiality throughout the institution welcomes innovation and change far better than I have observed at any other academic medical center, so I am confident that we will continue to accomplish a great deal. That spirit was demonstrated in world-class style by the 1,800 employees on our ride-out team, who left their homes and families to care for our patients and protect our facilities during Hurricane Ike. I could not have been more impressed and proud.
In are data that I report each year on this occasion, presenting metrics that describe our activities and the changes that have occurred over a decade. It is a track record of which all of us can be proud.
I am grateful for your continued support, as we work together to face the many challenges I have discussed, and to achieve our institutional mission, as well as the personal missions of each and every employee, volunteer and patient at M. D. Anderson.