Is MD Anderson An Academic Cancer Center For Tomorrow Or Another Money-Focused Corporate Medical Behemoth?
By
Leonard Zwelling
https://www.nejm.org/doi/full/10.1056/NEJMp2415750
https://www.science.org/doi/10.1126/science.adz4433
The one thing that I rarely criticize at MD Anderson is the competent delivery of outstanding cancer care by the clinical faculty. And I am not about to start now, BUT…
One of the hallmarks of excellence in academic medical centers is their adherence to the core values of academic medicine as outlined in the first attached article by Dr. Jatin M. Vyas from The New England Journal of Medicine on May 7. In essence, the mission of academic medical centers is the delivery of quality health care, doing medical research, and teaching the next generation of physicians and scientists. It is also key that these three functions be integrated so trainees see how research can improve clinical care.
Here’s how Vyas describes the current state of academic medicine:
“Academic medical centers have expanded through mergers and acquisitions to become hub-and-spoke systems, using aggressive marketing and branding strategies as well as ‘workforce optimization’ in attempts to boost profits. These approaches lead to high patient volumes, increased focus on relative-value-unit metrics, and ‘operational efficiencies’…Trainees feel like their work serves someone else’s bottom line, not their patients’ or their own.”
Remove “patients” and substitute “faculty” and protection of the classified employees from “workforce optimization” and you have MD Anderson in a nutshell.
As I have reflected before, MD Anderson’s org chart looks more like that of a crime family or, maybe even a poorly run mid-size corporation without a functioning board or any shareholders.
The final thing I extracted from this excellent editorial came towards the end.
“Hospital leaders should be physicians who engage in direct patient care and work alongside trainees.” But who is the true MD Anderson hospital leader? The President? The Executive Vice President and Chief Physician Executive? The Chief Operations Officer? The latter is not even a physician at MD Anderson.
A careful reading and re-reading of this editorial suggested to me that MD Anderson really does need that outside, independent assessment given its lack of a real board. It cannot happen soon enough. Who is watching the fort who has a knowledgeable eye to actually know how the current leadership is doing?
The second article is from the Science Magazine of April 30 by Brodeur et al. This group challenged a large learning model and a large group (hundreds) of physicians to analyze cases on paper and in a real-world emergency room environment for diagnostic acumen. The large language models outperformed the docs.
The point is not to prove that machines can out do humans in doctoring. It is to demonstrate that large language models have progressed to the point that they should be included in the tool box of any physician. No one is suggesting that the final decision on identifying the cause of a clinical problem or formulating a treatment plan be foisted off to machines, but, just like a stethoscope, these large language models can be useful tools in generating a differential diagnosis and a strategy to narrow down the cause of clinical symptoms as well as generate a treatment plan.
My question again is whether or not MD Anderson is on the cutting edge of the implementation of this AI technology or is it represented best by the fact that the current scheduling system (or the schedulers) gave me an appointment with cardiology to clear me for an MRI now that I have a pacemaker AFTER the MRI will be done?
As a past faculty member, current faculty in trouble helper, and current patient, I am concerned. Can anybody allay my worry?
