More than 75 years ago, surgeon Ernst Bertner envisioned the Texas Medical Center (TMC) as “breathtaking in the scope and breadth of its conception,” that would be “one of the largest in the world”; ...a gigantic medical enterprise that would “attract the greatest scientists of the world” and would combine patient care, research, and education, on a scale that was “second to none.” During the next 3 years, Bertner accomplished important pieces of the Herculean task to bring onto the campus 11 major buildings, including the University of Texas MD Anderson Hospital for Cancer Research, for which he was the interim director. This was an extraordinary accomplishment because at the outset he had only a strategic plan, the deed to 134 acres of forest, and financial support from the MD Anderson Foundation! Bertner further forecasted world-class clinical and educational programs in the TMC, stating: “We envision the time when the Medical Center will become a great magnet, drawing leaders in education, medicine, and dental professions. It will provide the physical facilities and the environment in which research will flourish and bring forth for all of us new discoveries in the field of medicine.” So how did his bold vision and passionate leadership culminate in the TMC today? By any criteria of scale and program excellence, the TMC today can be regarded as the largest medical center in the world. Occupying a contiguous campus of 1345 acres (2.1 square miles), it comprises 162 buildings, 60+ member institutions, 21 hospitals (> 9200 beds), 21 academic institutions, 4 medical schools, 7 nursing schools, 3 public health schools, 2 pharmacy schools, and a dental school. More than 106,000 patients and visitors come daily to the TMC, which has more than 120,000 employees, including 5000 physicians, 5700 researchers, and 11,000 registered nurses. Ernst Bertner is credited for transforming the original vision of the TMC into a workable program, and whose dynamic devotion to the idea captured the devotion of others to accomplish this extraordinary feat. Thus, during this short interval from 1946 to 1950, Bertner transitioned the leadership of the MD Anderson Cancer Hospital to Dr. R. Lee Clark, conducted a busy general surgery and gynecologic practice, facilitated the monumental transfer of the Baylor Medical School from Dallas to Houston, helped to recruit Dr. Michael DeBakey from New Orleans, and fought a heroic battle against rhabdomyosarcoma, a very rare and aggressive cancer.
The MD Anderson Hospital for Cancer Research (as it was named in 1946) incorporated pioneering changes that set new standards in hospital design, construction, and function. It is remarkable that ...surgeon R. Lee Clark, the new Director of the MD Anderson Hospital, and with no previous experience in hospital construction, personally led the design and supervision of a world class medical care and research facility. This is the untold story of his leadership and his diligence visiting hospitals and cancer facilities in America and Europe, his clever hiring, his supervision of the architectural firms (through 23 versions of architectural plans), his adaptability to the market when building costs were skyrocketing, and his extraordinary ability in raising enormous funds from private, state, and federal sources. He was such a creative genius in his inaugural building project that the new MD Anderson “cancer station” was described by national magazines as totally unique in its design that set new standards in cancer care delivery. With his typical determination, enthusiasm, and creative approach to problem-solving, Clark embarked on this building project in 1946 with a budget of $1,750,000, expecting to complete this project in 2 to 3 years. In fact, the entire project took 8 years and cost five times more than the original estimate, at almost $9,000,000! The process took 2 years for Dr. Clark to visit more than 30 cancer facilities and many academic hospitals in America and in Europe, 2 years of architectural planning, and 4 years of construction. When MD Anderson opened its doors in 1954, it was described by national magazines as “one of the most modern hospitals in the nation.”
Dr R. Lee Clark Jr was the first Surgeon-in-Chief and permanent Director of the University of Texas MD Anderson Cancer Hospital, leading the institution from 1946 to 1978. He is known for his ...visionary leadership as President, but much less about his prodigious activity as a general surgeon and for his academic contributions as a clinical researcher and surgical educator. His general surgery training at the Mayo Clinic from 1935 to 1939 was extensive, having been involved in over 2000 operations. Dr Clark then began a prodigious surgery practice for 2 years in Jackson, MS. He described his clinical practice: “I have done more than 600 major operations a year, of all types—from the brain to the colon”. He was commissioned into the Army Air Force in 1942, as Chief of Surgical Services, with 30 surgeons at a 1000-bed hospital in North Carolina. In 1944, he transferred to Wright Patterson Field in Dayton, OH, as Chief of the Experimental Surgical Unit. He published numerous articles about surgical problems in aviation medicine and edited the journal
Air Surgeon’s Bulletin.
His final assignment in 1945 was Chairman of the Department of Surgery at Randolph Field in San Antonio, TX. On 12 July 1946, after a rather turbulent and vacillating recruitment process, Dr Clark received a unanimous vote by the University of Texas Board of Regents to become the first permanent Director and Surgeon-in-Chief, and so, Randolph Lee Clark Jr began the most productive and impactful phase of his career.
Dr. R. Lee Clark Jr brought a broad-based cancer surgery experience to MD Anderson Hospital for Cancer Research when he became its first Surgeon-in-Chief and full-time salaried physician in 1946. He ...performed major surgery until 1971 including major head and neck operations, thyroidectomy, mastectomy, radical melanoma and sarcoma surgery, gastric and abdominal-perineal resection, and even hemipelvectomy. He initiated major programs in radiation therapy and mammography breast screening, and organized teams of specialists in a group practice providing multidisciplinary cancer care. Dr. Clark was elected into membership by the James Ewing Society (currently the Society of Surgical Oncology), the Southern Surgical Association, and the American Surgical Association, and was a founding member of the Society of Head and Neck Surgery. The Society of Surgical Oncology honored him with the Lucy Wortham James Award in 1965 and the James Ewing Lecture Award in 1977. Dr. Clark also provided invaluable leadership in the American College of Surgeons, leading a fledgling Committee on Cancer into a robust organization that became the Commission on Cancer. The College of Surgeons honored him with their Distinguished Service Award in 1969. Dr. Clark recruited major surgical leaders and personally designed the new hospital that opened in 1954, described in
Time
magazine as “the most modern, most ingeniously designed hospital in the U.S.” R. Lee Clark, Jr. was an accomplished and busy clinical surgeon, a visionary and charismatic leader, and an organizational genius. Indeed, he was one of the first pioneers in the specialty of surgical oncology.
The MD Anderson Cancer Center is one of the world’s largest programs in cancer patient care, research, and education; yet, there were many historical twists and turns that almost led the cancer ...hospital to be located in a different place, under a different authority, and under different leadership. Although it was finally located in
Houston
, Texas, historical events could possibly have resulted in the cancer hospital being located in
Dallas
, Galveston, or Austin, Texas. Although Dr. R. Lee Clark Jr eventually became the first permanent Director, five other physicians were offered the position before him. After the war ended, Dr. Bertner, as acting director, urged the university Regents to press their search for a permanent director, but the selection process was snafued and prolonged because Regent D. Frank Strickland filibustered for his own candidate for the permanent job. And it was not Dr. R. Lee Clark Jr, who was favored by the other eight Regents.
Dr. R. Lee Clark Jr. was a man of bold and extraordinary vision. He was truly a surgical oncology leader of the twentieth century. His leadership had a significant impact on the cancer community ...nationally and internationally. Historically, it is intriguing that Dr. Clark almost did not become President of the UT MD Anderson Cancer Center, since five other candidates were first offered the position and turned it down, and then Clark himself almost withdrew during the search process because of the political stalemate among the UT Regents to select a candidate. The saga began in 1945, when the Acting Director of MD Anderson Hospital for Cancer Research, Dr. Ernst Bertner, pressed the UT Regents to recruit a permanent Director, since he had just been appointed as the first President of the Texas Medical Center. Bertner was a major figure in recruiting Dr. R. Lee Clark, who was then a Lt. Colonel in the Army Air Force. Dr. Clark’s vision for this unique cancer facility was first drafted on Randolph Army Airfield stationary in February 1946. An interesting twist to the story is that Dr. Clark almost did not get the job because of an alternative candidate, and because of the political vicissitudes among the University of Texas Board of Regents. Many of these political barriers were eventually overcome, and Dr. Clark was unanimously approved as the first permanent Director on 13 July 1946, and his leadership over the next 32 years changed the course of history.
The year 2020 marks the 80th anniversary of the Society of Surgical Oncology (SSO), so it is appropriate to celebrate the vision and leadership of Dr. William MacComb, who led the formation of the ...James Ewing Society as an alumni organization of the Memorial Hospital in New York City. The Ewing Society was later renamed and reorganized as the SSO in 1975. Dr. MacComb was elected as the first and second President of the James Ewing Society from 1940 to 1942. He was elected onto the Executive Council when it first formed in 1947 as the Secretary/Treasurer from 1947 to 1948, as Vice-President from 1948 to 1949, and then continued as a member of the Executive Council for 3 years until 1952. He was elected again as Vice President from 1958 to 1959, as President-elect from 1959 to 1960, as President for a third time from 1960 to 1961, and then as Chair of the Executive Committee from 1961 to 1962. No other person in the history of the SSO was President for multiple terms and also was one of the founding leaders. For these reasons, it would be a fitting accolade to refer to Dr. William MacComb as “the Father of the Society of Surgical Oncology” (founded as the James Ewing Society). Dr. MacComb also served as President of both the American Radium Society (1950) and the Society of Head and Neck Surgery (1969). He one of the first surgical oncologist trained in head and neck surgery, and, uniquely, one of the first physicians to be Board Certified in Radiology because of his training and publications in therapeutic radiology. Dr. MacComb made important contributions in the field of Head and Neck surgery, as a pioneer in the development of radiation therapy and radiation physics, and for advancing the use of combined surgery and radiation therapy for head and neck cancers.
To evaluate the relationship between burnout and perceived major medical errors among American surgeons.
Despite efforts to improve patient safety, medical errors by physicians remain a common cause ...of morbidity and mortality.
Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in June 2008. The survey included self-assessment of major medical errors, a validated depression screening tool, and standardized assessments of burnout and quality of life (QOL).
Of 7905 participating surgeons, 700 (8.9%) reported concern they had made a major medical error in the last 3 months. Over 70% of surgeons attributed the error to individual rather than system level factors. Reporting an error during the last 3 months had a large, statistically significant adverse relationship with mental QOL, all 3 domains of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and symptoms of depression. Each one point increase in depersonalization (scale range, 0-33) was associated with an 11% increase in the likelihood of reporting an error while each one point increase in emotional exhaustion (scale range, 0-54) was associated with a 5% increase. Burnout and depression remained independent predictors of reporting a recent major medical error on multivariate analysis that controlled for other personal and professional factors. The frequency of overnight call, practice setting, method of compensation, and number of hours worked were not associated with errors on multivariate analysis.
Major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.
PDF