Simone’s OncOpinion

Career development observations and advice for medical professionals from Dr. Joseph V. Simone.

Thursday, March 20, 2014

Unease in Cancer Centers?

I wrote a post in December focused on the unusually large turnover of cancer center directors and what characteristics I would look for if I were engaged in replacing them. At least one-quarter of the 60 comprehensive and clinical centers experienced this change in the past two years or anticipate a change in the next year or so.


I did not mention the impact of so many changes in the operations of the cancer centers, but it is significant -- particularly in the projected changes in funding under consideration by the NCI.


A change of the CEO of any complex organization can be smooth, rough, or destabilizing -- virtually all will face at least a period of instability or an undercurrent of fear that changes might adversely affect one’s job. Particularly in centers that had the same director for a decade or more, the transition can mean lost jobs at any level, rearrangement of leadership roles, a steep and treacherous learning curve, and the loss of the useful contacts and “connections” of the retiring director.


Bearing the responsibility of preparing a Cancer Center Support Grant for renewal can be daunting, with at least 18 months needed for preparation and working to get all the data and text together for a wide range of clinical and basic scientists, particularly if the new director is new to the institution.


The other problem is NCI funding for cancer centers, which has been largely stuck at the same level for years. Furthermore, based on recommendations of a committee of the National Cancer Advisory Board, there are plans for restructuring the grant support system to compensate for the advantage that large, long-term centers have had over the newer and smaller centers in funding increases. The discussion of this plan was reported in detail in the most recent issue of The Cancer Letter (14 March 2014).


As reported in the article, NCI Director Harold Varmus said he likes the new formula, “because it allows de novo consideration of each of the centers’ budgets, eliminating the advantages of longevity.”


As always, the devil is in the details, and it is not clear that all of these recommendations will be adopted. But this clearly complicates not only how a center prepares for a grant renewal, but what internal changes might need to be made to offer the best chance for receiving a maximum monetary benefit.


One might argue that the new directors will be better prepared to deal with a new grant formula because they didn’t have the old one engrained in their thinking. On the other hand, it is hard enough for a new director to restructure a center; adding another factor in that restructuring will cause some additional headaches, especially as the new NCI approach will likely be at least somewhat different than first offered, with enough uncertainty to raise the gastric acid levels in directors.


History says they will get through this OK since the new directors are talented and hard working. But these changes almost certainly will cause some unease.